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. 2021 Dec 1;127(23):4512-4515.
doi: 10.1002/cncr.33859. Epub 2021 Aug 26.

Changes in breast cancer screening rates among 32 community health centers during the COVID-19 pandemic

Stacey A Fedewa  1 , Megan M Cotter  1 , Kristen A Wehling  1 , Karla Wysocki  1 , Richard Killewald  1 , Laura Makaroff  1
Affiliations

Changes in breast cancer screening rates among 32 community health centers during the COVID-19 pandemic

Stacey A Fedewa et al. Cancer. .

Abstract

Background: Breast cancer screening utilization steeply dropped at the start of the coronavirus disease 2019 (COVID-19) pandemic. However, the effects on breast cancer screening in lower income populations are unknown. This study examined changes in breast cancer screening rates (BCSRs) during the pandemic among 32 community health centers (CHCs) that provided health care to lower income populations.

Methods: Secondary data from 32 CHCs participating in an American Cancer Society grant program to increase breast cancer screening services were used. BCSRs were defined as the percentage of women aged 50 to 74 years who had a medical visit in the past 12 months (142,207 in 2018, 142,003 in 2019, and 150,630 in 2020) and received a screening mammogram within the last 27 months. BCSRs in July 2020, July 2019, and June 2018 were compared with screening rate ratios (SRRs) and corresponding 95% confidence intervals (CIs).

Results: BCSRs significantly rose by 18% between 2018 and 2019 (from 45.8% to 53.9%; SRR, 1.18; 95% CI, 1.17-1.18) and then declined by 8% between 2019 and 2020 (from 53.9% to 49.6%; SRR, 0.92; 95% CI, 0.92-0.93). If the 2018-2019 BCSR trends had continued through 2020, 63.3% of women would have been screened in 2020 in contrast to the 49.6% who were; this potentially translated into 47,517 fewer mammograms and 242 missed breast cancer diagnoses in this population.

Conclusions: In this study of 32 CHCs, BCSRs declined by 8% from July 2019 to 2020, and this reversed an 18% improvement between July 2018 and 2019. Declining BCSRs among CHCs during the COVID-19 pandemic call for policies to support and resources to identify women in need of screening.

Keywords: access; breast cancer screening; community health centers; coronavirus disease 2019 (COVID-19); disparities; neoplasm.

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Conflict of interest statement

All the authors are employed by the American Cancer Society, which receives grants from private and corporate foundations, including foundations associated with companies in the health sector for research outside the submitted work. The salaries for Kristen A. Wehling and Karla Wysocki are partially funded by Pfizer grants for projects outside the scope of this article. Stacey A. Fedewa, Megan M. Cotter, Richard Killewald, and Laura Makaroff are not funded by or key personnel for any of these grants, and their salaries are solely funded through American Cancer Society funds. Fedewa also reports National Cancer Institute honoraria for a Cancer Epidemiology Education in Special Populations talk (August 2019), which were donated to the American Cancer Society, and Makaroff has served on an advisory board for the University of New Mexico project ECHO.

Figures

Figure 1
Figure 1
Observed BCSRs among 32 community health centers: 2018, 2019, and 2020. The observed BCSRs were defined according to the CMS‐125 measure as the percentage of women aged 50 to 74 years who had a medical visit within the past 12 months and received a screening mammogram within the last 27 months. The observed 2018, 2019, and 2020 BCSRs were as of June 2018, July 2019, and July 2020, respectively. Hypothetical 2020 BCSRs were projected under 2 scenarios: 1) if the 2018‐2019 trend extended through 2020 and 2) if 2019 rates remained level. BCSR indicates breast cancer screening rate.
Figure 2
Figure 2
Observed and projected numbers of women screened among 32 community health centers: 2018, 2019, and 2020. Observed numbers of breast cancer screenings were computed as of July 2018, 2019, and 2020. The number of breast cancer screenings was projected under 2 scenarios: 1) if the 2018‐2019 trend extended through 2020 and (2) if 2019 rates remained level.
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