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McKee Hurwitz H, Shah C. Cancer Prevention for Women Experiencing Homelessness: Onsite Mammography, Navigation, and Education. JCO Oncol Pract 2024:OP2400188. [PMID: 38986028 DOI: 10.1200/op.24.00188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/20/2024] [Accepted: 05/29/2024] [Indexed: 07/12/2024] Open
Abstract
PURPOSE Persons experiencing homelessness (PEHs) represent a medically underserved population with a disproportionately high rate of late-stage cancer diagnoses and cancer mortality. During mobile onsite mammography and breast health education events, we studied PEH's barriers to and uptake of cancer screenings. METHODS This study used patient surveys and review of the electronic health record. The main outcome measures included mammogram and diagnostic imaging (as needed) results. A questionnaire assessed patient's views and barriers related to social determinants of health. The study included women accessing community organization resources who were 40 years or older or who met criteria for screening mammography. RESULTS Forty-six individuals completed mammograms and 41 individuals participated in the survey, for a response rate of 89%. Thirty-five participants (85%) held health insurance provided by a Medicaid managed plan. Thirty-six participants (87%) received a negative mammogram result, and five participants (12%) required follow-up for abnormal results. Of these five, two participants completed diagnostic follow-up with negative results, and three did not complete diagnostic follow-up. In addition to barriers related to housing insecurity, five patients (12%) reported transportation barriers. A majority (n = 28, 68%) disagreed or strongly disagreed with the statement, "I'm afraid the mammogram will be painful." A majority (n = 31, 76%) disagreed or strongly disagreed with the statement, "I'm busy and do not have time." Nearly all participants (n = 37, 90%) responded yes to the statement, "I believe in preventative care screenings." Eight participants (20%) completed at least one additional cancer screening. CONCLUSION By creating enduring programs offering screening, navigation, and education, academic-community partnerships may begin to address the increased cancer mortality among PEHs by improving screening adherence.
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Affiliation(s)
- Heather McKee Hurwitz
- Department of Hematology and Medical Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
| | - Chirag Shah
- Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH
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Bermudez Y, DeGroff A, Miller J, Kenney K, Lockhart J, Joseph D, Richardson L. Changes in Screening Test Volume in the National Breast and Cervical Cancer Early Detection Program during the COVID-19 Pandemic, 2020-2022. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:816. [PMID: 39063394 PMCID: PMC11276804 DOI: 10.3390/ijerph21070816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 06/13/2024] [Accepted: 06/17/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) observed significant declines in screening volume early in the COVID-19 pandemic, January-June 2020, with variation by race/ethnicity and geography. We aimed to determine how screening in the NBCCEDP recovered from these early declines as it is important for monitoring the long-term impact on women served by the program. METHODS Extending the previous analyses, we compared monthly breast (BC) and cervical cancer (CVC) screening volume in the NBCCEDP during 2020-2022, to five-year, pre-COVID-19 pandemic averages (2015-2019), and calculated percent change. Results were stratified by race/ethnicity and rurality groups. We employed multiple one-way ANOVA tests, which included multiple comparisons, to test for significant differences between groups. RESULTS By December 2022, NBCCEDP breast and cervical cancer screening volumes had not fully recovered to pre-COVID-19 5-year averages, and recovery in breast cancer screening volume was slower than that of cervical cancer. Both BC and CVC screening among women in metro areas showed the smallest average monthly deficits (-8.8% BC and -4.9% CVC) compared to monthly pre-COVID-19 pandemic 5-year averages, and screening among women in rural areas showed the greatest deficits (-37.3% BC and -26.7% CVC). BC and CVC screening among Hispanic women showed the greatest improvements compared to the pre-COVID-19 averages (8.2% BC and 9.5% CVC), and cervical cancer screening among non-Hispanic Asian and Pacific Islander women showed the greatest deficits (-41.4% CVC). CONCLUSION For increased intervention efforts, NBCCEDP recipients can focus on populations demonstrating greatest deficits in screening volume.
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Affiliation(s)
- Yamisha Bermudez
- Totally Joined for Achieving Collaborative Techniques, Atlanta, GA 30303, USA
| | - Amy DeGroff
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Jacqueline Miller
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Kristy Kenney
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Jala Lockhart
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Djenaba Joseph
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Lisa Richardson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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Johnson KJ, O’Connell CP, Waken RJ, Barnes JM. Impact of COVID-19 pandemic on breast cancer screening in a large midwestern United States academic medical center. PLoS One 2024; 19:e0303280. [PMID: 38768115 PMCID: PMC11104587 DOI: 10.1371/journal.pone.0303280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/22/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Access to breast screening mammogram services decreased during the COVID-19 pandemic. Our objectives were to estimate: 1) the COVID-19 affected period, 2) the proportion of pandemic-associated missed or delayed screening encounters, and 3) pandemic-associated patient attrition in screening encounters overall and by sociodemographic subgroup. METHODS We included screening mammogram encounter EPIC data from 1-1-2019 to 12-31-2022 for females ≥40 years old. We used Bayesian State Space models to describe weekly screening mammogram counts, modeling an interruption that phased in and out between 3-1-2020 and 9-1-2020. We used the posterior predictive distribution to model differences between a predicted, uninterrupted process and the observed screening mammogram counts. We estimated associations between race/ethnicity and age group and return screening mammogram encounters during the pandemic among those with 2019 encounters using logistic regression. RESULTS Our analysis modeling weekly screening mammogram counts included 231,385 encounters (n = 127,621 women). Model-estimated screening mammograms dropped by >98% between 03-15-2020 and 05-24-2020 followed by a return to pre-pandemic levels or higher with similar results by race/ethnicity and age group. Among 79,257 women, non-Hispanic (NH) Asians, NH Blacks, and Hispanics had significantly (p < .05) lower odds of screening encounter returns during 2020-2022 vs. NH Whites with odds ratios (ORs) from 0.70 to 0.91. Among 79,983 women, those 60-69 had significantly higher odds of any return screening encounter during 2020-2022 (OR = 1.28), while those ≥80 and 40-49 had significantly lower odds (ORs 0.77, 0.45) than those 50-59 years old. A sensitivity analysis suggested a possible pre-existing pattern. CONCLUSIONS These data suggest a short-term pandemic effect on screening mammograms of ~2 months with no evidence of disparities. However, we observed racial/ethnic disparities in screening mammogram returns during the pandemic that may be at least partially pre-existing. These results may inform future pandemic planning and continued efforts to eliminate mammogram screening disparities.
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Affiliation(s)
- Kimberly J. Johnson
- Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
- Siteman Cancer Center, Washington University in St Louis, St. Louis, Missouri, United States of America
| | - Caitlin P. O’Connell
- Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - R. J. Waken
- Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Center for Advancing Health Services, Policy & Economics Research, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Justin M. Barnes
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, United States of America
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Lohfeld L, Sharma M, Bennett D, Gavin A, Hawkins ST, Irwin G, Mitchell H, O'Neill S, McShane CM. Impact of the COVID-19 pandemic on breast cancer patient pathways and outcomes in the United Kingdom and the Republic of Ireland - a scoping review. Br J Cancer 2024:10.1038/s41416-024-02703-w. [PMID: 38704477 DOI: 10.1038/s41416-024-02703-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/06/2024] Open
Abstract
The COVID-19 pandemic brought unplanned service disruption for breast cancer diagnostic, treatment and support services. This scoping review describes these changes and their impact in the UK and the Republic of Ireland based on studies published between January 2020 and August 2023. Thirty-four of 569 papers were included. Data were extracted and results thematically organized. Findings include fewer new cases; stage shift (fewer early- and more late-stage disease); and changes to healthcare organization, breast screening and treatment. Examples are accepting fewer referrals, applying stricter referral criteria and relying more on virtual consultations and multi-disciplinary meetings. Screening service programs paused during the pandemic before enacting risk-based phased restarts with longer appointment times to accommodate reduced staffing numbers and enhanced infection-control regimes. Treatments shifted from predominantly conventional to hypofractionated radiotherapy, fewer surgical procedures and increased use of bridging endocrine therapy. The long-term impact of such changes are unknown so definitive guidelines for future emergencies are not yet available. Cancer registries, with their large sample sizes and population coverage, are well placed to monitor changes to stage and survival despite difficulties obtaining definitive staging during diagnosis because surgery and pathological assessments are delayed. Multisite longitudinal studies can also provide guidance for future disaster preparedness.
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Affiliation(s)
- Lynne Lohfeld
- Queen's University Belfast, Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Royal Victoria Hospital, 247 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK.
| | - Meenakshi Sharma
- Queen's University Belfast, Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Royal Victoria Hospital, 247 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
| | - Damien Bennett
- Northern Ireland Cancer Registry, Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast, BT12 6DP, Northern Ireland, UK
| | - Anna Gavin
- Queen's University Belfast, Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Royal Victoria Hospital, 247 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
- Northern Ireland Cancer Registry, Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast, BT12 6DP, Northern Ireland, UK
| | - Sinéad T Hawkins
- Queen's University Belfast, Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Royal Victoria Hospital, 247 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
- Northern Ireland Cancer Registry, Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast, BT12 6DP, Northern Ireland, UK
| | - Gareth Irwin
- Belfast Health and Social Care Trust, 51 Lisburn Road, Belfast, BT9 7AB, Northern Ireland, UK
| | - Helen Mitchell
- Northern Ireland Cancer Registry, Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Queen's University Belfast, Mulhouse Building, Grosvenor Road, Belfast, BT12 6DP, Northern Ireland, UK
| | - Siobhan O'Neill
- Belfast Health and Social Care Trust, 51 Lisburn Road, Belfast, BT9 7AB, Northern Ireland, UK
| | - Charlene M McShane
- Queen's University Belfast, Centre for Public Health, School of Medicine, Dentistry & Biomedical Sciences, Royal Victoria Hospital, 247 Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK
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5
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Chung A, Chen Q, Curry W, Felix T, Tuan WJ. Breast Cancer Screening During the COVID-19 Pandemic in the United States: Results From Real-World Health Records Data. Ann Fam Med 2024; 22:208-214. [PMID: 38806260 PMCID: PMC11237221 DOI: 10.1370/afm.3098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 01/24/2024] [Accepted: 01/31/2024] [Indexed: 05/30/2024] Open
Abstract
PURPOSE The COVID-19 pandemic abruptly interrupted breast cancer screening, an essential preventive service in primary care. We aimed to evaluate the pandemic's impact on overall and follow-up breast cancer screening using real-world health records data. METHODS We retrospectively analyzed a cohort of women eligible for breast cancer screening through the study period from January 1, 2017 to February 28, 2022 using TriNetX Research Network data. We examined the temporal trend of monthly screening volume throughout the study period and compared the rate of adherence to follow-up screening within 24 months after the previous screening when the follow-up screening was due in the pre-COVID period vs the COVID period. To account for multiple screenings in the longitudinal data, we applied a logistic regression model using generalized estimating equations with adjustment for individual-level covariates. RESULTS Among 1,186,669 screening-eligible women, the monthly screening volume temporarily decreased by 80.6% from February to April 2020 and then rebounded to close to pre-COVID levels by June 2020. Yet, the follow-up screening rate decreased from 78.9% (95% CI, 78.8%-79.0%) in the pre-COVID period to 77.7% (95% CI, 77.6%-77.8%) in the COVID period. Multivariate regression analysis also showed a lower adherence to follow-up screening during the COVID period (odds ratio = 0.86; 0.86-0.87) and a greater pandemic impact among women aged 65 years and older and women of non-Hispanic "other" race (Asian, American Indian or Alaska Native, and Native Hawaiian or Other Pacific Islander). CONCLUSIONS The COVID-19 pandemic had a transient negative effect on breast cancer screening overall and a prolonged negative effect on follow-up screening. It also exacerbated gaps in adherence to follow-up screening, especially among certain vulnerable groups, requiring innovative strategies to address potential health disparities in primary care.
