LCOM & Department News

UVM Researchers Help Identify Impact of COVID-caused Delays in Breast Cancer Screening

November 23, 2021 by Jennifer Nachbur

New research from U.S. Breast Cancer Surveillance Consortium (BCSC) members, including several University of Vermont researchers, found that from March to September 2020, breast biopsies and detected cancers at U.S. BCSC facilities dropped sharply, compared with the same span a year earlier.

Pictured: Brian Sprague, Ph.D., (left); Sally Herschorn, M.D. (center); and Donald Weaver, M.D. (right).

Study highlights racial disparities in biopsies and detected breast cancers during a 2020 span when routine screenings were greatly slowed

New research from U.S. Breast Cancer Surveillance Consortium (BCSC) members, including several University of Vermont researchers, found that from March to September 2020, breast biopsies and detected cancers at U.S. BCSC facilities dropped sharply, compared with the same span a year earlier. Biopsies declined by 23 percent and detected cancers by 24 percent – findings that the research team attributes mostly to the postponement of routine screening mammograms as the COVID-19 pandemic took hold. 

The findings were published recently in Radiology. UVM Associate Professor of Surgery Brian Sprague, Ph.D., is senior author on the paper, and Professor of Radiology Sally Herschorn, M.D., and Professor of Pathology and Laboratory Medicine Donald Weaver, M.D., are coauthors. All three are also members of the UVM Cancer Center.

“The large deficit in breast cancers detected by screening during 2021 raises concern that cancers we would have hoped to detect early with screening will now present symptomatically or through delayed screening at a more advanced stage in the coming year,” said Sprague.

Weaver explains, “Breast cancers that are self-detected or cancers discovered by mammogram after missed screening exams tend to be larger and pathologically more aggressive than those detected by routine screening.”

Additionally, the research suggests that those postponed mammograms appeared to disproportionately affect women of color, as breast cancer diagnoses during the span diminished at different rates across demographic groups: Non-Hispanic white women had 17 percent fewer breast cancer diagnoses, while the year-over-year decline was 53 percent for Asian women, 43 percent for Hispanic women, and 27 percent for Black women.

“We know that prolonged delayed screening (more than a few months) will result in more cancers detected at larger sizes and later stages, making treatment more difficult,” said Hershorn. “We do not know the long-term effects of this on prognosis.”

Back on March 26, 2020, the American College of Radiology and American Society of Breast Surgeons jointly recommended that medical facilities immediately postpone all breast cancer-screening exams. Three weeks later, on April 16, the Society for Breast Imaging issued guidelines for resumption of breast cancer screening. That guidance noted, however, that the facilities’ ability to offer screening would depend on many factors, including the local COVID-19 burden, the availability of personal protective equipment, and the ability of breast surgeons and oncologists to manage newly diagnosed breast cancer patients.

Medical facilities rolled out COVID-19 safety protocols and, as October began, the American College of Radiology launched a “Return to Mammography” initiative, encouraging women who had missed a screening to return as soon as possible.

These efforts appear to have been largely successful. As early as July 2020, monthly biopsies and cancer diagnoses had returned to near-normal, even as total year-over-year cancer diagnoses remained lower. The new findings suggest, though, that breast imaging facilities may be struggling to meet demand for rescheduled examinations.

“All facilities in the BCSC were having difficulty catching up on screening backlogs,” Herschorn said. “We are seeing patients who usually screen every year coming in at 15, 18, or 24 months from their last mammogram. Some of this is access, but some may be hesitancy due to COVID-19 or other family obligations that make going for routine care difficult.”

First author Kathryn Lowry, M.D., assistant professor of radiology at the University of Washington School of Medicine, suggested that it’s likely that women of color have faced greater barriers to returning for routine mammograms based on evidence demonstrating that U.S. communities of color have borne the brunt of COVID-19’s trauma. 

“These communities have disproportionately experienced SARS-CoV-2 illness and mortality, as well as economic hardship due to job losses during the pandemic,” said Lowry. “It’s also possible that some medical facilities serving these communities have been less able to compensate for increased demand.”

Lowry noted that the researchers’ just-published results do not account for the delta variant surge, which peaked only a month ago.

“Based on our findings, particular efforts are needed to facilitate utilization of breast cancer screening among communities of color during the pandemic,” added Sprague.

The research was supported by the National Cancer Institute (R01CA248068, R50CA211115, P01CA154292, U54CA163303, P30CA014520, and P20GM103644); the Patient-Centered Outcomes Research Institute (PCS-1504-30370); the Agency for Healthcare Research and Quality (R01 HS018366-01A1); and the Breast Cancer Surveillance Consortium. The collection of SABIR data was supported by the UC Davis Comprehensive Cancer Center, the Placer County Breast Cancer Foundation, and the UC Davis Clinical and Translational Science Center.

(This article was adapted from a press release written by Brian Donohue of the University of Washington School of Medicine.)

