Impact of the COVID-19 breast cancer screening hiatus on clinical stage and racial disparities in New York City

Fasano, Genevieve A.; Bayard, Solange; Tamimi, Rulla M.; Bea, Vivian J.; Malik, Manmeet; Davis, Melissa B.; Simmons, Rache M.; Swistel, Alexander; Marti, Jennifer L.; Drotman, Michele; Katzen, Janine; Formenti, Silvia C.; Ng, John N.; Astrow, Alan B.; Taiwo, Evelyn; Balogun, Onyinye; Siegel, Beth; Radzio, Agnes; Elreda, Lauren; Chen, Yalei; Newman, Lisa A.

doi:10.1016/j.amjsurg.2022.05.037

Cited by 9 publications

(10 citation statements)

References 15 publications

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“…Several US studies have shown sociodemographic variation in COVID-associated decreases in cancer screening, with the largest reductions in breast cancer screening associated with African American and Asian women and women of other races and women who were insured by Medicaid. [41][42][43] Fedewa et al 44 found that US residents who became unemployed during the pandemic were 10% to 30% less likely to be screened for cancers than employed adults. In their analysis of electronic medical records from over 40 000 primary care patients in Michigan, Gorin et al 45 observed an abrupt decrease in cancer screening between March and June 2020 but with a more modest decrease for fecal immunochemical tests.…”

Section: Discussionmentioning

confidence: 99%

“…Our results are in line with other literature. Several US studies have shown sociodemographic variation in COVID-associated decreases in cancer screening, with the largest reductions in breast cancer screening associated with African American and Asian women and women of other races and women who were insured by Medicaid . Fedewa et al found that US residents who became unemployed during the pandemic were 10% to 30% less likely to be screened for cancers than employed adults.…”

Section: Discussionmentioning

confidence: 99%

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Cancer Screening Disparities Before and After the COVID-19 Pandemic

Lofters,

Wu,

Frymire

et al. 2023

JAMA Netw Open

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ImportanceBreast, cervical, and colorectal cancer–screening disparities existed prior to the COVID-19 pandemic, and it is unclear whether those have changed since the pandemic.ObjectiveTo assess whether changes in screening from before the pandemic to after the pandemic varied for immigrants and for people with limited income.Design, Setting, and ParticipantsThis population-based, cross-sectional study, using data from March 31, 2019, and March 31, 2022, included adults in Ontario, Canada, the country’s most populous province, with more than 14 million people, almost 30% of whom are immigrants. At both dates, the screening-eligible population for each cancer type was assessed.ExposuresNeighborhood income quintile, immigrant status, and primary care model type.Main Outcomes and MeasuresFor each cancer screening type, the main outcome was whether the screening-eligible population was up to date on screening (a binary outcome) on March 31, 2019, and March 31, 2022. Up to date on screening was defined as having had a mammogram in the previous 2 years, a Papanicolaou test in the previous 3 years, and a fecal test in the previous 2 years or a flexible sigmoidoscopy or colonoscopy in the previous 10 years.ResultsThe overall cohort on March 31, 2019, included 1 666 943 women (100%) eligible for breast screening (mean [SD] age, 59.9 [5.1] years), 3 918 225 women (100%) eligible for cervical screening (mean [SD] age, 45.5 [13.2] years), and 3 886 345 people eligible for colorectal screening (51.4% female; mean [SD] age, 61.8 [6.4] years). The proportion of people up to date on screening in Ontario decreased for breast, cervical, and colorectal cancers, with the largest decrease for breast screening (from 61.1% before the pandemic to 51.7% [difference, −9.4 percentage points]) and the smallest decrease for colorectal screening (from 65.9% to 62.0% [difference, −3.9 percentage points]). Preexisting disparities in screening for people living in low-income neighborhoods and for immigrants widened for breast screening and colorectal screening. For breast screening, compared with income quintile 5 (highest), the β estimate for income quintile 1 (lowest) was −1.16 (95% CI, −1.56 to −0.77); for immigrant vs nonimmigrant, the β estimate was −1.51 (95% CI, −1.84 to −1.18). For colorectal screening, compared with income quintile 5, the β estimate for quntile 1 was −1.29 (95% CI, 16 −1.53 to −1.06); for immigrant vs nonimmigrant, the β estimate was −1.41 (95% CI, −1.61 to −1.21). The lowest screening rates both before and after the COVID-19 pandemic were for people who had no identifiable family physician (eg, moving from 11.3% in 2019 to 9.6% in 2022 up to date for breast cancer). In addition, patients of interprofessional, team-based primary care models had significantly smaller reductions in β estimates for breast (2.14 [95% CI, 1.79 to 2.49]), cervical (1.72 [95% CI, 1.46 to 1.98]), and colorectal (2.15 [95% CI, 1.95 to 2.36]) postpandemic screening and higher uptake of screening in general compared with patients of other primary care models.Conclusions and RelevanceIn this cross-sectional study in Ontario that included 2 time points, widening disparities before compared with after the COVID-19 pandemic were found for breast cancer and colorectal cancer screening based on income and immigrant status, but smaller declines in disparities were found among patients of interprofessional, team-based primary care models than among their counterparts. Policy makers should investigate the value of prioritizing and investing in improving access to team-based primary care for people who are immigrants and/or with limited income.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cancer Screening Disparities Before and After the COVID-19 Pandemic