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Affiliation(s)
- Andrew Chung
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, Pennsylvania
| | - Qiushi Chen
- The Harold and Inge Marcus Department of Industrial and Manufacturing Engineering, The Pennsylvania State University, University Park, Pennsylvania
| | - William Curry
- Department of Family and Community Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Todd Felix
- Department of Family and Community Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Wen-Jan Tuan
- Department of Family and Community Medicine, The Pennsylvania State University, Hershey, Pennsylvania
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6
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Sprague BL, Nowak SA, Ahern TP, Herschorn SD, Kaufman PA, Odde C, Perry H, Sowden MM, Vacek PM, Weaver DL. Long-term Mammography Screening Trends and Predictors of Return to Screening after the COVID-19 Pandemic: Results from a Statewide Registry. Radiol Imaging Cancer 2024; 6:e230161. [PMID: 38578209 PMCID: PMC11148837 DOI: 10.1148/rycan.230161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/09/2024] [Accepted: 02/27/2024] [Indexed: 04/06/2024]
Abstract
Purpose To evaluate long-term trends in mammography screening rates and identify sociodemographic and breast cancer risk characteristics associated with return to screening after the COVID-19 pandemic. Materials and Methods In this retrospective study, statewide screening mammography data of 222 384 female individuals aged 40 years or older (mean age, 58.8 years ± 11.7 [SD]) from the Vermont Breast Cancer Surveillance System were evaluated to generate descriptive statistics and Joinpoint models to characterize screening patterns during 2000-2022. Log-binomial regression models estimated associations of sociodemographic and risk characteristics with post-COVID-19 pandemic return to screening. Results The proportion of female individuals in Vermont aged 50-74 years with a screening mammogram obtained in the previous 2 years declined from a prepandemic level of 61.3% (95% CI: 61.1%, 61.6%) in 2019 to 56.0% (95% CI: 55.7%, 56.3%) in 2021 before rebounding to 60.7% (95% CI: 60.4%, 61.0%) in 2022. Screening adherence in 2022 remained substantially lower than that observed during the 2007-2010 apex of screening adherence (66.1%-67.0%). Joinpoint models estimated an annual percent change of -1.1% (95% CI: -1.5%, -0.8%) during 2010-2022. Among the cohort of 95 644 individuals screened during January 2018-March 2020, the probability of returning to screening during 2020-2022 varied by age (eg, risk ratio [RR] = 0.94 [95% CI: 0.93, 0.95] for age 40-44 vs age 60-64 years), race and ethnicity (RR = 0.84 [95% CI: 0.78, 0.90] for Black vs White individuals), education (RR = 0.84 [95% CI: 0.81, 0.86] for less than high school degree vs college degree), and by 5-year breast cancer risk (RR = 1.06 [95% CI: 1.04, 1.08] for very high vs average risk). Conclusion Despite a rebound to near prepandemic levels, Vermont mammography screening rates have steadily declined since 2010, with certain sociodemographic groups less likely to return to screening after the pandemic. Keywords: Mammography, Breast, Health Policy and Practice, Neoplasms-Primary, Epidemiology, Screening Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Brian L. Sprague
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Sarah A. Nowak
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Thomas P. Ahern
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Sally D. Herschorn
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Peter A. Kaufman
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Catherine Odde
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Hannah Perry
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Michelle M. Sowden
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Pamela M. Vacek
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
| | - Donald L. Weaver
- From the Department of Surgery (B.L.S., T.P.A., M.M.S.), Department
of Radiology (B.L.S., S.D.H., H.P.), University of Vermont Cancer Center
(B.L.S., S.A.N., T.P.A., S.D.H., P.A.K., H.P., M.M.S., P.M.V., D.L.W.),
Department of Pathology and Laboratory Medicine (S.A.N., D.L.W.), Department of
Medicine (P.A.K.), and Department of Biostatistics (P.M.V.), University of
Vermont Larner College of Medicine, 1 S Prospect St, UHC Bldg Rm 4425,
Burlington, VT 05401; and Bachelor of Individualized Studies Program, College of
Liberal Arts, University of Minnesota, Minneapolis, Minn (C.O.)
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7
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Wang H, Yang M, Xiong W, Wang Q, Zheng B, Bai Y, Zou K, Li J, Ren J, Chen W, Zhai J, Li J. Noteworthy impacts of COVID-19 pandemic on cancer screening: A systematic review. FUNDAMENTAL RESEARCH 2024; 4:484-494. [PMID: 38933198 PMCID: PMC11197616 DOI: 10.1016/j.fmre.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 12/18/2023] [Accepted: 12/26/2023] [Indexed: 06/28/2024] Open
Abstract
The sudden onset of the coronavirus disease 2019 (COVID-19) in January 2020 has affected essential global health services. Cancer-screening services that can reduce cancer mortality are strongly affected. However, the specific role of COVID-19 in cancer screening is not fully understood. This study aimed to assess the efficiency of global cancer screening programs before and during the COVID-19 pandemic and to promote potential cancer-screening strategies for the next pandemic. Electronic searches in PubMed, Embase, and Web of Science, and manual searches were performed between January 1, 2020 and March 1, 2023. Cohort studies that reported the number of participants who underwent cancer screening before and during the COVID-19 pandemic were included. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. Differences in cancer-screening rates were estimated using the incidence rate ratio (IRR). Fifty-five cohort studies were included in this meta-analysis. The screening rates of colorectal cancer using invasive screening methods (Pooled IRR = 0.52, 95% CI: 0.42 to 0.65, p < 0.01), cervical cancer (Pooled IRR = 0.56, 95% CI: 0.47 to 0.67, p < 0.01), breast cancer (Pooled IRR = 0.57, 95% CI: 0.49 to 0.66, p < 0.01) and prostate cancer (Pooled IRR = 0.71, 95% CI: 0.56 to 0.90, p < 0.01) during the COVID-19 pandemic were significantly lower than those before the COVID-19 pandemic. The screening rates of lung cancer (Pooled IRR = 0.77, 95% CI: 0.58 to 1.03, p = 0.08) and colorectal cancer using noninvasive screening methods (Pooled IRR = 0.74, 95% CI: 0.50 to 1.09, p = 0.13) were reduced with no statistical differences. The subgroup analyses revealed that the reduction in cancer-screening rates varied across economies. Our results suggest that the COVID-19 pandemic has had a noteworthy impact on colorectal, cervical, breast, and prostate cancer screening. Developing innovative cancer-screening technologies is important to promote the efficiency of cancer-screening services in the post-COVID-19 era and prepare for the next pandemic.
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Affiliation(s)
- Huilin Wang
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Min Yang
- Department of Comprehensive Intervention, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wei Xiong
- Department of Gynecology Endocrine & Reproductive Center, National Clinical Research Center for Obstetric & Gynecologic Diseases Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College/Chinese Academy of Medical Sciences, Beijing 100005, China
| | - Quan Wang
- Ambulatory Surgery Center of Xijing Hospital, Fourth Military Medical University, Xi'an 710068, China
| | - Bobo Zheng
- Department of General Surgery, Shaanxi Provincial People’ s Hospital, Xi'an 710068, China
| | - Yang Bai
- College of Clinical Medicine, Capital Medical University, Beijing 100069, China
| | - Kaiyong Zou
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jibin Li
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jiansong Ren
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Wanqing Chen
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jingbo Zhai
- School of Public Health, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China
| | - Jiang Li
- Office for Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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8
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Cohen EO, Edelkamp P, Sun J, Leung JWT. Breast Imaging Patient Demographics at a Major Comprehensive Cancer Center Before and During the COVID-19 Pandemic. J Am Coll Radiol 2024; 21:576-588. [PMID: 37952808 DOI: 10.1016/j.jacr.2023.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE The coronavirus disease of 2019 (COVID-19) pandemic disproportionately affected certain vulnerable communities. The purpose of our study was to determine how COVID-19 affected the socioeconomic demographics of breast imaging patients at a major comprehensive cancer center. METHODS This retrospective cohort study compared female patients who underwent screening mammograms, diagnostic mammograms, breast ultrasound, or breast MRI during the following time periods: prepandemic (February 1, 2018, through February 29, 2020), acute pandemic (March 1, 2020, through June 30, 2020), subacute pandemic (August 1, 2020, through December 31, 2020), and chronic pandemic (January 1, 2021, through June 30, 2022). Statistics were performed using the generalized estimating equations approach. RESULTS A total of 74,398 female patients (mean age, 55.6 ± 12.4 years) underwent 238,776 total breast imaging examinations. For screening mammograms, Hispanics represented 27.1% (9,197 of 33,960) of patients in the prepandemic time period compared with 16.7% (604 of 3,621) in the acute pandemic time period, 18.7% (1,835 of 9,830) in the subacute pandemic time period, and 24.3% (7,492 of 30,869) in the chronic pandemic time period (all P < .0001). Self-pay patients saw similar declines for screening mammograms during the same time periods: 21.7% (7,375 of 33,960), 7.9% (286 of 3,621), 9.5% (933 of 9,830), and 17.4% (5,357 of 30,869), respectively (all P < .0001, compared with the prepandemic time period). Similarly dramatic trends were not observed for race or other imaging examinations. DISCUSSION At our cancer center, Hispanics and self-pay patients were disproportionately affected by the COVID-19 pandemic. Strategies to improve health inequities are needed.
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Affiliation(s)
- Ethan O Cohen
- Faculty Lead, Marketing, Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas.
| | - Paul Edelkamp
- Division of Information Services, Enterprise Data Engineering, and Analytics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jia Sun
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jessica W T Leung
- Faculty Lead, Marketing, Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas; Deputy Chair, Department of Breast Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
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9
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Narvacan K, Patlas MN. Disproportionate Sociodemographic Effects of Suspended Breast Cancer Screening During the COVID-19 Pandemic. Can Assoc Radiol J 2023:8465371231217398. [PMID: 38063155 DOI: 10.1177/08465371231217398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Affiliation(s)
- Karl Narvacan
- Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael N Patlas
- Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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10
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Keim-Malpass J, Vavolizza RD, Cohn WF, Kennedy EM, Showalter SL. Cancer Screening and Treatment Delays During the COVID-19 Pandemic and the Role of Health Literacy in Care Re-engagement: Findings from an NCI-Designated Comprehensive Cancer Center sample. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1405-1412. [PMID: 37202597 PMCID: PMC10195653 DOI: 10.1007/s13187-023-02312-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
The COVID-19 pandemic has led to numerous delays in cancer-related care and cancer-specific screening, but the extent is not fully understood. For those that experience a delay or disruption in care, health related self-management is required to re-engage in care pathways and the role of health literacy in this pathway has not been explored. The purpose of this analysis is to (1) report the frequency of self-reported delays in cancer treatment and preventative screening services at an academic, NCI-designated center during the COVID-19 pandemic and (2) investigate cancer-related care and screening delays among those with adequate and limited health literacy. A cross-sectional survey was administered from an NCI-designated Cancer Center with a rural catchment area during November 2020 through March 2021. A total of 1,533 participants completed the survey, and nearly 19 percent of participants were categorized as having limited health literacy. Twenty percent of those with a cancer diagnosis reported a delay in cancer-related care; and 23-30% of the sample reported a delay in cancer screening. In general, the proportions of delays among those with adequate and limited health literacy were similar with the exception of colorectal cancer screening. There was also a notable difference in the ability to re-engage in cervical cancer screening among those with adequate and limited health literacy. Thus, there is a role for those engaged in cancer-related education and outreach to offer additional navigation resources for those at risk to cancer-related care and screening disruptions. Future study is warranted to investigate the role of health literacy on cancer care engagement.
