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. 2025 Sep 24.
doi: 10.1007/s10552-025-02063-7. Online ahead of print.

COVID-19 impacts on the breast cancer care pathway among systemically marginalized communities in Ontario

Aisha K Lofters  1   2 , Priya Premranjith  3 , Anastasia Gayowksy  3 , Ielaf Khalil  4 , Andrea M Covelli  5   6   7 , Juliet M Daniel  8
Affiliations

COVID-19 impacts on the breast cancer care pathway among systemically marginalized communities in Ontario

Aisha K Lofters et al. Cancer Causes Control. .

Abstract

Purpose: Healthcare system pauses occurred worldwide due to COVID-19, and may have worsened pre-existing disparities in breast cancer care. In this population-based, retrospective cohort study, we investigated indicators of breast cancer care (i.e., adherence to screening guidelines, early vs. late-stage diagnosis, and mastectomy vs. breast-conserving surgery) before and after COVID-19 lockdowns in Ontario, with an emphasis on immigrant women.

Methods: We had three binary outcomes and corresponding cohorts, and each outcome/cohort was ascertained relative to two time periods: April 1, 2018-March 31, 2020 ("pre-pandemic") and April 1, 2020-March 31, 2022 ("pandemic"): i) up to date on screening, ii) early vs late stage of breast cancer diagnosis, and iii) mastectomy vs breast-conserving surgery at any time after diagnosis for women who were diagnosed at stages I-III during each two-year time period. We conducted descriptive analyses, and used logistic regression, both unadjusted and adjusted, to determine odds ratios for our dichotomous outcomes.

Results: Breast cancer screening rates dropped from 59.4% to 51.0%, and the number of women diagnosed dropped from 18,821 to 14,269, in the pre-pandemic vs pandemic period. In multivariable analyses, screening significantly dropped (AOR = 0.69 [95% CI (0.69-0.69)]), there was no significant difference for diagnostic stage (AOR = 0.99 [95% CI (0.92-1.05)]), and the use of mastectomy vs breast-conserving surgery was higher in the pandemic period (AOR = 1.14 [95% CI (1.08-1.20)]). Women from the Caribbean had lower odds of early-stage diagnosis in the pre-pandemic period despite a screening advantage.

Conclusion: Future work should further explore the reasons for these findings and potential system-level solutions.

Keywords: Breast cancer; COVID-19; Cancer care; Cancer screening; Immigrant health.

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Conflict of interest statement

Declarations. Conflict of interest: AL reports receiving a quality improvement grant from Pfizer and ReThink Breast Cancer titled “Improving the care of Black women living with metastatic breast cancer”. Ethical approval: This study was approved by the research ethics board at McMaster University (Hamilton Integrated Research Ethics Board (HiREB) project no. 16012). Consent to participate: N/A. Consent to publish: N/A.

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