Impact of the COVID-19 breast cancer screening hiatus on clinical stage and racial disparities in New York City

Abstract

Background: The impact of the COVID-19 mammography screening hiatus as well as of post-hiatus efforts promoting restoration of elective healthcare on breast cancer detection patterns and stage distribution is unknown.

Methods: Newly diagnosed breast cancer patients (2019-2021) at the New York Presbyterian (NYP) Hospital Network were analyzed. Chi-square and student's t-test compared characteristics of patients presenting before and after the screening hiatus.

Results: A total of 2137 patients were analyzed. Frequency of screen-detected and early-stage breast cancer declined post-hiatus (59.7%), but returned to baseline (69.3%). Frequency of screen-detected breast cancer was lowest for African American (AA) (57.5%) and Medicaid patients pre-hiatus (57.2%), and this disparity was reduced post-hiatus (65.3% for AA and 63.2% for Medicaid).

Conclusions: The return to baseline levels of screen-detected cancer, particularly among AA and Medicaid patients suggest that large-scale breast health education campaigns may be effective in resuming screening practices and in mitigating disparities.

Keywords: Breast cancer; COVID-19; Healthcare disparities; Mammography; Screening.

Fig. 1

Patient inclusion and reasons for exclusion.

Fig. 2

Characteristics of patients presenting before and after the mammography screening hiatus was lifted, stratified by post-hiatus interval (Post-hiatus I: patients diagnosed between June 16, 2020–October 31, 2020; Post-hiatus II: November 1, 2020–February 28, 2021; Post-hiatus III: March 1, 2021–June 30, 2021); DCIS = Ductal carcinoma in situ *p-value denotes comparison of Post-Hiatus I, Post-Hiatus II and Post-Hiatus III.