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Affiliation(s)
- Jessica Keim-Malpass
- Department of Pediatrics, Division of Hematology-Oncology, School of Medicine, University of Virginia, Charlottesville, VA, USA.
| | - Rick D Vavolizza
- Department of Surgery, Division of Surgical Oncology, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Wendy F Cohn
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
- University of Virginia Comprehensive Cancer Center, Charlottesville, VA, USA
| | - Erin M Kennedy
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
- University of Virginia Comprehensive Cancer Center, Charlottesville, VA, USA
| | - Shayna L Showalter
- Department of Surgery, Division of Surgical Oncology, School of Medicine, University of Virginia, Charlottesville, VA, USA
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11
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Star J, Bandi P, Siegel RL, Han X, Minihan A, Smith RA, Jemal A. Cancer Screening in the United States During the Second Year of the COVID-19 Pandemic. J Clin Oncol 2023; 41:4352-4359. [PMID: 36821800 PMCID: PMC10911528 DOI: 10.1200/jco.22.02170] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/12/2022] [Accepted: 01/13/2023] [Indexed: 02/25/2023] Open
Abstract
PURPOSE To examine whether cancer screening prevalence in the United States during 2021 has returned to prepandemic levels using nationally representative data. METHODS Information on receipt of age-eligible screening for breast (women age 50-74 years), cervical (women without a hysterectomy age 21-65 years), prostate (men age 55-69 years), and colorectal cancer (men and women age 50-75 years) according to the US Preventive Services Task Force recommendations was obtained from the 2019 and 2021 National Health Interview Survey. Past-year screening prevalence in 2019 and 2021 and adjusted prevalence ratios (aPRs), 2021 versus 2019, with their 95% CIs were calculated using complex survey logistic regression models. RESULTS Between 2019 and 2021, past-year screening in the United States decreased from 59.9% to 57.1% (aPR, 0.94; 95% CI, 0.91 to 0.97) for breast cancer, from 45.3% to 39.0% (aPR, 0.85; 95% CI, 0.82 to 0.89) for cervical cancer, and from 39.5% to 36.3% (aPR, 0.9; 95% CI, 0.84 to 0.97) for prostate cancer. Declines were most notable for non-Hispanic Asian persons. Colorectal cancer screening prevalence remained unchanged because an increase in past-year stool testing (from 7.0% to 10.3%; aPR, 1.44; 95% CI, 1.31 to 1.58) offset a decline in colonoscopy (from 15.5% to 13.8%; aPR, 0.88; 95% CI, 0.83 to 0.95). The increase in stool testing was most pronounced in non-Hispanic Black and Hispanic populations and in persons with low socioeconomic status. CONCLUSION Past-year screening prevalence for breast, cervical, and prostate cancer among age-eligible adults in the United States continued to be lower than prepandemic levels in the second year of the COVID-19 pandemic, reinforcing the importance of return to screening health system outreach and media campaigns. The large increase in stool testing emphasizes the role of home-based screening during health care system disruptions. [Media: see text].
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Affiliation(s)
- Jessica Star
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Priti Bandi
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Rebecca L. Siegel
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Xuesong Han
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Adair Minihan
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
| | - Robert A. Smith
- Early Cancer Detection Science Research Program, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Surveillance & Health Equity Science Research Program, American Cancer Society, Atlanta, GA
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12
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Myers C, Waldron C, Bennett K, Cahir C. Impact of the COVID-19 pandemic on women living with and beyond breast cancer: a qualitative study of women's experiences and how they varied by social determinants of health. BMC Cancer 2023; 23:867. [PMID: 37715181 PMCID: PMC10503161 DOI: 10.1186/s12885-023-11351-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/30/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND The aim of this study is to explore the general impact of COVID-19 on the access and use of BC services and support and overall well-being in women living with a diagnosis of breast cancer (BC) and to investigate how these experiences varied by the social determinants of health (SDH). METHODS Semi-structured qualitative interviews were conducted with women selected through stratified purposive sampling to ensure data were available on information-rich cases. Interviews were conducted in early 2021 during government restrictions due to COVID-19. Thematic analysis was conducted to obtain overall experience and variation of experience based on SDH. RESULTS Thirty seven women participated in interviews. Three major themes, with additional subthemes, emerged from analysis: 1. breast cancer services (screening, active treatment, and routine care); 2. breast cancer support and communication (continuity of care, role of liaison, and support services); and 3. quality of life (QoL) and well-being (emotional well-being; social well-being; and functional well-being). Women's experiences within the themes varied by socio-economic status (SES) and region of residence (urban/rural) specifically for BC services and support. CONCLUSION The pandemic impacted women living with and beyond BC, but the impact has not been the same for all women. This study highlights areas for improvement in the context of BC care in Ireland and the findings will inform further policy and practice, including standardized BC services, improved communication, and enhancement of cancer support services.
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Affiliation(s)
- Charlotte Myers
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Catherine Waldron
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kathleen Bennett
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Caitriona Cahir
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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13
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Lee R, Xu W, Dozier M, McQuillan R, Theodoratou E, Figueroa J. A rapid review of COVID-19's global impact on breast cancer screening participation rates and volumes from January to December 2020. eLife 2023; 12:e85680. [PMID: 37698273 PMCID: PMC10569787 DOI: 10.7554/elife.85680] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 08/20/2023] [Indexed: 09/13/2023] Open
Abstract
COVID-19 has strained population breast mammography screening programs that aim to diagnose and treat breast cancers earlier. As the pandemic has affected countries differently, we aimed to quantify changes in breast screening volume and uptake during the first year of COVID-19 . We systematically searched Medline, the World Health Organization (WHO) COVID-19 database, and governmental databases. Studies covering January 2020 to March 2022 were included. We extracted and analyzed data regarding study methodology, screening volume, and uptake. To assess for risk of bias, we used the Joanna Briggs Institute (JBI) Critical Appraisal Tool. Twenty-six cross-sectional descriptive studies (focusing on 13 countries/nations) were included out of 935 independent records. Reductions in screening volume and uptake rates were observed among eight countries. Changes in screening participation volume in five nations with national population-based screening ranged from -13 to -31%. Among two countries with limited population-based programs, the decline ranged from -61 to -41%. Within the USA, population participation volumes varied ranging from +18 to -39%, with suggestion of differences by insurance status (HMO, Medicare, and low-income programs). Almost all studies had high risk of bias due to insufficient statistical analysis and confounding factors. The extent of COVID-19-induced reduction in breast screening participation volume differed by region and data suggested potential differences by healthcare setting (e.g., national health insurance vs. private healthcare). Recovery efforts should monitor access to screening and early diagnosis to determine whether prevention services need strengthening to increase the coverage of disadvantaged groups and reduce disparities.
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Affiliation(s)
- Reagan Lee
- Usher Institute, University of EdinburghEdinburghUnited Kingdom
| | - Wei Xu
- Usher Institute, University of EdinburghEdinburghUnited Kingdom
- Centre for Global Health, University of EdinburghEdinburghUnited Kingdom
| | - Marshall Dozier
- Information Services, University of EdinburghEdinburghUnited Kingdom
| | - Ruth McQuillan
- Usher Institute, University of EdinburghEdinburghUnited Kingdom
| | - Evropi Theodoratou
- Centre for Global Health, University of EdinburghEdinburghUnited Kingdom
| | - Jonine Figueroa
- Centre for Global Health, University of EdinburghEdinburghUnited Kingdom
- Division of Cancer Epidemiology and Genetics, National Cancer InstituteBethesdaUnited States
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14
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Richardson-Parry A, Silva M, Valderas JM, Donde S, Woodruff S, van Vugt J. Video Interventions for Reducing Health Inequity in Cancer Screening Programmes: a Systematic Review. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01749-5. [PMID: 37603223 DOI: 10.1007/s40615-023-01749-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Health equity can lead to disparities in cancer screening, treatment, and mortality. This systematic review aims to identify and describe interventions that used video or DVD formats to reduce health inequity in cancer screening and review the effectiveness of such interventions in increasing screening rates compared to usual care conditions. METHODS We searched PubMed, Web of Science, Embase, and Cochrane databases for randomized control trials (RCTs) published until 18/01/2023 that compared intervention versus usual care control groups, with the percentage of cancer screening uptake during follow-up as an outcome. The risk of Bias was assessed with the Cochrane Collaboration tool. RESULTS After screening 4201 abstracts, 192 full texts were assessed for eligibility and 18 were included that focused on colorectal (n = 9), cervical (n = 5), breast (n = 5), and prostate (n = 1) cancer screening. All were based in the USA except one and most focused on ethnicity/race, while some included low-income populations. Most of the video interventions used to increase cervical cancer screening reported positive results. Studies aimed at increasing mammography uptake were mostly effective only in specific groups of participants, such as low-income or less-educated African American women. Results for colorectal cancer screening were conflicting. Videos that were culturally tailored or used emotive format were generally more effective than information-only videos. CONCLUSIONS Video interventions to increase cancer screening among populations with low screening uptake show some positive effects, though results are mixed. Interventions that use individual and cultural tailoring of the educational material should be further developed and investigated outside of the USA.
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Affiliation(s)
| | - Mitchell Silva
- Esperity, Veldkapelgaarde 30b1.30.30, 1200, Brussels, Belgium
| | - Jose Maria Valderas
- Department of Family Medicine, National University Health System and Yong Loo Lin School of Medicine, 1E Kent Ridge Road, NUHS Tower Block, Singapore, 119228, Singapore
| | - Shaantanu Donde
- Viatris, Building 4, Trident Place, Mosquito Way, Hatfield, AL10 9UL, UK
| | | | - Joris van Vugt
- Viatris, Krijgsman 20, Amstelveen, 1186DM, The Netherlands
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15
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Olesen TB, Jensen H, Møller H, Jensen JW, Andersen B, Vejborg I, Njor SH. Nationwide mammography screening participation in Denmark during the COVID-19 pandemic: An observational study. eLife 2023; 12:e83541. [PMID: 37589381 PMCID: PMC10513477 DOI: 10.7554/elife.83541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 07/27/2023] [Indexed: 08/18/2023] Open
Abstract
Background In most of the world, the mammography screening programmes were paused at the start of the pandemic, whilst mammography screening continued in Denmark. We examined the mammography screening participation during the COVID-19 pandemic in Denmark. Methods The study population comprised all women aged 50-69 years old invited to participate in mammography screening from 2016 to 2021 in Denmark based on data from the Danish Quality Database for Mammography Screening in combination with population-based registries. Using a generalised linear model, we estimated prevalence ratios (PRs) and 95% confidence intervals (CIs) of mammography screening participation within 90, 180, and 365 d since invitation during the pandemic in comparison with the previous years adjusting for age, year and month of invitation. Results The study comprised 1,828,791 invitations among 847,766 women. Before the pandemic, 80.2% of invitations resulted in participation in mammography screening within 90 d, 82.7% within 180 d, and 83.1% within 365 d. At the start of the pandemic, the participation in screening within 90 d was reduced to 69.9% for those invited in pre-lockdown and to 76.5% for those invited in first lockdown. Extending the length of follow-up time to 365 d only a minor overall reduction was observed (PR = 0.94; 95% CI: 0.93-0.95 in pre-lockdown and PR = 0.97; 95% CI: 0.96-0.97 in first lockdown). A lower participation was, however, seen among immigrants and among women with a low income. Conclusions The short-term participation in mammography screening was reduced at the start of the pandemic, whilst only a minor reduction in the overall participation was observed with longer follow-up time, indicating that women postponed screening. Some groups of women, nonetheless, had a lower participation, indicating that the social inequity in screening participation was exacerbated during the pandemic. Funding The study was funded by the Danish Cancer Society Scientific Committee (grant number R321-A17417) and the Danish regions.
