4 Ways to Clear the COVID-19 Diagnostic Mammogram Backlog

There are solutions to your breast cancer screening backlog, if you think outside the box.

While health clinics and news outlets are promoting screenings for Breast Cancer Awareness month, imaging departments are still trying to catch up on the backlog of those who missed a diagnostic mammogram due to the restrictions and shutdowns caused by COVID-19 throughout 2020 and 2021. 

Healthcare systems struggle to keep up with long lists of imaging appointments, knowing that a delayed screening for breast cancer can have devastating consequences. In the United States, an estimated 3.9 million people missed a breast cancer screening between January and July 2020. And the Ontario Medical Association found that during the pandemic, the province’s health facilities performed 400,000 fewer mammograms than normal.

Delaying mammograms and other breast cancer screenings can allow undetected tumors to grow and metastasize, worsening a person’s prognosis. Typically Ottawa Hospital detects half of is patients’ breast cancers through a diagnostic mammogram, but during the pandemic, that decreased to one-third of all diagnoses. This screening delay led to nearly 2,800 Ottawa women not receiving a timely breast cancer diagnosis. 

The Journal of the National Cancer Institute projected that by 2030, 2,500 additional breast cancer deaths by 2030 in the U.S., due to fewer screenings and chemotherapy delays for early-stage disease diagnoses.

Imaging departments are working hard to reduce breast cancer screening backlogs, but it’s not easy. In Manitoba, for example, March’s mammogram backlog was 35,686, the latest data available. Here are four ways that health systems globally are addressing breast cancer screenings, which can help decrease diagnostic mammogram backlogs. 

1. Mobile imaging

Not everyone can easily visit a health center. Some living in rural areas, or with less flexible schedules can take advantage of mobile imaging. In Saskatchewan, a mammogram bus helps to address its backlog. In non-pandemic times, the bus visited rural and remote communities, but last year, it was used to help decrease the diagnostic mammogram backlog in Regina, Saskatoon and Prince Albert. In 2021, the bus staff performed 3,650 mammograms in eight months, compared to 1,365 screenings in the 11 months prior to that.

Similarly, RadNet, a Los Angeles-based medical imaging network, uses Maddy, a mobile coach to provide mammograms to underserved women in Southern California. They launched the service to address a spike in demand and reduce the backlog of screening for breast cancer. And in New York, Mount Sinai Hospital introduced its mobile mammography van in 2022, to visit New York City’s five boroughs for preventative screenings.

2. Investing in new mammography equipment

The Canadian Association of Radiologists recommends that the federal government invest $1.5 billion over five years on medical imaging equipment overall, and on the human resources to support it. That would be helpful, as not all health facilities can afford to purchase new equipment to replace slower machinery or supplement what they have.

Women’s College Hospital in Toronto fundraised to acquire new mammography and ultrasound machines. Staff found that when the old equipment stalled, waiting room times drastically increased, resulting in an average of five minutes added to each appointment . With the new equipment, the breast cancer team projects screening capacity to increase from 5,400 to 6,500, decreasing the breast cancer screening backlog from five years to two years.

3. Utilizing radiographers and artificial intelligence to read images

Typically, diagnostic mammograms are read by radiologists. Given the radiologist shortage, researchers are looking for innovative ways to accurately interpret imaging studies, without the radiologist always at the center. A UK study recently published in Radiology showed that radiographers trained to read mammograms performed on-par with  radiologists. The study used double reading, where at least two of these technologists interpreted the same image. The study found no difference in the accuracy between radiologist and radiographer cancer detection rates.

Researchers are also testing artificial intelligence (AI) algorithms for workflow triage and to detect abnormalities in mammography. The AI programs are trained on large reference databases, and supplement, but don’t replace, the radiologists’ readings. University of Chicago Medicine is investigating QuantX, which the FDA recently cleared for use. It was shown to improve breast cancer tumor discovery by 39%. RadNet is working with Saige-Q – a worklist prioritization tool that helps identify suspicious diagnostic mammograms.

The Canadian Association of Radiologists recommends that the government harness AI for the strategic prioritization of [healthcare staff] technology, and infrastructure for medical imaging in the wake of the pandemic and beyond.”

4. Improve connectivity and interoperability of PACS

Another way to work smarter is making imaging available across the health network so radiologists in other locations can access and read the images. Scotland’s National Health Service partnered with Philips PACS to increase imaging access through interoperability. By sharing images across its six regional breast screening centers and mobile screening unit, the Scottish health service can more easily manage its pandemic mammography backlog while improving the patient experience. 

The Bottom Line

Other technologies can improve the patient experience while easing administrative requirements. Currently when patients need to share mammogram imaging with a provider, staff have to burn a CD and patients retrieve it from the facility. The imaging staff can better use this time on direct patient care. When sharing that disk with providers, staff may find it time consuming or difficult to upload, and receiving the file electronically is not always possible. 

PocketHealth makes it easy and cost-effective for patients to share images with their providers, returning time to radiology staff and enabling them to perform more mammograms and other imaging exams. The return-on-investment is significant as well, with facilities reporting savings of over $100,000 annually – that could cover the total cost of one new mammography device.

With bank-level encryption, PocketHealth allows staff to quickly view imaging online with a password, no downloads required. This makes it easy for radiologists to compare past studies and review current studies. Gaining time back means patients can be scheduled and seen more efficiently, helping to reduce that breast cancer screening backlog.

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