SPOKANE, Washington. – Breast cancer screening has taken a hard hit during the COVID-19 pandemic, suggests new research that has shown the number of screening mammograms performed in a large group of women living in Washington state has dropped by almost half. Posted today in JAMA network open, the study found the largest declines among women of color and those living in rural communities.
“Detecting breast cancer at an early stage greatly increases the chances of successful treatment,” said lead study author Ofer Amram, assistant professor at Elson S. Floyd College of Medicine at the University of Washington State, whose research focuses on health inequalities. “The results of our study suggest that health care providers need to redouble their efforts to maintain prevention services and reach these underserved populations, who faced significant health disparities even before the pandemic.
The study was conducted by researchers at Washington State University Health Sciences Spokane in partnership with MultiCare, a nonprofit healthcare system that includes 230 clinics and eight hospitals across the state. Washington. The research team used data from the medical records of MultiCare patients who had screening mammograms between April and December 2019 and during the same months in 2020, after the World Health Organization declared COVID-19 global pandemic in March 2020.
Researchers saw the number of completed screening mammograms in Washington state drop from 55,678 in 2019 to 27,522 in 2020, a decrease of 49%. When they analyzed the data by race, they found a similar decrease in screening of 49% for white women, but saw significantly larger decreases in non-white women. For example, breast cancer screening decreased by 64% among Hispanic women and 61% among Native American and Alaska Native women. The researchers also looked at geographic location and found that screening mammograms for rural women were reduced by almost 59%, while the number of mammograms performed for urban women was reduced by about 50%.
In addition, the research team analyzed the data by type of insurance and found that compared to women who had a commercial or government health insurance plan, reductions in screening were greater among women using Medicaid or self-paying for treatment, which Amram says are indicators of lower socioeconomic status.
“We know that the COVID-19 virus has had disproportionate impacts on certain populations, including minority racial and ethnic groups,” said Pablo Monsivais, lead author of the study and associate professor at WSU Elson S. Floyd College of Medicine. “What our study adds is that some of the side effects of the COVID-19 pandemic are also having a disproportionate impact on these populations, so it’s a double whammy.”
While previous studies have looked at missed cancer screening during the pandemic, Monsivais said this study is the first to look at racial and socio-economic differences, in particular. The research team’s goal is to find ways to remove barriers to cancer screening, which would help reduce cancer-related health disparities. The next step is to conduct a follow-up study to identify the social and economic factors that have interfered with access to cancer screening during the pandemic. In addition to breast cancer, this study will also look at missed colon cancer and lung cancer screening in women and men.
Factors that may have played a role in reducing cancer screening include job loss, loss of employer-provided health insurance, and caregiver stress due to school or daycare closures. or other circumstances. Fear of contracting COVID-19 may also have played into this, said Jeanne Robison, study co-author, oncology nurse practitioner and principal investigator on this project with the MultiCare Cancer and Blood Specialty Centers in Spokane, Washington.
“One of the things we found this year is that women who were good enough to go for screening continued to fear entering even after health care facilities reopened for routine screening,” said Robison. . “I had to convince some of my patients to come, because even when protocols were in place to safely offer breast cancer screening, there was still a perceived risk.”
A decline in primary care visits during the pandemic may also have been a factor, she said, as primary care providers often play a key role in reminding women of the timing and importance of breast cancer screening. breast. And while increased access to virtual tours may have mitigated this decline, there may have been barriers to providing virtual care that disproportionately impacted certain groups of people, which the researchers’ follow-up study found. will help determine.
In addition to Amram, Monsivais and Robison, the authors of the article included Solmaz Amiri and John Roll of the WSU Elson S. Floyd College of Medicine and Bethann Pflugeisen of the MultiCare Institute for Research & Innovation.
The study was funded by a grant from the Andy Hill Cancer Research Endowment Fund.
- Ofer Amram, WSU Elson S. Floyd College of Medicine, 509-368-6863, firstname.lastname@example.org
- Judith Van Dongen, WSU Health Sciences Spokane Office of Research, 509-358-7524, email@example.com