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Affiliation(s)
- Tina Bech Olesen
- The Danish Clinical Quality Program – National Clinical Registries (RKKP)Aarhus NDenmark
| | - Henry Jensen
- The Danish Clinical Quality Program – National Clinical Registries (RKKP)Aarhus NDenmark
| | - Henrik Møller
- The Danish Clinical Quality Program – National Clinical Registries (RKKP)Aarhus NDenmark
| | - Jens Winther Jensen
- The Danish Clinical Quality Program – National Clinical Registries (RKKP)Aarhus NDenmark
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional HospitalRandersDenmark
- Department of Clinical Medicine, Aarhus UniversityAarhusDenmark
| | - Ilse Vejborg
- Department of Breast Examinations, Copenhagen University HospitalCopenhagenDenmark
| | - Sisse H Njor
- The Danish Clinical Quality Program – National Clinical Registries (RKKP)Aarhus NDenmark
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional HospitalRandersDenmark
- Department of Clinical Medicine, Aarhus UniversityAarhusDenmark
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16
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Davis KL, Ackermann N, Klesges LM, Leahy N, Walsh-Bailey C, Humble S, Drake B, Sanders Thompson VL. Understanding disruptions in cancer care to reduce increased cancer burden. eLife 2023; 12:e85024. [PMID: 37643471 PMCID: PMC10449381 DOI: 10.7554/elife.85024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 08/08/2023] [Indexed: 08/31/2023] Open
Abstract
Background This study seeks to understand how and for whom COVID-19 disrupted cancer care to understand the potential for cancer health disparities across the cancer prevention and control continuum. Methods In this cross-sectional study, participants age 30+residing in an 82-county region in Missouri and Illinois completed an online survey from June-August 2020. Descriptive statistics were calculated for all variables separately and by care disruption status. Logistic regression modeling was conducted to determine the correlates of care disruption. Results Participants (N=680) reported 21% to 57% of cancer screening or treatment appointments were canceled/postponed from March 2020 through the end of 2020. Approximately 34% of residents stated they would need to know if their doctor's office is taking the appropriate COVID-related safety precautions to return to care. Higher education (OR = 1.26, 95% CI:1.11-1.43), identifying as female (OR = 1.60, 95% CI:1.12-2.30), experiencing more discrimination in healthcare settings (OR = 1.40, 95% CI:1.13-1.72), and having scheduled a telehealth appointment (OR = 1.51, 95% CI:1.07-2.15) were associated with higher odds of care disruption. Factors associated with care disruption were not consistent across races. Higher odds of care disruption for White residents were associated with higher education, female identity, older age, and having scheduled a telehealth appointment, while higher odds of care disruption for Black residents were associated only with higher education. Conclusions This study provides an understanding of the factors associated with cancer care disruption and what patients need to return to care. Results may inform outreach and engagement strategies to reduce delayed cancer screenings and encourage returning to cancer care. Funding This study was supported by the National Cancer Institute's Administrative Supplements for P30 Cancer Center Support Grants (P30CA091842-18S2 and P30CA091842-19S4). Kia L. Davis, Lisa Klesges, Sarah Humble, and Bettina Drake were supported by the National Cancer Institute's P50CA244431 and Kia L. Davis was also supported by the Breast Cancer Research Foundation. Callie Walsh-Bailey was supported by NIMHD T37 MD014218. The content does not necessarily represent the official view of these funding agencies and is solely the responsibility of the authors.
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Affiliation(s)
- Kia L Davis
- Department of Surgery, Public Health Sciences, School of Medicine, Washington University in St. LouisSt LouisUnited States
| | - Nicole Ackermann
- Department of Surgery, Public Health Sciences, School of Medicine, Washington University in St. LouisSt LouisUnited States
| | - Lisa M Klesges
- Department of Surgery, Public Health Sciences, School of Medicine, Washington University in St. LouisSt LouisUnited States
| | - Nora Leahy
- Department of Surgery, Public Health Sciences, School of Medicine, Washington University in St. LouisSt LouisUnited States
| | | | - Sarah Humble
- Department of Surgery, Public Health Sciences, School of Medicine, Washington University in St. LouisSt LouisUnited States
| | - Bettina Drake
- Department of Surgery, Public Health Sciences, School of Medicine, Washington University in St. LouisSt LouisUnited States
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Myers C, Bennett K, Cahir C. Breast cancer care amidst a pandemic: a scoping review to understand the impact of coronavirus disease 2019 on health services and health outcomes. Int J Qual Health Care 2023; 35:mzad048. [PMID: 37497806 PMCID: PMC10373113 DOI: 10.1093/intqhc/mzad048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/19/2023] [Accepted: 06/28/2023] [Indexed: 07/28/2023] Open
Abstract
Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, health services for breast cancer (BC) have been disrupted. Our scoping review examines the impact of the COVID-19 pandemic on BC services, health outcomes, and well-being for women. Additionally, this review identifies social inequalities specific to BC during the pandemic. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines, the literature search was conducted using scientific databases starting from March 2020 through November 2021. Studies were identified and selected by two researchers based on inclusion criteria, and the relevant data were extracted and charted to summarize the findings. Ninety-three articles were included in this review. Main themes included are as follows: (i) the impact of COVID-19 on BC services; (ii) the impact of COVID-19 on health outcomes and well-being in women with BC; and (iii) any variation in the impact of COVID-19 on BC by social determinants of health. There were apparent disruptions to BC services across the cancer continuum, especially screening services. Clinical repercussions were a result of such disruptions, and women with BC experienced worsened quality of life and psychosocial well-being. Finally, there were social inequalities dependent on social determinants of health such as age, race, insurance status, and region. Due to the disruption of BC services during the COVID-19 pandemic, women were impacted on their health and overall well-being. The variation in impact demonstrates how health inequities have been exacerbated during the pandemic. This comprehensive review will inform timely health-care changes to minimize long-term impacts of the pandemic and improve evidence-based multidisciplinary needs.
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Affiliation(s)
- Charlotte Myers
- School of Population Health, RCSI University of Medicine and Health Science, Dublin D02 DH60, Ireland
| | - Kathleen Bennett
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Science, Dublin D02 DH60, Ireland
| | - Caitriona Cahir
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Science, Dublin D02 DH60, Ireland
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18
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Yamaguchi S, Atarashi T, Okada A, Nasu S, Yamauchi T, Arase Y, Aizawa T, Nangaku M, Kadowaki T. Impact of the COVID-19 Pandemic on Health Check-ups: A Nationwide Questionnaire Survey in 639 Healthcare Facilities in Japan Society of Ningen Dock. JMA J 2023; 6:321-331. [PMID: 37560372 PMCID: PMC10407420 DOI: 10.31662/jmaj.2023-0040] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/08/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Health check-ups have been disrupted worldwide by the COVID-19 pandemic, especially at its beginning. In Japan, undergoing annual check-ups is mandatory for full-time employees of all ages, while those other than full-time employees are entitled to undergo nonmandatory cancer screenings and specific health check-ups. To evaluate the impact of the COVID-19 pandemic on health check-ups, we conducted a nationwide questionnaire survey targeting healthcare facilities. METHODS A questionnaire survey was conducted between December 10, 2021, and January 28, 2022. Healthcare facilities were eligible if they were members of Japan Society of Ningen Dock and could respond via email. The monthly and yearly numbers of examinees undergoing mandatory or nonmandatory check-ups in 2020 and 2021 were compared with those in 2019. The proportions of examinees requiring follow-up visits and adhering to follow-up visits were compared between 2020 and 2019. Precautions taken against COVID-19 were also investigated. RESULTS Of the 1,299 eligible facilities, 639 participated (response rate, 49.2%). Health check-up services were suspended in 484 (75.7%) facilities for a median duration of 5 (interquartile range [IQR]: 4-8) weeks. A total of 19,861,230 and 21,748,125 examinees underwent health check-ups in 591 facilities in 2020 and 2021, respectively, 10.0% and 1.4% less than the numbers in 2019. The number of examinees undergoing health check-ups decreased by a median of 8.3% (IQR: -14.6 to -3.1) in 2020 compared to that in 2019, with the largest decrease of 70.3% (IQR -87.9 to -48.5) in May. Although the number of examinees undergoing mandatory check-ups increased in 2021 compared with that in 2019, the number of those undergoing nonmandatory check-ups remained low. CONCLUSIONS While people eligible for mandatory check-ups were adherent to check-ups in 2021, those ineligible for mandatory check-ups seemed less adherent. Public health efforts to encourage these people to adhere to check-ups during the pandemic are required.
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Affiliation(s)
- Satoko Yamaguchi
- Department of Prevention of Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomofumi Atarashi
- Japan Society of Ningen Dock, Tokyo, Japan
- Medical Check-up Center, JA Hokkaido P.W.F.A.C. Obihiro-Kosei General Hospital, Hokkaido, Japan
| | - Akira Okada
- Department of Prevention of Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shigeru Nasu
- Japan Society of Ningen Dock, Tokyo, Japan
- Hakuaikai Hospital, Fukuoka, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuji Arase
- Japan Society of Ningen Dock, Tokyo, Japan
- Health Management Center, Toranomon Hospital, Tokyo, Japan
| | - Takao Aizawa
- Japan Society of Ningen Dock, Tokyo, Japan
- Aizawa Hospital, Nagano, Japan
| | - Masaomi Nangaku
- Division of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Prevention of Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Toranomon Hospital, Tokyo, Japan
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19
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Richardson-Parry A, Silva M, Valderas JM, Donde S, Woodruff S, van Vugt J. Interactive or tailored digital interventions to increase uptake in cervical, breast, and colorectal cancer screening to reduce health inequity: a systematic review. Eur J Cancer Prev 2023; 32:396-409. [PMID: 37144585 PMCID: PMC10249608 DOI: 10.1097/cej.0000000000000796] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Significant health inequities exist in screening uptake for certain types of cancer. The review question was to identify and describe interactive, tailored digital, computer, and web-based interventions to reduce health inequity in cancer screening and review the effectiveness of such interventions in increasing screening rates versus usual care. METHODS We searched four medical literature databases for randomized control trials (RCTs) published until 12 January 2023 that evaluated interventions aimed at increasing the percentage of breast, prostate, cervical, or colorectal cancer screening uptake. Meta-analysis was not conducted due to heterogeneity among studies. RESULTS After screening 4200 titles and abstracts, 17 studies were included. Studies focused on colorectal ( n = 10), breast ( n = 4), cervical ( n = 2), and prostate ( n = 1) cancer screening. All were based in the USA except two. Most studies focused on ethnicity/race, while some included low-income populations. Intervention types were heterogeneous and used computer programs, apps, or web-based methods to provide tailored or interactive information to participants about screening risks and options. Some studies found positive effects for increasing cancer screening uptake in the intervention groups compared to usual care, but results were heterogeneous. CONCLUSION Interventions that use individual and cultural tailoring of cancer screening educational material should be further developed and investigated outside of the USA. Designing effective digital intervention strategies, with components that can be adapted to remote delivery may be an important strategy for reducing health inequities in cancer screening during the coronavirus disease 2019 pandemic.