Lofters,

Wu,

Frymire

et al. 2023

JAMA Netw Open

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“…This decision resulted in delays in surgery and radiation; simultaneously, patients meeting criteria were triaged to neoadjuvant medical therapy (e.g., chemotherapy). While an increasing number of studies have been done to characterize the diagnosis and treatment of breast cancer patients during the COVID-19 pandemic, the psychological impact of the experienced delays on newly diagnosed breast cancer patients has not been established [2][3][4][5]. In this study, we sought to determine if there were differences in psychosocial outcomes among women with and without breast cancer who experienced delays.…”

mentioning

confidence: 99%

“…1 n (%)2 Wilcoxon rank-sum test; Fisher's Exact Test3 COPE-IS = Coronavirus Perinatal Experiences -Impact Survey 1 n (%)2 Wilcoxon rank-sum test; Fisher's Exact Test…”

mentioning

confidence: 99%

“…1 n (%)2 Wilcoxon rank-sum test; Fisher's Exact Test3 COPE-IS = Coronavirus Perinatal Experiences -Impact Survey 1 n (%) 2 Wilcoxon rank-sum test; Fisher's Exact Test 3 COPE-IS = Coronavirus Perinatal Experiences -Impact Survey 1 n (%) 2 Wilcoxon rank-sum test; Fisher's Exact Test 3 COPE-IS = Coronavirus Perinatal Experiences -Impact Survey 2 Wilcoxon rank-sum test; Fisher's Exact Test 3 COPE-IS = Coronavirus Perinatal Experiences -Impact Survey 2 Wilcoxon rank-sum test; Fisher's Exact Test 3 COPE-IS = Coronavirus Perinatal Experiences -Impact Survey Clinical Characteristics of Recently Diagnosed Breast Cancer Patients Reporting Delays vs. Delays…”

mentioning

confidence: 99%

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Impact of the COVID-19 pandemic on psychosocial outcomes among women experiencing breast health delays in New York City

Fasano

Bayard

et al. 2023

Preprint

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Purpose: Reallocation of healthcare resources during the beginning of the COVID-19 pandemic resulted in delays for breast cancer care. Data are sparse regarding the impact of these delays on psychosocial outcomes. Methods: This cross-sectional study utilized validated instruments to measure psychosocial outcomes of women with and without breast cancer experiencing healthcare delays. Results: The study population was comprised of 30 (35%) recently diagnosed breast cancer patients, 24 (28%) women without cancer, and 31 (36%) breast cancer survivors (n = 85). Overall, 58% reported a delay in breast health care. Compared to those who did not report any delays, women with delays had higher levels of anxiety, (78% vs. 58%; p = 0.059), perceived stress (45% vs. 28%; p = 0.17), loneliness (67% vs. 32%; p = 0.003), and depression (16% vs. 8.3%; p = 0.34); and no or low emotional support (58% vs. 28%; p = 0.008). Conclusion: Women with and without breast cancer experiencing a healthcare delay reported more symptoms of anxiety, depression, perceived stress, and loneliness, and less emotional support. Longer time to treatment was experienced by breast cancer patients with higher levels of psychosocial morbidity. When future healthcare resource constraints lead to substantial treatment delays, providers should consider the psychosocial impacts of these delays and consider systematic screening to identify patients in need of additional support.

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Redressing breast cancer screening disparities during the COVID-19 pandemic: Turning crisis into opportunity

Fayanju

Dickens

2022

The American Journal of Surgery

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Impact of the COVID-19 breast cancer screening hiatus on clinical stage and racial disparities in New York City

Cited by 9 publications

References 15 publications

Cancer Screening Disparities Before and After the COVID-19 Pandemic

Cancer Screening Disparities Before and After the COVID-19 Pandemic

Impact of the COVID-19 pandemic on psychosocial outcomes among women experiencing breast health delays in New York City

Redressing breast cancer screening disparities during the COVID-19 pandemic: Turning crisis into opportunity

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