The COVID-19 pandemic has disrupted preventive care, including cancer screening. Studies from the United States and Europe have shown that cancer screening dropped dramatically during the pandemic, 1,2 with breast cancer screening and diagnostic mammograms falling by 58% and 38%, respectively. 1,2 A United Kingdom modeling study estimated that delayed and missed screenings would likely increase breast cancer deaths, a leading cancer among women, by 7.9% to 9.6%. 2,3 The adverse impact of COVID-19 on screening may differ among sociodemographic groups, given the disproportionate impact the pandemic has had on underserved racial and ethnic groups and other vulnerable population groups. 4 In this report, we used clinical data to examine differences in breast cancer screenings before and during the COVID-19 pandemic overall and among sociodemographic population groups.
Methods
DataData included completed screening mammograms within a large statewide nonprofit community health care system in Washington State between April 1, 2018, and December 31, 2020. This health care system included more than 230 primary care, specialty care, and urgent care clinics, and 8 hospitals across Washington State. The MultiCare institutional review board approved this study protocol and granted waivers of individual consent based on removal of individually identifying data. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline.
Measures and Statistical AnalysisSociodemographic data included patients' race and ethnicity, insurance, and zip code of residence.Rural-urban commuting area codes differentiated between urban vs rural residence. Inclusion criteria included women who had at least 1 screening mammogram within the health system in 2018 or 2019.Frequency analysis and χ 2 tests were performed using a significance level of P < .05 to test for differences in screening in 2019 and 2020. Testing was 2-sided. Statistical analysis was performed using R statistical software version 4.03 (R Project for Statistical Computing).
ResultsAmong the 55 678 screenings in April to December 2019, 45 572 patients were non-Hispanic White (81.8%), 54 620 patients lived in urban areas (98.1%), and 22 761 patients were commercially insured (40.9%); the mean (SD) age was 62.0 (11.3) years. From 2019 to the same period in 2020, there was a 49% decrease in screenings (55 678 screenings in 2019 vs 27 522 screenings in 2020), with some differences apparent in the demographic characteristics between the 2 years (Table ). We observed greater and significant reductions in the number of screenings from 2019 to 2020 for women who were Hispanic (1727 vs 619; −64.2%), American Indian/Alaska Native (215 vs 84; −60.9%), mixed race Author affiliations and article information are listed at the end of this article.