Breast and Colorectal Cancer Screening Utilization after Hurricane María and the COVID-19 Pandemic in Puerto Rico

Abstract

Puerto Rico (PR) has faced environmental and public health challenges that could have significantly affected cancer screening access. Using administrative claims data from PR's Medicaid population, this study assessed trends in colorectal and breast cancer screening from 2016 to 2021, the impact of disasters in screening, and the absolute deficit in screening due to the pandemic. The monthly rates of claims were analyzed using Poisson regression. Significant reductions in breast and colorectal cancer screening utilization were observed. The colorectal cancer screening rate in 2017 was 77% lower a month after Hurricanes Irma and María [RR_adj: 0.23; 95% CI: 0.20, 0.25] compared to the same time period in 2016. Breast cancer screening dropped 50% in November 2017 compared to November 2016 [RR_adj: 0.50; 95% CI: 0.47, 0.54]. Prospectively, a recovery in utilization has been observed only for breast cancer screening. The results revealed that cancer screening utilization substantially declined after environmental disasters and the pandemic. These findings have potentially severe long-term implications for cancer health disparities and mortality in PR.

Keywords: COVID-19 pandemic; breast cancer; cancer screening; colorectal cancer.

Figure 1

Annual colorectal cancer screening rate, 2016–2021.

Figure 2

Monthly colorectal cancer screening rates, stratified by sex, of Medicaid beneficiaries, 2016–2021.

Figure 3

Monthly colorectal cancer screening rates, stratified by age, of Medicaid beneficiaries, 2016–2021.

Figure 4

Annual breast cancer screening rate, 2016–2021.

Figure 5

Monthly breast cancer screening rate, stratified by age, of Medicaid beneficiaries, 2016–2021.