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Women of Color, Rural Women More Likely to Miss Breast Cancer Screening During Pandemic

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Breast cancer screening came to a virtual standstill during the COVID-19 pandemic, with women of color and women living in rural areas most likely to miss a screening mammogram, according to a study by Washington State University scientists.

The study was published in the May 24, 2021, issue of the journal JAMA Network Open. Read the abstract of “Socioeconomic and Racial Inequities in Breast Cancer Screening During the COVID-19 Pandemic in Washington State.

Breast cancer screening and the COVID-19 pandemic
About the study
What this means for you

Breast cancer screening and the COVID-19 pandemic

At the beginning of the COVID-19 pandemic, most hospitals and other healthcare facilities delayed or cancelled elective procedures, including screening mammograms. Healthcare providers made this decision to help protect people from the increased risk of being infected with the virus that causes COVID-19 and to focus their resources on treating people who were infected with the virus.

As healthcare facilities adopted stricter safety practices to reduce the risk of exposing people to COVID-19 and with the vaccine rollout well underway, healthcare providers were able to start offering screening mammograms and other elective procedures again.

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About the study

To do the study, the researchers looked at the records of screening mammograms done between April 1 and Dec. 31, 2019, and between April 1 and Dec. 31, 2020. The mammogram records came from more than 230 primary care, specialty care, and urgent care clinics, and eight hospitals across Washington State.

The researchers considered a number of factors about the women whose mammograms they reviewed, including:

  • race
  • ethnicity
  • insurance
  • zip code of residence

Among the 55,678 people who had screening mammograms between April and December 2019:

  • 45,572 were non-Hispanic white women (81.8%)
  • 2,779 were Asian women (5.0%)
  • 2,320 were Black women (4.2%)
  • 1,892 were mixed race women (3.4%)
  • 1,727 were Hispanic women of any race (3.1%)
  • 365 were Native Hawaiian or Pacific Islander women (0.7%)
  • 215 were American Indian or Alaska Native women (0.4%)
  • 54,620 lived in urban areas (98.1%) and 1,046 lived in rural areas (1.9%)
  • 22,761 had private health insurance (40.9%)
  • 19,847 had Medicare (35.6%)
  • 2,503 had Medicaid (4.5%)
  • the average age was 62 years

The number of screening mammograms done between April and December 2020 dropped to 27,522, a decrease of 49% from the same period the year before. Among the 27,522 people who had mammograms in 2020:

  • 23,163 were non-Hispanic white women (84.2%)
  • 1,265 were Asian women (4.6%)
  • 1,069 were Black women (3.9%)
  • 828 were mixed race women (3.0%)
  • 619 were Hispanic women of any race (2.2%)
  • 166 were Native Hawaiian or Pacific Islander women (0.6%)
  • 84 were American Indian or Alaska Native women (0.3%)
  • 27,089 lived in urban areas (98.4%) and 431 lived in rural areas (1.6%)
  • 11,378 had private health insurance (41.3%)
  • 10,614 had Medicare (38.6%)
  • 931 had Medicaid (3.4%)
  • the average age was 62.8 years

The researchers’ analysis found that for the same periods in 2019 and 2020, screening mammograms decreased by:

  • 49.2% for white women, which matches the overall decrease
  • 64.2% for Hispanic women of any race
  • 60.9% for American Indian or Alaska Native women
  • 56.2% for mixed race women
  • 54.5% for Native Hawaiian or Pacific Islander women
  • 54.5% for Asian women
  • 53.9% for Black women
  • 59% for women who lived in rural areas
  • 50% for women who lived in urban areas

“Our study findings suggest that health care providers need to double down on efforts to maintain prevention services and reach out to these underserved populations, who faced considerable health disparities even before the pandemic,” lead author Ofer Amram, Ph.D., assistant professor of medicine at Washington State University whose research focuses on health inequities, said in a statement.

“We know that the COVID-19 virus has had disproportionate impacts on certain populations, including racial and ethnic minority groups,” added Pablo Monsivais, Ph.D., MPH, senior author and associate professor of medicine at Washington State. “What our study adds is that some of the secondary effects of the COVID-19 pandemic are also disproportionately impacting those populations, so it’s a double whammy.”

While previous studies have looked at missed cancer screenings during the pandemic, Monsivais said this study is the first to examine racial and socioeconomic differences, specifically. The researchers’ goal is to find ways to eliminate barriers to cancer screening. They plan to conduct a follow-up study to figure out which social and economic factors affected access to cancer screening during the pandemic.

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What this means for you

We know that many people in our Community at Breastcancer.org felt upset and frustrated when their mammograms were delayed or cancelled because of COVID-19.

The good news is that most radiology and imaging centers are offering routine screening mammograms again.

Everyone — no matter their age, race, ethnicity, economic status, or health insurance status — deserves the best healthcare possible. This includes regular screening mammograms.

If your annual mammogram was delayed because of the COVID-19 pandemic, you should call your facility to reschedule. If you’re concerned about COVID-19, it makes sense to ask what steps your facility is taking to protect you from the virus. Many facilities have hotlines you can call. It also makes sense for you to take steps of your own to protect yourself from COVID-19, including:

  • not touching your face while you are at the facility
  • wearing a face mask
  • using hand sanitizer when you leave the facility
  • washing your hands as soon as you get home

Of course, if you have any COVID-19 symptoms — such as cough, shortness of breath, or loss of sense of smell — cancel your appointment, get tested for COVID-19, and self-quarantine for the required amount of time if you test positive.

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Written by: Jamie DePolo, senior editor

Reviewed by: Brian Wojciechowski, M.D., medical adviser


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