Breast cancer screening rates decline during COVID-19 pandemic in underserved communities
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Breast cancer screening rates declined within 32 community health centers serving lower-income populations during the COVID-19 pandemic, according to an American Cancer Society study published in Cancer.
“At the start of the COVID-19 pandemic, health care procedures were delayed and steep drops in breast cancer screening utilization were observed. However, the pandemic’s effects on breast cancer screening in populations with lower incomes was not fully known,” Stacey A. Fedewa, PhD, MPH, senior principal scientist of risk factors and screening surveillance research at American Cancer Society, told Healio. “We examined changes in breast cancer screening rates during the pandemic among 32 community health centers that provide health care to people who are medically underserved. This is important because these populations have long-standing barriers to accessing care and are especially vulnerable to health care disruptions.”
The analysis included 32 community health centers that participated in American Cancer Society’s CHANGE grant program, funded by the society and the National Football League to improve breast cancer screening rates in underserved urban (n = 28) and rural (n = 4) areas. Most of the clinics (68.7%) had medium or high percentages of Hispanic or Black women.
Fedewa reviewed clinic-level breast cancer screening rates — defined as the percentage of women aged 50 to 74 years who had a medical visit during the last 12 months in 2018 (n = 142,207), 2019 (n = 142,003) and 2020 (n = 150,630) and a screening mammogram during the last 27 months. They then compared screening rates as of July 2020 vs. July 2019 vs. June 2018 overall and by clinic region, rural/urban status and demographic characteristics.
Results showed breast cancer screening rates at the centers declined by 8% between July 2019 and July 2020, from 53.9% to 49.6% (screening rate ratio [SRR] = 0.92,95% CI, 0.92-0.93). This reversed a previous trend of an 18% increase in screening rates between July 2018 and July 2019, from 45.8% to 53.9% (SRR = 1.18, 95% CI, 1.17-1.18). Had that trend continued during 2020, the screening rate would have been 63.3% last year, potentially equating to 47,517 more mammograms and an additional 242 breast cancer diagnoses.
“We anticipated some declines in breast cancer screening rates, but we were not sure of the magnitude. The percentage point does not sound very large, but the absolute number of women impacted is,” Fedewa told Healio.
Fedewa and colleagues observed greater declines in screening rates between 2019 and 2020 among clinics that serve a higher proportion of Black women (SRR = 0.88, 95% CI 0.87, 0.9) and lower proportion of individuals who lack health insurance (SRR = 0.85; 95% CI, 0.84-0.86).
“We saw an 8% decline in breast cancer screening rates between 2019-2020 in the 32 clinics studied, but there was a 12% decline in clinics that predominately served African American women,” Fedewa said. “This is an important health equity issue.”
Study limitations included use of reports from a single month and a screening metric that included a 27-month lookback period, capturing a period before the pandemic, researchers wrote. Fedewa also acknowledged that CHANGE program-funded interventions may have mitigated the pandemic’s effects on breast cancer screening services among the community health centers in the study.
“We would like to continue tracking breast cancer screening rates in these 32 clinics and more broadly in other community health centers,” she said.
Grant programs such as CHANGE will continue to be important in helping such communities restore to a healthier state following the pandemic, Lee G. Wilke, MD, FACS, professor in the division of surgical oncology, director of the Health Breast Center, and Hendricks chair in breast cancer surgery research at University of Wisconsin School of Medicine and Public Health, wrote in an editorial accompanying the study.
“The CHANGE grant outcomes from Fedewa and co-authors ... provide an indication that targeted community partnerships and education programs will enable a quicker return to baseline screening and, more importantly, to a higher rate than that before the pandemic,” Wilke wrote. “It will be vital to ‘catch up’ on the missed screening examinations from the first months of the pandemic and increase baseline screening rates in populations already at risk.”
References:
Fedewa SA, et al. Cancer. 2021;doi:10.1002/cncr.33859.
Wilke LG, Cancer. 2021;doi: 10.1002/cncr.33858.
For more information:
Stacey A. Fedewa, PhD, MPH, can be reached at American Cancer Society, 250 Williams St. NW, Atlanta, GA 30303; email: stacey.fedewa@cancer.org.
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