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Affiliation(s)
| | | | - Jose M. Valderas
- Department of Family Medicine, National University Health System and Yong Loo Lin School of Medicine, Centre for Research in Health Systems Performance, Singapore, Singapore
| | - Shaantanu Donde
- European Developed Markets Medical Affairs Viatris, Hatfield, UK
| | - Seth Woodruff
- North America Medical Affairs, Viatris, New York, USA
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20
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Chesebro AL, Amornsiripanitch N, Lan Z, Bay CP, Chikarmane SA. Experience of a single healthcare system with screening mammography before and after COVID-19 shutdown. Clin Imaging 2023; 101:97-104. [PMID: 37327551 PMCID: PMC10249341 DOI: 10.1016/j.clinimag.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 05/24/2023] [Accepted: 06/06/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE To evaluate COVID-19's longitudinal impact on screening mammography volume trends. METHODS HIPAA-compliant, IRB-approved, single institution, retrospective study of screening mammogram volumes before (10/21/2016-3/16/2020) and greater than two years after (6/17/2020-11/30/2022) a state-mandated COVID-19 shutdown (3/17/2020-6/16/2020) were reviewed. A segmented quasi-poisson linear regression model adjusting for seasonality and network and regional population growth compared volume trends before and after the shutdown of each variable: age, race, language, financial source, risk factor for severe COVID-19, and examination location. RESULTS Adjusted model demonstrated an overall increase of 65 screening mammograms per month before versus a persistent decrease of 5 mammograms per month for >2 years after the shutdown (p < 0.0001). In subgroup analysis, downward volume trends were noted in all age groups <70 years (age < 50: +9/month before vs. -7/month after shutdown; age 50-60: +17 vs. -7; and age 60-70: +21 vs. -2; all p < 0.001), those identifying as White (+55 vs. -8, p < 0.0001) and Black (+4 vs. +1, p = 0.009), all financial sources (Medicare: +22 vs. -3, p < 0.0001; Medicaid: +5 vs. +2, p = 0.006; private insurance/self-pay: +38 vs. -4, p < 0.0001), women with at least one risk factor for severe COVID-19 (+30 vs. -48, p < 0.0001), and screening mammograms performed at a hospital-based location (+48 vs. -14, p = 0.0001). CONCLUSION The screening mammogram volume trend more than two years after the COVID-19 shutdown has continued to decline for most patient populations. Findings highlight the need to identify additional areas for education and outreach.
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Affiliation(s)
- Allyson L Chesebro
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St., Boston, MA 02115, United States of America; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States of America.
| | - Nita Amornsiripanitch
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St., Boston, MA 02115, United States of America; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States of America.
| | - Zhou Lan
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St., Boston, MA 02115, United States of America; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States of America.
| | - Camden P Bay
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St., Boston, MA 02115, United States of America; Takeda Pharmaceuticals, USA, Inc., 650 Kendall St., Cambridge, MA 02142, United States of America
| | - Sona A Chikarmane
- Brigham and Women's Hospital, Department of Radiology, 75 Francis St., Boston, MA 02115, United States of America; Harvard Medical School, 25 Shattuck St., Boston, MA 02115, United States of America.
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21
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Sivanushanthan S, Wu T, Wahl A, Li T, Luta G, Song JH, O’Neill S, Conley CC. Patterns of Screening Mammography and Breast MRI During the COVID-19 Pandemic: A Retrospective, Chart-Review Study. JOURNAL OF BREAST IMAGING 2023; 5:277-286. [PMID: 37223455 PMCID: PMC10202024 DOI: 10.1093/jbi/wbad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Indexed: 02/25/2024]
Abstract
Objective This study examined patterns of breast cancer screening during the COVID-19 pandemic. Methods This retrospective study was approved by the Georgetown University IRB. Review of electronic medical records identified screening mammograms and breast MRIs between March 13, 2018 and December 31, 2020, for female patients aged 18 to 85 years. Descriptive statistics characterized patterns of breast cancer screening before and during the COVID-19 pandemic. Logistic regression analyses examined whether receipt of breast MRI differed over time and demographic and clinical factors associated with receipt of breast MRI in 2020. Results Data included 47 956 mammography visits in 32 778 patients and 407 screening breast MRI visits in 340 patients. After an initial decrease following the declaration of the COVID-19 pandemic, both screening mammograms and screening breast MRI demonstrated early recovery. Although the mammography receipt remained sustained, the receipt of screening breast MRI decreased in late 2020. Odds of having a breast MRI did not differ between 2018 and 2019 (OR = 1.07; 95% CI = 0.92%-1.25%; P = 0.384) but were significantly lower in 2020 versus 2019 (OR = 0.76; 95% CI = 0.61%-0.94%; P = 0.011). No demographic or clinical factors were associated with receipt of breast MRI during the COVID-19 pandemic (all P-values ≥0.225). Conclusion Breast cancer screening decreased following the declaration of the COVID-19 pandemic. Although both procedures demonstrated early recovery, the rebound in screening breast MRI was not sustained. Interventions promoting return to screening breast MRI may be needed for high-risk women.
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Affiliation(s)
| | - Tianmin Wu
- Georgetown University, Department of Biostatistics, Bioinformatics, and Biomathematics, Washington, DC, USA
| | - Anastacia Wahl
- Georgetown University, School of Medicine, Washington, DC, USA
| | - Tengfei Li
- Georgetown University, Department of Biostatistics, Bioinformatics, and Biomathematics, Washington, DC, USA
| | - George Luta
- Georgetown University, Department of Biostatistics, Bioinformatics, and Biomathematics, Washington, DC, USA
| | - Judy H Song
- Georgetown University, Department of Radiology, Washington, DC, USA
| | - Suzanne O’Neill
- Georgetown University, Department of Oncology, Washington, DC, USA
| | - Claire C Conley
- Georgetown University, Department of Oncology, Washington, DC, USA
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22
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Lomahan S, Rauscher GH, Murphy AM. The role of facility and patient mix factors on recovery of screening and diagnostic mammography volumes following the initial COVID-19 pandemic wave. Cancer Med 2023; 12:10877-10888. [PMID: 36924321 PMCID: PMC10225188 DOI: 10.1002/cam4.5793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION The goal of this study was to understand the extent to which mammography facilities were able to recover monthly screening and diagnostic mammography volumes to their prepandemic levels and to determine what facility and patient mix factors were associated with recovery. METHOD Facilities, located in and adjacent to Cook County, Illinois, were eligible. In all, 58 screening and 30 diagnostic mammogram facilities submitted mammogram volumes by month with a cross-listing of patient ZIP codes by screening volumes. Monthly screening and diagnostic volumes for the 6-month immediate postpandemic period (July-December 2020) and for the subsequent postpandemic period (January-June 2021) were compared with the same months in 2019. ZIP code distributions were used to define patient mix characteristics related to disadvantage. RESULTS Compared with the prepandemic period, Breast Imaging Centers of Excellence conducted roughly 50 fewer monthly screening mammograms (95% CI: -91, -9) but 50 more diagnostic mammograms (95% CI: 24, 82) on average in the immediate postpandemic period. Facilities serving a predominantly Black population conducted roughly 50 fewer monthly screens (95% CI: -93, -13) without any increase in monthly diagnostics. CONCLUSION Highly accredited (and typically higher volume) facilities appeared to actively triage diagnostics, whereas lower resource facilities appeared to struggle to recover to prepandemic volumes without triage to diagnostics. The pandemic disproportionally impacted minority populations already affected by differential access to and utilization of high-quality mammography. Potential explanations are discussed. Policies should be strengthened to facilitate triaging of services during times of stress to the healthcare system.
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Affiliation(s)
| | - Garth H. Rauscher
- Division of Epidemiology and BiostatisticsUniversity of Illinois at ChicagoChicagoIllinoisUSA
- University of Illinois Cancer CenterChicagoIllinoisUSA
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23
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Curtis HJ, MacKenna B, Wiedemann M, Fisher L, Croker R, Morton CE, Inglesby P, Walker AJ, Morley J, Mehrkar A, Bacon SC, Hickman G, Evans D, Ward T, Davy S, Hulme WJ, Macdonald O, Conibere R, Lewis T, Myers M, Wanninayake S, Collison K, Drury C, Samuel M, Sood H, Cipriani A, Fazel S, Sharma M, Baqir W, Bates C, Parry J, Goldacre B. OpenSAFELY NHS Service Restoration Observatory 2: changes in primary care clinical activity in England during the COVID-19 pandemic. Br J Gen Pract 2023; 73:e318-e331. [PMID: 37068964 PMCID: PMC10131234 DOI: 10.3399/bjgp.2022.0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/14/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has disrupted healthcare activity across a broad range of clinical services. The NHS stopped non-urgent work in March 2020, later recommending services be restored to near-normal levels before winter where possible. AIM To describe changes in the volume and variation of coded clinical activity in general practice across six clinical areas: cardiovascular disease, diabetes, mental health, female and reproductive health, screening and related procedures, and processes related to medication. DESIGN AND SETTING With the approval of NHS England, a cohort study was conducted of 23.8 million patient records in general practice, in situ using OpenSAFELY. METHOD Common primary care activities were analysed using Clinical Terms Version 3 codes and keyword searches from January 2019 to December 2020, presenting median and deciles of code usage across practices per month. RESULTS Substantial and widespread changes in clinical activity in primary care were identified since the onset of the COVID-19 pandemic, with generally good recovery by December 2020. A few exceptions showed poor recovery and warrant further investigation, such as mental health (for example, for 'Depression interim review' the median occurrences across practices in December 2020 was down by 41.6% compared with December 2019). CONCLUSION Granular NHS general practice data at population-scale can be used to monitor disruptions to healthcare services and guide the development of mitigation strategies. The authors are now developing real-time monitoring dashboards for the key measures identified in this study, as well as further studies using primary care data to monitor and mitigate the indirect health impacts of COVID-19 on the NHS.
