Impact of the COVID-19 Pandemic on Breast Cancer Mortality in the US

Estimates From Collaborative Simulation Modeling

Oguzhan Alagoz; Kathryn P. Lowry; Allison W. Kurian; Jeanne S. Mandelblatt; Mehmet A. Ergun; Hui Huang; Sandra J. Lee; Clyde B. Schechter; Anna N. A. Tosteson; Diana L. Miglioretti; Amy Trentham-Dietz; Sarah J. Nyante; Karla Kerlikowske; Brian L. Sprague; Natasha K. Stout


J Natl Cancer Inst. 2021;113(11):1484-1494. 

In This Article

Abstract and Introduction


Background: The coronavirus disease 2019 (COVID-19) pandemic has disrupted breast cancer control through short-term declines in screening and delays in diagnosis and treatments. We projected the impact of COVID-19 on future breast cancer mortality between 2020 and 2030.

Methods: Three established Cancer Intervention and Surveillance Modeling Network breast cancer models modeled reductions in mammography screening use, delays in symptomatic cancer diagnosis, and reduced use of chemotherapy for women with early-stage disease for the first 6 months of the pandemic with return to prepandemic patterns after that time. Sensitivity analyses were performed to determine the effect of key model parameters, including the duration of the pandemic impact.

Results: By 2030, the models project 950 (model range = 860–1297) cumulative excess breast cancer deaths related to reduced screening, 1314 (model range = 266–1325) associated with delayed diagnosis of symptomatic cases, and 151 (model range = 146–207) associated with reduced chemotherapy use in women with hormone positive, early-stage cancer. Jointly, 2487 (model range = 1713–2575) excess breast cancer deaths were estimated, representing a 0.52% (model range = 0.36%-0.56%) cumulative increase over breast cancer deaths expected by 2030 in the absence of the pandemic's disruptions. Sensitivity analyses indicated that the breast cancer mortality impact would be approximately double if the modeled pandemic effects on screening, symptomatic diagnosis, and chemotherapy extended for 12 months.

Conclusions: Initial pandemic-related disruptions in breast cancer care will have a small long-term cumulative impact on breast cancer mortality. Continued efforts to ensure prompt return to screening and minimize delays in evaluation of symptomatic women can largely mitigate the effects of the initial pandemic-associated disruptions.


The novel coronavirus disease 2019 (COVID-19) pandemic has led to broad disruptions in health care in the United States, including major impacts on breast cancer control activities. Early in the pandemic, public health measures barred elective procedures, including screening mammography.[1] Hospitals faced concerns with capacity and shortages of personal protective equipment, and women weighed the benefits of attending medical care facilities vs the risks of possible exposure.

In the initial months of the pandemic in 2020, there were severe declines in screening mammography[2–7] and reductions in diagnostic mammography of up to 80%.[8,9] Breast cancer treatment protocols were also modified, with patient-reported delays in treatment[10] and reductions in chemotherapy administration.[11]

Although weekly mammography volumes nearly recovered to prepandemic levels within 6 months,[2,9,12–14] the impact of these disruptions on long-term breast cancer mortality remains unclear. We used 3 independently developed breast cancer simulation models from the National Cancer Institute's Cancer Intervention and Surveillance Modeling Network (CISNET)[15–18] to estimate the cumulative, long-term effect of COVID-19–related disruptions on breast cancer mortality. The results are intended to inform plans for mitigating these effects during and after the pandemic.