 

Past Department Highlights

Mark_FungCongratulations to Dr. Mark Fung, M.D., PhD., Professor Pathology and Laboratory Medicine, on receiving the 2023 College of American Pathologists (CAP) Lifetime Achievement Award. Dr. Fung is a nationally recognized expert in transfusion medicine. (10/2023) 

Congratulations to Jessica Crothers, M.D., Assistant Professor Pathology and Laboratory Medicine, on achieving the Notice of Special Interest Team Science award from NIAID for: "Effects of the gut microbiota on oral vaccine response in adults and children." (10/2023)

Nicole BouffardCongratulations to Nicole Bouffard on being awarded the "Scientific Research Staff Award" for 2023. This was presented to Nicole at the September 21, 2023, LCOM Research Excellence Award Ceremony. This is a great honor for Nicole and the Department of Pathology and recognizes her contributions and importance to the department and MIC. (10/2023)

Congratulations to Brian Cunniff, Ph.D., Assistant Professor Pathology and Laboratory Medicine, on being awarded a $1.6 million R01 grant by the National Institute of General Medical Sciences to study the role of mitochondrial trafficking in regulating cell migration, a key feature of metastatic tumors. (9/2023)

Congratulations to Yvonne Janssen-Heininger, Ph.D., Professor Pathology and Laboratory Medicine, on becoming a University of Vermont Cancer Center Program Co-Leader, Cancer Cell. (9/2023)

Congratulations to the following pathology members on receiving research support funds in April 2023. Recipients were: John Kennedy, M.D., $6520 for morphologic and immunohistochemical re-evaluation of renal cell carcinomas exhibiting papillary architecture, with emphasis on tumors demonstrating "type 2" morphology. Yvonne Janssen-Heininger, Ph.D., $15,000 for a joint initiative between RBP, UVM Cancer Center, and faculty in the Department of Chemistry. Megan Tarte $745 for Stem Cells, Cell Therapies, and Bioengineering in Lung Biology and Disease Conference. Albert van der Vliet, Ph.D., $14,400 for Redox processes in macrophage activation in IPF. (9/2023)

Congratulations to the following faculty members on their promotions: Vikas Anathy, Ph.D., to Professor with tenure, Bronwyn Bryant, M.D., to Associate Professor, John DeWitt, M.D., Ph.D., to Associate Professor, Sarah Nowak Ph.D., to Associate Professor, and Christi Wojewoda, M.D., to Professor. (6/2023)

Bei Zhang, M.D., M.S., Ph.D., MLS(ASCP), associate professor of pathology and laboratory medicine, did an educational scholarship session titled "Activate Students Learning Outside Classroom." at the 8th International meeting of the Association of Biochemistry Educators. Dr. Zhang also conducted two additional workshops with other ABE members titled "Linking Clinical Presentations to Their Biochemistry: A novel ABE Clinical-Biochemistry Curricular Treat Mapping Educational Tool.", and "Getting to Clerkship and Beyond: Crafting Biochemistry Learning Objectives that Connect and Integrate Basic Science Concepts with Clinical Application." (5/2023)

Congratulations to Dr. Maureen Harmon, M.D., associate professor of pathology and laboratory medicine, and Dr. Amer Abu Alfa, M.D., assistant professor of pathology and laboratory medicine for being recognized by medical students for their professionalism. Dr. Harmon was recognized for social responsibility and Dr. Abu Alfa was recognized for compassion. (5/2023)

Congratulations to Mary Cushman, Ph.D., M.Sc., professor of medicine and pathology and laboratory medicine, on being named a University Distinguished Professor of Medicine, Hematology/Oncology Division, and Pathology and Laboratory Medicine. (5/2023)

View the story Mammograms of a study by Sarah Nowak, Ph.D., assistant professor of pathology and laboratory medicine, and researchers at the UVM Cancer Center showing data that fewer women being screened for breast cancer. (4/2023)

vandervliet-habibovic420x280A new study by Albert van der Vliet, Ph.D., professor of pathology and laboratory medicine, and a team of University of Vermont (UVM) researchers is honing in on why people with asthma often have worse symptoms if they are obese. This new research demonstrates that the gene DUOX1 likely contributes to the connection between obesity and asthma.  The research was published ahead of print in the American Journal of Physiology-Lung Cellular and Molecular Physiology and was highlighted as an APSselect article for March 2023. Albert van der Vliet, Ph.D., was the senior author on the paper, along with department of pathology and laboratory medicine coauthors Aida Habibovic, lab research technician;Litiele Cruz, Ph.D., visiting scholar; Vikas Anathy, Ph.D., associate professor; University Distinguished Professor Yvonne Janssen-Heininger, Ph.D.; and additional team members and authors from UVM. Read the full LCOM News story LCOM News (4/2023)

Congratulations to Bronwyn Bryant, M.D., Assistant Professor of Pathology and Laboratory Medicine, for having your proposal, Consequential Validity of Entrustable Professional Activities in Pathology Residency Training selected to receive a Frymoyer Scholars Program project of $48,000 to be funded July 1, 2023 through June 30, 2025. (4/2023)

Congratulations to Martin Chang, M.D., Ph.D., on accepting the new role as Vice Chair for Faculty Affairs. (4/2023)