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Affiliation(s)
- Helen J Curtis
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Brian MacKenna
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Milan Wiedemann
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Louis Fisher
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Richard Croker
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Caroline E Morton
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Peter Inglesby
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Alex J Walker
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Jessica Morley
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Amir Mehrkar
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Sebastian Cj Bacon
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - George Hickman
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - David Evans
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Tom Ward
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Simon Davy
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - William J Hulme
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | - Orla Macdonald
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
| | | | - Tom Lewis
- Royal Devon University Healthcare NHS Foundation Trust, Barnstaple
| | - Martin Myers
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston
| | | | | | - Charles Drury
- Herefordshire and Worcestershire Health and Care NHS Trust, Worcester
| | - Miriam Samuel
- Wolfson Institute of Population Health, Queen Mary University of London, London
| | - Harpreet Sood
- University College London Hospitals NHS Foundation Trust, London
| | | | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford
| | - Manuj Sharma
- Department of Primary Care and Population Health, University College London, London
| | | | | | | | - Ben Goldacre
- The Bennett Institute for Applied Data Science, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford
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24
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Li T, Nickel B, Ngo P, McFadden K, Brennan M, Marinovich ML, Houssami N. A systematic review of the impact of the COVID-19 pandemic on breast cancer screening and diagnosis. Breast 2023; 67:78-88. [PMID: 36646004 PMCID: PMC9813855 DOI: 10.1016/j.breast.2023.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/27/2022] [Accepted: 01/04/2023] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Breast cancer care has been affected by the COVID-19 pandemic. This systematic review aims to describe the observed pandemic-related changes in clinical and health services outcomes for breast screening and diagnosis. METHODS Seven databases (January 2020-March 2021) were searched to identify studies of breast cancer screening or diagnosis that reported observed outcomes before and related to the pandemic. Findings were presented using a descriptive and narrative approach. RESULTS Seventy-four studies were included in this systematic review; all compared periods before and after (or fluctuations during) the pandemic. None were assessed as being at low risk of bias. A reduction in screening volumes during the pandemic was found with over half of studies reporting reductions of ≥49%. A majority (66%) of studies reported reductions of ≥25% in the number of breast cancer diagnoses, and there was a higher proportion of symptomatic than screen-detected cancers. The distribution of cancer stage at diagnosis during the pandemic showed lower proportions of early-stage (stage 0-1/I-II, or Tis and T1) and higher proportions of relatively more advanced cases than that in the pre-pandemic period, however population rates were generally not reported. CONCLUSIONS Evidence of substantial reductions in screening volume and number of diagnosed breast cancers, and higher proportions of advanced stage cancer at diagnosis were found during the pandemic. However, these findings reflect short term outcomes, and higher-quality research examining the long-term impact of the pandemic is needed.
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Affiliation(s)
- Tong Li
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia; School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Brooke Nickel
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Preston Ngo
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Kathleen McFadden
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Meagan Brennan
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia
| | - M Luke Marinovich
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Nehmat Houssami
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, Australia,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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25
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Rocha AFBM, Freitas-Junior R, Ferreira GLR, Rodrigues DCN, Rahal RMS. COVID-19 and Breast Cancer in Brazil. Int J Public Health 2023; 68:1605485. [PMID: 36938303 PMCID: PMC10020228 DOI: 10.3389/ijph.2023.1605485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
Objectives: This study aimed to evaluate COVID-19 effects on breast cancer screening and clinical stage at diagnosis in patients of 50-69 years of age receiving care within the public healthcare network (SUS) in 2013-2021 in Brazil and its macro-regions. Methods: This ecological study used Poisson regression to analyze trends in screening and staging. A secondary database was formed using SUS sources: outpatient data system of the SUS network and Oncology-Brazil Panel. Results: There was a reduction in screening, with an annual percent change of -5.9 (p < 0.022). The number of notified cases fell by 31.5% in 2020-2021 compared to 2018-2019. There was a 10.7% increase in the proportion of stage III/IV cases (p < 0.001) in 2020-2021 compared to 2013-2019, now surpassing the number of cases of early stage breast cancer. Conclusion: COVID-19 led to a reduction in breast cancer screening and an expressive increase in advanced tumors in users of the public healthcare network. Urgent interventions in public policies are required as the negative effects of the pandemic on the diagnosis/treatment of breast cancer are becoming apparent even earlier than expected.
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Affiliation(s)
- Aline Ferreira Bandeira Melo Rocha
- Postgraduate Program in Health Sciences, Federal University of Goiás, Goiânia, Brazil
- *Correspondence: Aline Ferreira Bandeira Melo Rocha,
| | - Ruffo Freitas-Junior
- Advanced Center for Breast Diagnosis (CORA), Federal University of Goiás, Goiânia, Brazil
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26
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Nguyen DL, Ambinder EB, Myers KS, Oluyemi E. Addressing Disparities Related to Access of Multimodality Breast Imaging Services Before and During the COVID-19 Pandemic. Acad Radiol 2022; 29:1852-1860. [PMID: 35562265 PMCID: PMC8947962 DOI: 10.1016/j.acra.2022.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 01/26/2023]
Abstract
Despite technological advancements focused on reducing breast cancer mortality through early detection, there have been reported disparities in the access to these imaging services with underserved patient populations (including racial minority groups and patients of low socioeconomic status) showing underutilization compared to other patient groups. These underserved populations tend to have more advanced breast cancer presentations, in part due to delays in diagnosis resulting in later stage of disease presentation. To make matters worse, the COVID-19 pandemic declared in March 2020 has resulted in significant healthcare disruptions leading to extensive delays in breast imaging services which are expected to negatively impact breast cancer mortality long-term. Given the worsening disparity in breast cancer mortality among racial/ethnic minorities and financially disadvantaged groups, it is vital to address these disparity gaps with the goal of reducing the barriers to timely breast cancer diagnosis and addressing breast cancer mortality differences among breast cancer patients. Therefore, this review aims to provide a discussion highlighting the disparities related to breast imaging access, the effects of the COVID-19 pandemic on these disparities, current targeted interventions implemented in breast imaging practices to reduce these disparities, and future directions on the journey to reducing disparity gaps for breast imaging patients. Tackling the root cause factors of the persistent breast cancer-related disparities is critical to meeting the needs of patients who are disadvantaged and can lead to continued improvement in the quality of individualized care for patients who have higher breast cancer morbidity and mortality risks.
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27
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Makurumidze G, Lu C, Babagbemi K. Addressing Disparities in Breast Cancer Screening: A Review. APPLIED RADIOLOGY 2022. [DOI: 10.37549/ar2849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
| | - Connie Lu
- Weill Cornell Medicine New York Presbyterian
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28
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Teng H, Dang W, Curpen B. Impact of COVID-19 and Socioeconomic Factors on Delays in High-Risk MRI Breast Cancer Screening. Tomography 2022; 8:2171-2181. [PMID: 36136878 PMCID: PMC9498669 DOI: 10.3390/tomography8050182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study is to investigate if there was a delay in high-risk MRI breast cancer screening in our local region, if this delay is ongoing despite COVID-19 vaccinations, and if demographic and socioeconomic factors are associated with these delays. Six-hundred and sixty-five high-risk breast patients from 23 January 2018–30 September 2021 were included. Delays were determined by comparing the time in between each patients’ MRI screening exams prior to the COVID-19 pandemic to the time in between MRI screening exams during the height of the COVID-19 pandemic as well as the time in between exams when our patients started receiving vaccinations. Delays were analyzed via logistical regression with demographic and socioeconomic factors to determine if there was an association between these factors and delays. Significant time delays in between MRI screening exams were found between the pre-COVID timeframe compared to during the height of COVID. Significant time delays also persisted during the timeframe after patients started getting vaccinations. There were no associations with delays and socioeconomic or demographic factors. Significant time delays were found in between MRI high-risk breast cancer screening examinations due to the COVID-19 pandemic. These delays were not exacerbated by demographic or socioeconomic factors.
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Affiliation(s)
- Helena Teng
- Faculty of Health Sciences, McMaster University, 1200 Main Street West, Hamilton, ON L8N 3Z5, Canada
- Correspondence:
| | - Wilfred Dang
- Department of Medical Imaging, Sunnybrook Health Sciences, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
| | - Belinda Curpen
- Department of Medical Imaging, Sunnybrook Health Sciences, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada
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Epstein MM, Sundaresan D, Fair M, Fouayzi H, Warner ET, Garber LD, Gurwitz JH, Field TS. Trends in breast and prostate cancer screening and diagnostic procedures during the COVID-19 pandemic in central Massachusetts. Cancer Causes Control 2022; 33:1313-1323. [PMID: 35933572 PMCID: PMC9361987 DOI: 10.1007/s10552-022-01616-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 07/18/2022] [Indexed: 10/24/2022]
Abstract
PURPOSE We calculated rates of breast and prostate cancer screening and diagnostic procedures performed during the COVID-19 pandemic through December 2021 compared to the same months in 2019 in a large healthcare provider group in central Massachusetts. METHODS We included active patients of the provider group between January 2019 and December 2021 aged 30-85 years. Monthly rates of screening mammography and digital breast tomosynthesis, breast MRI, total prostate specific antigen (PSA), and breast or prostate biopsy per 1,000 people were compared by year overall, by age, and race/ethnicity. Completed procedures were identified by relevant codes in electronic health record data. RESULTS Rates of screening mammography, tomosynthesis, and PSA testing reached the lowest levels in April-May 2020. Breast cancer screening rates decreased 43% in March and 99% in April and May 2020, compared to 2019. Breast cancer screening rates increased gradually beginning in June 2020 through 2021, although more slowly in Black and Hispanic women and in women aged 75-85. PSA testing rates decreased 34% in March, 78% in April, and 53% in May 2020, but rebounded to pre-pandemic levels by June 2020; trends were similar across groups defined by age and race/ethnicity. CONCLUSION The observed decline in two common screening procedures during the COVID-19 pandemic reflects the impact of the pandemic on cancer early detection and signals potential downstream effects on the prognosis of delayed cancer diagnoses. The slower rate of return for breast cancer screening procedures in certain subgroups should be investigated to ensure all women return for routine screenings.
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Affiliation(s)
- Mara M Epstein
- The Meyers Health Care Institute, A Joint Endeavor of the University of Massachusetts Chan Medical School, Fallon Health, and Reliant Medical Group, 365 Plantation Street Biotech 1, Suite 100, Worcester, MA, 01605, USA. .,Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | | | | | - Hassan Fouayzi
- The Meyers Health Care Institute, A Joint Endeavor of the University of Massachusetts Chan Medical School, Fallon Health, and Reliant Medical Group, 365 Plantation Street Biotech 1, Suite 100, Worcester, MA, 01605, USA.,Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, USA
| | - Erica T Warner
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital, Mongan Institute, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | | | - Jerry H Gurwitz
- The Meyers Health Care Institute, A Joint Endeavor of the University of Massachusetts Chan Medical School, Fallon Health, and Reliant Medical Group, 365 Plantation Street Biotech 1, Suite 100, Worcester, MA, 01605, USA.,Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Terry S Field
- The Meyers Health Care Institute, A Joint Endeavor of the University of Massachusetts Chan Medical School, Fallon Health, and Reliant Medical Group, 365 Plantation Street Biotech 1, Suite 100, Worcester, MA, 01605, USA.,Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Bosch G, Posso M, Louro J, Roman M, Porta M, Castells X, Macià F. Impact of the COVID-19 pandemic on breast cancer screening indicators in a Spanish population-based program: a cohort study. eLife 2022; 11:77434. [PMID: 35686727 PMCID: PMC9212994 DOI: 10.7554/elife.77434] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/09/2022] [Indexed: 12/23/2022] Open
Abstract
Background: To assess the effect of the COVID-19 pandemic on performance indicators in the population-based breast cancer screening program of Parc de Salut Mar (PSMAR), Barcelona, Spain. Methods: We conducted a before-and-after, study to evaluate participation, recall, false positives, the cancer detection rate, and cancer characteristics in our screening population from March 2020 to March 2021 compared with the four previous rounds (2012–2019). Using multilevel logistic regression models, we estimated the adjusted odds ratios (aORs) of each of the performance indicators for the COVID-19 period, controlling by type of screening (prevalent or incident), socioeconomic index, family history of breast cancer, and menopausal status. We analyzed 144,779 invitations from 47,571women. Results: During the COVID-19 period, the odds of participation were lower in first-time invitees (aOR = 0.90 [95% CI = 0.84–0.96]) and in those who had previously participated regularly and irregularly (aOR = 0.63 [95% CI = 0.59–0.67] and aOR = 0.95 [95% CI = 0.86–1.05], respectively). Participation showed a modest increase in women not attending any of the previous rounds (aOR = 1.10 [95% CI = 1.01–1.20]). The recall rate decreased in both prevalent and incident screening (aOR = 0.74 [95% CI = 0.56–0.99] and aOR = 0.80 [95% CI = 0.68–0.95], respectively). False positives also decreased in both groups (prevalent aOR = 0.92 [95% CI = 0.66–1.28] and incident aOR = 0.72 [95% CI = 0.59–0.88]). No significant differences were observed in compliance with recall (OR = 1.26, 95% CI = 0.76–2.23), cancer detection rate (aOR = 0.91 [95% CI = 0.69–1.18]), or cancer stages. Conclusions: The COVID-19 pandemic negatively affected screening attendance, especially in previous participants and newcomers. We found a reduction in recall and false positives and no marked differences in cancer detection, indicating the robustness of the program. There is a need for further evaluations of interval cancers and potential diagnostic delays. Funding: This study has received funding by grants PI19/00007 and PI21/00058, funded by Instituto de Salud Carlos III (ISCIII) and cofunded by the European Union and Grant RD21/0016/0020 funded by Instituto de Salud Carlos III and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia (MRR).
