Disruptions in preventive care: Mammograms during the COVID-19 pandemic

Abstract

Objective: To measure the extent to which the provision of mammograms was impacted by the COVID-19 pandemic and surrounding guidelines.

Data sources: De-identified summary data derived from medical claims and eligibility files were provided by Independence Blue Cross for women receiving mammograms.

Study design: We used a difference-in-differences approach to characterize the change in mammograms performed over time and a queueing formula to estimate the time to clear the queue of missed mammograms.

Data collection: We used data from the first 30 weeks of each year from 2018 to 2020.

Principal findings: Over the 20 weeks following March 11, 2020, the volume of screening mammograms and diagnostic mammograms fell by 58% and 38% of expected levels, on average. Lowest volumes were observed in week 15 (April 8 to 14), when screening and diagnostic mammograms fell by 99% and 74%, respectively. Volumes began to rebound in week 19 (May), with diagnostic mammograms reaching levels to similar to previous years' and screening mammograms remaining 14% below expectations. We estimate it will take a minimum of 22 weeks to clear the queue of missed mammograms in our study sample.

Conclusions: The provision of mammograms has been significantly disrupted due to the COVID-19 pandemic.

Keywords: COVID-19; early detection of cancer; mammography; missed diagnosis; preventive medicine.

FIGURE 1

Trends in count of weekly mammograms in weeks 1 to 30 of the year. Notes. Based on claims posted as of August 31, 2020, for mammograms performed in the first 30 weeks of each year. Week 11 (vertical gray line) indicates the beginning of the post period. Dotted horizontal line shows the expected volume of mammograms that would have occurred during the post period in 2020 in the absence of the COVID‐19 pandemic. Shaded region captures missed mammograms during the post period in 2020. [Color figure can be viewed at wileyonlinelibrary.com]