The effect of the COVID-19 health disruptions on breast cancer mortality for older women: A semi-Markov modelling approach

We propose a methodology to quantify the impact on breast cancer mortality of diagnostic delays caused by public health measures introduced as a response to the COVID-19 pandemic. These measures affected cancer pathways by halting cancer screening, delaying diagnostic tests, and reducing the numbers of patients starting treatment. We introduce a semi-Markov model, to quantify the impact of the pandemic based on publicly available population data for women age 65{89 years in England and relevant medical literature. We quantify age-specific excess deaths, for a period up to 5 years, along with years of life expectancy lost and change in cancer mortality by cancer stage. Our analysis suggests a 3-6% increase in breast cancer deaths, corresponding to more than 40 extra deaths, per 100,000 women, after age 65 years old over 5 years, and a 4-6% increase in registrations of advanced (Stage 4) breast cancer. Our modelling approach exhibits consistent results in sensitivity analyses, providing a model that can account for changes in breast cancer diagnostic and treatment services.