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Affiliation(s)
- Guillermo Bosch
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Preventive Medicine and Public Health Training Unit PSMar-ASPB-UPF, Barcelona, Spain
| | - Margarita Posso
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Javier Louro
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Marta Roman
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Miquel Porta
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Hospital del Mar Institute of Medical Research (IMIM PSMar), Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Macià
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
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Joung RHS, Nelson H, Mullett TW, Kurtzman SH, Shafir S, Harris JB, Yao KA, Brajcich BC, Bilimoria KY, Cance WG. A national quality improvement study identifying and addressing cancer screening deficits due to the COVID-19 pandemic. Cancer 2022; 128:2119-2125. [PMID: 35307815 PMCID: PMC9086125 DOI: 10.1002/cncr.34157] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/21/2021] [Accepted: 01/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cancer-related deaths over the next decade are expected to increase due to cancer screening deficits associated with the coronavirus disease 2019 (COVID-19) pandemic. Although national deficits have been quantified, a structured response to identifying and addressing local deficits has not been widely available. The objectives of this report are to share preliminary data on monthly screening deficits in breast, colorectal, lung, and cervical cancers across diverse settings and to provide online materials from a national quality improvement (QI) study to help other institutions to address local screening deficits. METHODS This prospective, national QI study on Return-to-Screening enrolled 748 accredited cancer programs in the United States from April through June 2021. Local prepandemic and pandemic monthly screening test volumes (MTVs) were used to calculate the relative percent change in MTV to describe the monthly screening gap. RESULTS The majority of facilities reported monthly screening deficits (colorectal cancer, 80.6% [n = 104/129]; cervical cancer, 69.0% [n = 20/29]; breast cancer, 55.3% [n = 241/436]; lung cancer, 44.6% [n = 98/220]). Overall, the median relative percent change in MTV ranged from -17.7% for colorectal cancer (interquartile range [IQR], -33.6% to -2.8%), -6.8% for cervical cancer (IQR, -29.4% to 1.7%), -1.6% for breast cancer (IQR, -9.6% to 7.0%), and 1.2% for lung cancer (IQR, -16.9% to 19.0%). Geographic differences were not observed. There were statistically significant differences in the percent change in MTV between institution types for colorectal cancer screening (P = .02). CONCLUSION Cancer screening is still in need of urgent attention, and the screening resources made available online may help facilities to close critical gaps and address screenings missed in 2020. LAY SUMMARY Question: How can the effects of the coronavirus disease 2019 pandemic on cancer screening be mitigated? FINDINGS When national resources were provided, including methods to calculate local screening deficits, 748 cancer programs promptly enrolled in a national Return-to-Screening study, and the majority identified local screening deficits, most notably in colorectal cancer. Using these results, 814 quality improvement projects were initiated with the potential to add 70,000 screening tests in 2021. Meaning: Cancer screening is still in need of urgent attention, and the online resources that we provide may help to close critical screening deficits.
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Affiliation(s)
- Rachel Hae-Soo Joung
- Northwestern University Feinberg School of Medicine, Department of Surgery, Chicago, IL, USA
| | - Heidi Nelson
- American College of Surgeons Cancer Programs, Chicago, IL, USA
| | - Timothy W. Mullett
- American College of Surgeons Cancer Programs, Chicago, IL, USA
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Scott H. Kurtzman
- National Accreditation Program for Breast Centers, Chicago, IL, USA
- Waterbury Hospital, Waterbury, CT, USA
| | | | - James B. Harris
- American College of Surgeons Cancer Programs, Chicago, IL, USA
- University of Nevada Reno School of Medicine, Reno, Nevada
| | - Katharine A. Yao
- National Accreditation Program for Breast Centers, Chicago, IL, USA
- NorthShore University Health System, Evanston, IL, USA
| | - Brian C. Brajcich
- Northwestern University Feinberg School of Medicine, Department of Surgery, Chicago, IL, USA
| | - Karl Y. Bilimoria
- Northwestern University Feinberg School of Medicine, Department of Surgery, Chicago, IL, USA
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Duarte MB, Argenton JL, Carvalheira JB. Impact of COVID-19 in Cervical and Breast Cancer Screening and Systemic Treatment in São Paulo, Brazil: An Interrupted Time Series Analysis. JCO Glob Oncol 2022; 8:e2100371. [PMID: 35696624 PMCID: PMC9225667 DOI: 10.1200/go.21.00371] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE COVID-19 caused a disruption in cancer management around the world, resulting in an estimated excess burden secondary to screening disruption and excess lag time for treatment initiation. METHODS We gathered information from primary reimbursement data sets of the public health system of São Paulo, Brazil, from April 2020 to November 2021, and compared these data with those of the pre–COVID-19 period. We used an interrupted time series model to estimate the effect of the COVID-19 pandemic on the rate of key procedures of breast and cervical cancer health care chain. RESULTS We estimated that 1,149,727, 2,693, and 713,616 pap smears, conizations, and mammograms, respectively, were missed or delayed during the COVID-19 pandemic, compared with those in the years immediately before the COVID-19 stay-at-home restrictions. Specifically, we observed an acute decrease of procedures after the COVID-19 stay-at-home restrictions, with a trend to recovery in the long term. Regarding the systemic treatment analysis, we observed a 25% reduction in the rate of initiation of adjuvant systemic treatment for early breast cancer (stage I/II). However, we did not find a clear effect on the other settings of systemic treatment for breast cancer. We estimated an excess of 156 patients starting palliative care for cervical cancer after the COVID-19 stay-at-home restrictions. CONCLUSION The COVID-19 pandemic significantly reduced the performance rate of pap smears, conizations, and mammograms. The initiation of adjuvant treatment for early-stage breast cancer was most susceptible to COVID-19's health system disruption. Furthermore, the downward trend of treatment of advanced cervical cancer was interrupted. Therefore, public health policies are urgently needed to decrease the incidence of advanced cervical and breast cancers caused by delayed diagnosis and treatment initiation. The COVID-19 control policies resulted in reduction of cancer patients' delivery of care. This study evaluated the pandemic's influence in key procedures of breast and cervical cancer chain of care in São Paulo, Brazil. We observed a substantial reduction in the number of mammograms, pap smears, and conizations performed since the onset of the COVID-19 pandemic. In addition, stage I and II breast cancer adjuvant treatment presented a reduced realization rate, whereas palliative treatment delivered for advanced cervical cancer increased. Our results support the need for public health policies focused on mitigating the long-term effects of COVID-19 in cancer-related mortality.
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Affiliation(s)
- Mateus B.O. Duarte
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Uberlândia Cancer Hospital, Federal University of Uberlândia, UFU, Uberlândia, Minas Gerais, Brazil
| | - Juliana L.P. Argenton
- Fundação de Desenvolvimento da Universidade Estadual de Campinas (FUNCAMP), Campinas, São Paulo, Brazil
| | - José B.C. Carvalheira
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
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33
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Ng JS, Hamilton DG. Assessing the impact of the COVID-19 pandemic on breast cancer screening and diagnosis rates: A rapid review and meta-analysis. J Med Screen 2022; 29:209-218. [PMID: 35593115 DOI: 10.1177/09691413221101807] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The ongoing COVID-19 pandemic has caused an indefinite delay to cancer screening programs worldwide. This study aims to explore the impact on breast cancer screening outcomes such as mammography and diagnosis rates. METHODS We searched Ovid MEDLINE, Ovid Embase, medRxiv and bioRxiv between January 2020 to October 2021 to identify studies that reported on the rates of screening mammography and breast cancer diagnosis before and during the pandemic. The effects of 'lockdown' measures, age and ethnicity on outcomes were also examined. All studies were assessed for risk of bias using the Newcastle-Ottawa Scale (NOS). Rate ratios were calculated for all outcomes and pooled using standard inverse-variance random effects meta-analysis. RESULTS We identified 994 articles, of which 7 registry-based and 24 non-registry-based retrospective cohort studies, including data on 4,860,786 and 629,823 patients respectively across 18 different countries, were identified. Overall, breast cancer screening and diagnosis rates dropped by an estimated 41-53% and 18-29% respectively between 2019 and 2020. No differences in mammogram screening rates depending on patient age or ethnicity were observed. However, countries that implemented lockdown measures were associated with a significantly greater reduction in mammogram and diagnosis rates between 2019 and 2020 in comparison to those that did not. CONCLUSION The pandemic has caused a substantial reduction in the screening and diagnosis of breast cancer, with reductions more pronounced in countries under lockdown restrictions. It is early yet to know if delayed screening during the pandemic translates into higher breast cancer mortality.
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Affiliation(s)
- Jay Shen Ng
- Melbourne Medical School, Faculty of Medicine, Dentistry & Health Sciences, 569586The University of Melbourne, Melbourne, Australia.,Department of Medicine, Malacca General Hospital, Ministry of Health, Malaysia
| | - Daniel G Hamilton
- Melbourne Medical School, Faculty of Medicine, Dentistry & Health Sciences, 569586The University of Melbourne, Melbourne, Australia.,MetaMelb Research Group, School of BioSciences, 2281The University of Melbourne, Melbourne, Australia
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34
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Factors Associated with Screening Mammogram Uptake among Women Attending an Urban University Primary Care Clinic in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106103. [PMID: 35627637 PMCID: PMC9141597 DOI: 10.3390/ijerph19106103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/13/2022] [Accepted: 05/15/2022] [Indexed: 12/04/2022]
Abstract
Screening mammograms have resulted in a reduction in breast cancer mortality, yet the uptake in Malaysia was low. This study aimed to determine the prevalence and factors associated with screening mammogram uptake among women attending a Malaysian primary care clinic. A cross-sectional study was conducted among 200 women aged 40 to 74 attending the clinic. The data was collected using questionnaires assessing sociodemographic, clinical characteristics, knowledge and health beliefs. Multiple logistic regression was used to identify factors associated with mammogram uptake. The prevalence of screening mammograms was 46.0%. About 45.5% of women with high breast cancer risk had never undergone a mammogram. Older participants, aged 50 to 74 (OR = 2.57, 95% CI: 1.05, 6.29, p-value = 0.039) and those who received a physician’s recommendation (OR = 7.61, 95% CI: 3.81, 15.20, p-value < 0.001) were more likely to undergo screening mammography. Significant health beliefs associated with mammogram uptake were perceived barriers (OR = 0.81, 95% CI: 0.67, 0.97, p-value = 0.019) and cues to action (OR = 1.30, 95% CI: 1.06, 1.59, p-value = 0.012). Approximately half of the participants and those in the high-risk group had never undergone a mammogram. Older age, physician recommendation, perceived barriers and cues to action were significantly associated with mammogram uptake. Physicians need to play an active role in promoting breast cancer screening and addressing the barriers.
