The impact of COVID-19 on breast cancer care: Delays in screening.

Abstract

130 Background: Breast cancer (BC) screening is an integral part of cancer prevention. COVID-19 posed multiple obstacles on ensuring continuity of cancer care. The short and long-term outcomes of the pandemic on BC screening is unknown. The purpose of this study is to examine the challenges the pandemic has on mammogram completion using a granular measure of social economic deprivation: Area deprivation index (ADI). Methods: A Retrospective cohort study was conducted at an academic hospital system at the epicenter of COVID-19 pandemic comparing BC screening rates during the year of 2019 (pre-COVID19) and 2020 (COVID-19). For the year 2020, only charts between January-February and July-December were reviewed. March-June period was avoided as the USA declared a national emergency and the American Cancer Society recommended to temporarily pause cancer screening. The outcome variable was mammogram completion. The predictor variables were: COVID-19 period, race, insurance, age and ADI. ADI is a validated dataset that ranks census block groups based on socioeconomic deprivation (SED). Chi-square and Wilcoxon rank sum test were used to compare categorical and continuous variables by receipt of mammography. A multivariate logistic regression was used for associations between mammogram completion and the predictor variables. Results: A total of 694 patients were deemed eligible for BC screening in the year of 2019 (394) and 2020 (300). During the follow up period, only 106 and 30 patients from the pre-COVID-19 and COVID-19 cohorts underwent BC screening, respectively. During the pandemic, 30/30 patients who completed their screening were African Americans and had a high SED. In a multivariable analysis, COVID-19 period is associated with 79% lower odds of mammogram completion (OR 0.21; 95% CI 0.13, 0.35). ADI and race were not associated with higher screening rates. Medicaid status is associated with higher odds of mammogram completion (OR 1.97; 95% CI 1.12, 3.47). Conclusions: COVID-19 caused significant disruption in BC screening. In an area with high SED and high COVID-19 infection rates, private insurance holders and white patients had low rates mammogram completion. One potential explanation is that these patients sought care elsewhere. [Table: see text]