Trends in Breast Cancer Screening in a Safety-Net Hospital During the COVID-19 Pandemic

Abstract

National estimates project COVID-19 negatively influenced cancer screening, leading to an estimated deficit of 3.9 million breast cancer (BC) screenings among US adults. 1,2 In San Francisco, California, low-income neighborhoods disproportionately affected by COVID-19 bear the burden of higher BC stage at diagnosis. 3,4 We sought to evaluate the association of COVID-19 and BC screening in a safety-net hospital in San Francisco. MethodsThis cross-sectional study evaluated trends in BC screening at an urban integrated health system's safety-net hospital. We obtained the number of screening mammograms per month during 2019 from electronic health record (EHR) data, and aggregate numbers between September 1, 2019, and January 31, 2021, after the implementation of a new EHR. The number of screening mammograms per month was plotted against the 2019 baseline. Proportions of completed tests by phase of the pandemic (pre-COVID-19, first stay-at-home order, reopening, and second stay-at-home order) were compared by race/ethnicity and age with 2-sided, 2-sample proportion tests. Race/ethnicity was used as a proxy for the disproportionate burden of COVID-19 and experiences of individual and systemic racism experienced by minority communities. Analyses were conducted with Stata, version 16 (StataCorp LLC). P < .05 was used to determine significance. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline for cross-sectional studies. 5 Deidentified data collected for quality improvement activities does not require approval from The University of California, San Francisco institutional review board; this study was therefore exempted from review.

Assessing the impact of the COVID-19 pandemic on breast cancer screening and diagnosis rates: A rapid review and meta-analysis

“…Therefore, 33 reports consisting of 31 studies formed the basis of this review. 18 – 50 A PRISMA flow diagram outlining the screening process is presented in Figure 1 . The list of excluded studies with reasons of exclusion is reported in Supplementary Table S2.…”

“…Reductions in screening mammography rates were reported in all studies and ranged from 53.8% to 22.2% among registry-based studies 20 , 35 , 44 and 80.0% to 9.8% among non-registry-based studies. 18 , 24 , 25 , 31 , 34 , 36 , 39 , 41 , 43 , 49 Figure 2 displays the results of the meta-analysis of mammographic screening rate ratios. Overall, we noted that mammogram rates declined between 2019 and 2020 by 41% (RR: 0.59, 95% CI: 0.46–0.75) and 53% (RR: 0.47, 95% CI: 0.38–0.58) according to data derived from 3 registry-based and 10 non-registry-based studies respectively.…”

Reduction in Standard Cancer Screening in 2020 throughout the U.S.

“…Primary prevention is the main strategy to reduce the growing burden of colon, breast, and prostate cancer [ 37 ]. With regard to breast cancer alone, national estimates project that the COVID-19 pandemic is leading to an estimated deficit of 3.9 million breast cancer (BC) screenings among U.S. adults [ 38 ]. Unfortunately, the reduced rate of screening impacts cancer incidence, treatment, cancer-related mortality, and overall cost of cancer care long-term.…”

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

“…Furthermore, they found that the proportion of completed mammograms was lowest among Black women at all time points. 14 Another study by Marcondes et al found no significant improvement or worsening of racial and ethnic disparities for any cancer screening after the hiatus was lifted. 15 Our data show similar findings and suggest a trend toward a mitigation of these disparities.…”