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35
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Lowry KP, Bissell MCS, Miglioretti DL, Kerlikowske K, Alsheik N, Macarol T, Bowles EJA, Buist DSM, Tosteson ANA, Henderson L, Herschorn SD, Wernli KJ, Weaver DL, Stout NK, Sprague BL. Breast Biopsy Recommendations and Breast Cancers Diagnosed during the COVID-19 Pandemic. Radiology 2022; 303:287-294. [PMID: 34665032 PMCID: PMC8544262 DOI: 10.1148/radiol.2021211808] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/19/2021] [Accepted: 09/30/2021] [Indexed: 12/23/2022]
Abstract
Background The COVID-19 pandemic reduced mammography use, potentially delaying breast cancer diagnoses. Purpose To examine breast biopsy recommendations and breast cancers diagnosed before and during the COVID-19 pandemic by mode of detection (screen detected vs symptomatic) and women's characteristics. Materials and Methods In this secondary analysis of prospectively collected data, monthly breast biopsy recommendations after mammography, US, or both with subsequent biopsy performed were examined from 66 facilities of the Breast Cancer Surveillance Consortium between January 2019 and September 2020. The number of monthly and cumulative biopsies recommended and performed and the number of subsequent cancers diagnosed during the pandemic period (March 2020 to September 2020) were compared with data from the prepandemic period using Wald χ2 tests. Analyses were stratified by mode of detection and race or ethnicity. Results From January 2019 to September 2020, 17 728 biopsies were recommended and performed, with 6009 cancers diagnosed. From March to September 2020, there were substantially fewer breast biopsy recommendations with cancer diagnoses when compared with the same period in 2019 (1650 recommendations in 2020 vs 2171 recommendations in 2019 [24% fewer], P < .001), predominantly due to fewer screen-detected cancers (722 cancers in 2020 vs 1169 cancers in 2019 [38% fewer], P < .001) versus symptomatic cancers (895 cancers in 2020 vs 965 cancers in 2019 [7% fewer], P = .27). The decrease in cancer diagnoses was largest in Asian (67 diagnoses in 2020 vs 142 diagnoses in 2019 [53% fewer], P = .06) and Hispanic (82 diagnoses in 2020 vs 145 diagnoses in 2019 [43% fewer], P = .13) women, followed by Black women (210 diagnoses in 2020 vs 287 diagnoses in 2019 [27% fewer], P = .21). The decrease was smallest in non-Hispanic White women (1128 diagnoses in 2020 vs 1357 diagnoses in 2019 [17% fewer], P = .09). Conclusion There were substantially fewer breast biopsies with cancer diagnoses during the COVID-19 pandemic from March to September 2020 compared with the same period in 2019, with Asian and Hispanic women experiencing the largest declines, followed by Black women. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Heller in this issue.
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Affiliation(s)
- Kathryn P. Lowry
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Michael C. S. Bissell
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Diana L. Miglioretti
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Karla Kerlikowske
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Nila Alsheik
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Tere Macarol
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Erin J. A. Bowles
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Diana S. M. Buist
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Anna N. A. Tosteson
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Louise Henderson
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Sally D. Herschorn
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Karen J. Wernli
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Donald L. Weaver
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Natasha K. Stout
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
| | - Brian L. Sprague
- From the Department of Radiology, University of Washington, Seattle
Cancer Care Alliance, 1144 Eastlake Ave E, LG-215, Seattle, WA 98109 (K.P.L.);
Division of Biostatistics, Department of Public Health Sciences, University of
California Davis, Davis, Calif (M.C.S.B., D.L.M.); Kaiser Permanente Washington
Health Research Institute, Kaiser Permanente Washington, Seattle, Wash (D.L.M.,
E.J.A.B., D.S.M.B., K.J.W.); Departments of Medicine and Epidemiology and
Biostatistics, University of California, San Francisco, Calif (K.K.); Advocate
Aurora Health, Downers Grove, Ill (N.A., T.M.); The Dartmouth Institute for
Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth, Lebanon, NH (A.N.A.T.); Department of
Radiology, University of North Carolina at Chapel Hill School of Medicine,
Chapel Hill, NC (L.H.); Department of Radiology (S.D.H., B.L.S.), University of
Vermont Cancer Center (S.D.H., D.L.W., B.L.S.), Department of Pathology and
Laboratory Medicine (D.L.W.), and Office of Health Promotion Research,
Department of Surgery (B.L.S.), University of Vermont Larner College of
Medicine, Burlington, Vt; and Department of Population Medicine, Harvard Medical
School and Harvard Pilgrim Health Care Institute, Boston, Mass (N.K.S.)
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36
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Trivedi U, Omofoye TS, Marquez C, Sullivan CR, Benson DM, Whitman GJ. Mobile Mammography Services and Underserved Women. Diagnostics (Basel) 2022; 12:902. [PMID: 35453950 PMCID: PMC9032638 DOI: 10.3390/diagnostics12040902] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 02/05/2023] Open
Abstract
Breast cancer, the second most common cause of cancer in women, affects people across different ages, ethnicities, and incomes. However, while all women have some risk of breast cancer, studies have found that some populations are more vulnerable to poor breast cancer outcomes. Specifically, women with lower socioeconomic status and of Black and Hispanic ethnicity have been found to have more advanced stages of cancer upon diagnosis. These findings correlate with studies that have found decreased use of screening mammography services in these underserved populations. To alleviate these healthcare disparities, mobile mammography units are well positioned to provide convenient screening services to enable earlier detection of breast cancer. Mobile mammography services have been operating since the 1970s, and, in the current pandemic, they may be extremely helpful. The COVID-19 pandemic has significantly disrupted necessary screening services, and reinstatement and implementation of accessible mobile screenings may help to alleviate the impact of missed screenings. This review discusses the history and benefits of mobile mammography, especially for underserved women.
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Affiliation(s)
- Usha Trivedi
- Rutgers New Jersey Medical School, 187 S W Orange, Newark, NJ 07103, USA;
| | - Toma S. Omofoye
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030, USA; (T.S.O.); (C.M.); (C.R.S.)
| | - Cindy Marquez
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030, USA; (T.S.O.); (C.M.); (C.R.S.)
| | - Callie R. Sullivan
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030, USA; (T.S.O.); (C.M.); (C.R.S.)
| | - Diane M. Benson
- Office of Health Policy, The University of Texas MD Anderson Cancer Center, 7007 Bertner Avenue, Unit 1677, Houston, TX 77030, USA;
| | - Gary J. Whitman
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030, USA; (T.S.O.); (C.M.); (C.R.S.)
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37
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Fasano GA, Bayard S, Bea VJ. Breast Cancer Disparities and the COVID-19 Pandemic. CURRENT BREAST CANCER REPORTS 2022; 14:192-198. [PMID: 36059579 PMCID: PMC9425818 DOI: 10.1007/s12609-022-00458-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 01/07/2023]
Abstract
Purpose of Review The COVID-19 pandemic has placed unprecedented challenges on breast cancer patients and health care providers. The impact of the pandemic on preexisting breast cancer disparities remains unknown but is projected to have adverse outcomes. Recent Findings Early work has demonstrated that pandemic-related temporary suspensions in breast cancer screening, interruption of clinical trials, and treatment delays have an adverse impact on breast cancer patient outcomes and may worsen disparities. Summary In this review, we highlight existing knowledge regarding breast cancer disparities and the impact of the COVID-19 pandemic. Strategies for mitigating disparities moving forward include targeted research evaluating race-specific outcomes, targeted education for providers regarding breast health disparities, improved access to telehealth, maintenance of patient navigation programs, and patient education regarding the safety and necessity of enrollment in clinical trials.
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Affiliation(s)
- Genevieve A. Fasano
- Department of Surgery, New York Presbyterian – Weill Cornell Medicine, New York, NY USA
| | - Solange Bayard
- Department of Surgery, New York Presbyterian – Weill Cornell Medicine, New York, NY USA
| | - Vivian J. Bea
- Department of Surgery, New York Presbyterian – Weill Cornell Medicine, New York, NY USA ,Department of Surgery, New York Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, New York, NY 11215 USA
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38
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Acceptance of Psycho-Oncological Counseling Formats in a Cancer Counseling Center during the COVID-19 Pandemic: An Exploratory Care Study. ACTA ACUST UNITED AC 2021; 28:3795-3803. [PMID: 34677241 PMCID: PMC8535020 DOI: 10.3390/curroncol28050323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/20/2021] [Accepted: 09/25/2021] [Indexed: 12/03/2022]
Abstract
Background: The COVID-19 pandemic made it necessary to change established structures of medical counseling services and quickly establish digital counseling formats to ensure continuity of care. In this context, we offered telephone and video-telephonic counseling in addition to traditional face-to-face counseling in the office. Methods: Patients (n = 100) of the Cancer Counseling Center, Tübingen, were asked to complete a questionnaire to assess the acceptance of the counseling format following each counseling session (office, telephone, and video) in the period between July 2020 and February 2021. The questionnaire included the subject areas of patient characterization, assessment of therapeutic contact, therapeutic relationship, and hurdles and was used in this exploratory care study. Results: The satisfaction and acceptance of the three counseling formats (office, telephone, and video) were rated as “good” to “very good” in the three subgroups (range 1–6, office M = 1.2, telephone M = 1.3, video M = 1.4). Likewise, the “therapeutic relationship” achieved high ratings in terms of establishment of a therapeutic relationship in all three subgroups (office M = 5.7, telephone M = 5.0, video M = 5.0). The type of contact (office and video counseling) achieved a significant main effect on the therapeutic relationship for items such as “I believe that counseling is helping me” (F(2,97) = 4.80, p = 0.01) and “I feel that I can rely on the counselor/therapist” (F(2,97) = 3.29, p = 0.04). The “hurdles” were rated as minor and tolerable (office M = 1.3, telephone M = 1.3, video M = 1.4). Predictor analyses showed that there was no effect of age and gender on the acceptance of digital counseling formats in the present sample. Discussion and Conclusion: On the basis of this survey, it can be concluded that digital counseling formats were perceived by patients as a promising addition to the classic face-to-face setting. In addition, it can be stated that the digital formats (telephone and video) were not generally preferred to face-to-face counseling, but that the innovative telecounseling was accepted and perceived with great satisfaction and acceptance. Accordingly, the additional use of digital counseling formats could be an opportunity to enrich and expand the existing presence structures also after the COVID-19 pandemic.
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