Impact of the COVID-19 pandemic on breast cancer screening indicators in a Spanish population-based program: a cohort study

Abstract

Background:<br />To assess the effect of the COVID-19 pandemic on performance indicators in the population-based breast cancer screening program of Parc de Salut Mar (PSMAR), Barcelona, Spain.<br /><br />Methods:<br />We conducted a before-and-after, quasi-experimental study to evaluate participation, recall, false-positives, cancer detection rate, and cancer characteristics in our screening population from March 2020 to March 2021 compared with the four previous rounds (2012-2019). Using independent logistic regression models, we estimated the adjusted odds ratios (aOR) of each of the performance indicators for the COVID-19 period, controlling by type of screening (prevalent or incident), socioeconomic index, family history of breast cancer, and menopausal status. We analyzed 144,779 observations from 47,571 women.<br /><br />Results<br />During the COVID-19 period, the odds of participation were 11% lower in first-time invitees (aOR=0.89[95%CI=0.84-0.96]) and in those who had previously participated regularly and irregularly (aOR=0.65 [95%CI=0.61-0.69] and aOR=0.93 [95%CI=0.85-1.03], respectively). Participation showed a modest increase in women not attending any of the previous rounds (aOR=1.07 [95%CI=0.99-1.17]). The recall rate slightly decreased in both prevalent and incident screening (aOR=0.89 [95%CI=0.78-1.01] and aOR=0.89 [95%CI=0.79-1.00], respectively). No significant differences were observed in false-positives (prevalent - aOR=1.07 [95%CI=0.92-1.24] and incident screening -aOR=0.94 [95%CI=0.82-1.08]), cancer detection rate (aOR=0.91 [95%CI=0.69-1.18]), or cancer stages.<br /><br />Conclusions:<br />The COVID-19 pandemic negatively affected screening attendance, especially in previous participants and newcomers. We found no marked differences in recall, false-positives, or cancer detection, indicating the program’s resilience. There is a need for further evaluations of interval cancers and potential diagnostic delays.<br /><br /> Funding: <br />This study has received funding by grants from Instituto de Salud Carlos III FEDER (grant numbers: PI19/00007 and PI21/00058), and by the Health Outcomes-Oriented Cooperative Research Networks (RICORS) ), with reference RD21/0016/0020 co-funded with European Union – NextGenerationEU funds.

Nation-wide mammography screening participation in Denmark during the COVID-19 pandemic: An observational study

“…This indicates that the restrictions imposed in Denmark may have affected some groups of women disproportionally. A study from Spain (15) found that the participation in mammography screening decreased with age and with lower socio-economic level post-COVID-19; however, to our knowledge no studies have examined participation according to ethnicity throughout the pandemic. Immigrants may find it more difficult to navigate in the healthcare system in Denmark and possibly this has been exacerbated by the pandemic where the majority of the communication at press conferences and news media were conveyed in Danish; a language that may not be fully comprehensive to all immigrants.…”

“…This gap may have worsened during the pandemic. One study from Spain (15) found that the participation in mammography screening decreased with age and with lower socio-economic level post-COVID-19; however, to our knowledge no studies have examined participation according to ethnicity, cohabitation status or healthcare use throughout the pandemic.…”