Assessing the effects of COVID-19 on breast cancer screening rates

Background and goal: Breast cancer is the second most common cancer among women in the U.S. Early detection of the disease through screening can greatly improve the chances of successful treatment and is an essential preventive service in primary care. The COVID-19 pandemic interrupted breast cancer screening as many screening programs were temporarily suspended due to personal concerns about exposure to the virus and the burden on the health care system. The goal of this study was to use real-world electronic health records (EHR) across the U.S. to examine the changes in breast cancer screening utilization since the COVID-19 pandemic and how the follow-up screening rates were impacted by the pandemic.

Study approach: Using the TriNetX Research Network, a global platform that connects health care organizations and researchers, offering real-time access to anonymized clinical data, the researchers retrospectively analyzed a group of 1,186,669 women eligible for breast cancer screening from Jan. 1, 2017, to Feb. 28, 2022. The researchers looked at how frequently screenings occurred each month within the study period and observed any patterns or changes in frequency. They paid particular attention to how these patterns varied before and during the COVID-19 pandemic, especially regarding how often individuals returned for a follow-up screening within 24 months of their previous screening.

Main results: 

• The monthly screening volume temporarily decreased by 80.57% from February to April 2020 but rebounded to close to pre-pandemic levels after June 2020.
• Even after the rebound, there was still a decrease in the rate of follow-up breast cancer screenings. On average, COVID-19 led to a 2.47% decrease in follow up screening rates among all women participants, with a 95% confidence interval of -2.60 to -2.34. This indicates a significant number of missed screenings given the large population scale.
• Women were generally less likely to return for follow-up screenings during the pandemic, especially women over 65 years old and women from racial minority groups who are not Hispanic.

Why it matters: The slight decrease in follow-up screening rates translates to many missed opportunities for early detection and treatment of breast cancer, which can result in late-stage diagnoses and poorer health outcomes. The disparities in adherence to follow-up screenings among older and racial minority women are concerning as they suggest a risk of increased late-stage diagnoses and mortality among these groups. Innovative strategies, such as the use of technology and community-based interventions, are needed to ensure that all women, especially those from vulnerable groups, have access to screenings. 

"Understanding the medical comorbidities and social determinants that impact screening adherence in the COVID period and how that drives current gaps and disparities is crucial for family physicians and health systems to provide the best care for their patient population," the author wrote.