Congratulations to Joanna Conant, M.D., on becoming the new Pathology Student Fellowship Director starting July 1, 2023. (4/2023)

Congratulations to The Cunniff Lab, on receiving funding to support research focused on malignant mesothelioma. The funding was from The Butler Family Foundation Fund for Cancer Research at the University of Vermont Cancer Center. The Butler Fund was established by the Butler family in memory of two loved ones lost to mesothelioma. (03/2023)

Congratulations to the following recipients that received pathology research support funding. Nathaniel Shannon in Brian Cunniff's, Ph.D., lab was awarded $1800 towards the cost of travel to the 2022 Annual Meeting of the Society for Redox Biology and Medicine (SfRBM). Litiele Cruz, Ph.D., and faculty mentor Albert van der Vliet, PhD., were awarded $2622 for her project "Characterization of Laminin Oxidative Modifications by Peroxidasin in Pulmonary Fibrosis". Nels Olson, PhD., MPH., $14,582 for the purchase of an Agilent BioTek 405 TS Touch Microplate Washer, Model 405 TSRS. Ashley Volaric M.D., Joanna Conant M.D., and David Seward, M.D, Ph.D., were awarded $13,680 for their project, "The Effect of Epstein Barr Virus Latency on Cellular DNA Methylation Profile of Diffuse Large B Cell Lymphoma". (3/2023)

A number of faculty and students from the pathology and laboratory medicine department presented research at the American Heart Associations Epidemiology, Prevention, Lifestyle, and Cardiometabolic Health (EPI/Lifestyle) Scientific Sessions 2023 in Boston February 28 - March 3. Students presenting were Maggie King, a master in science pathology degree student who was mentored by faculty scientist J. Peter Durda, Ph.D. pathology and laboratory medicine.  Maggie presented on "Complete Blood Count Analysis in the Risk Underlying Rural Areas Longitudinal (RURAL) Cohort Study with a Point of Care Instrument." Her study is supported by NHLBI. And second-year medical student and 2022 Cardiovascular Research Institute Summer Research Fellow Megan Zhou, mentored by pathology and laboratory medicine associate professor Nels Olson, Ph.D. Megan presented on  "Coagulation Factor IX and Incident Diabetes Risk: The Reasons for Geographic and Race Differences in Stroke (REGARDS) Study." Also, pathology and laboratory faculty members that were coauthors of presentations given, assistant professor Margaret Doyle, Ph.D., and University Distinguished Professor of pathology and laboratory medicine, Russell Tracy, Ph.D. (3/2023)

Congratulations to Dr. Bei Zhang, M.D., Ph.D., MLS(ASCP), associate professor of pathology and laboratory medicine, for being selected for a Distinguished Scholar Award by the Association of Biochemistry Educators for her submission entitled "Activate Students' Learning Outside Classroom". Dr. Zhang will be presenting this submission at the 2023 Association of Biochemistry Education Conference. (3/2023)

Congratulations to our 2023 Gender Equity Award Nominees. Gender Equity Champion Award nominee, Debra Leonard, M.D., Ph.D., Chair and Professor Pathology and Laboratory Medicine. Our departmental nominees for The Polaris Award for Outstanding Mentorship- an award for informal or formal mentorship for women or gender diverse college community members, Rebecca Wilcox, M.D., Pam Gibson, M.D., Yvonne Janssen-Heininger, Ph.D., and Christi Wojewoda, M.D. (2/2023)  

Congratulations to Dr. Scott Anderson, M.D., on being selected to receive the Association of Pathology Chairs 2023 Margaret Grimes Distinguished Achievement Award in Graduate Medical Education. This award was made in recognition of Dr. Anderson's outstanding contributions to graduate medical education and his stature as a nationally recognized leader in pathology education. (2/2023)

Congratulations to Dr. Yvonne Janssen-Heininger, Ph.D., Dr. Kelly Butnor, M.D., Dr. David "Bebo" Seward, M.D., Ph.D., and Dr. Sharon Mount, M.D., on their news story in The Charlotte News, on their "giant steps in cancer research." Read the full article here:   Humble Superstar (1/2023)

Congratulations to Dr. Elizabeth Bundock, M.D., Ph.D., Chief Medical Examiner of Vermont and clinical assistant professor of pathology, for her appointment by the American Board of Pathology, to the Test Development and Advisory Committee for Forensic Pathology 2023. (1/2023)

Dr. Beri Zhang, M.D., Ph.D., MLS(ASCP), associate professor of pathology and laboratory medicine, presented a panel, at the Snow Season Education Retreat, titled "The Pearls and Pitfalls of Publishing in Medical Education", with three clinicians Dr. Hale, Dr. Halle, and Dr. Rideout. (1/2023)

Congratulations to Dr. Bronwyn Bryant, M.D., assistant professor of pathology and laboratory medicine on her Awards for  Teaching and Educational Excellence, Learner Assessment, conferred at the Teaching Academy Induction and Award Ceremony on January 11, 2023. (1/2023)