WSU researchers find racial, socioeconomic inequities in mammogram screenings during pandemic

SPOKANE, Wash. — New research shows that the number of screening mammograms of women living in Washington plummeted by nearly half during the pandemic. The study determined that the largest drop-offs are amongst women of color and those living in rural communities.

“Detecting breast cancer at an early stage dramatically increases the chances that treatment will be successful,” lead study author Ofer Amram said. “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.”

The study was conducted by researchers at Washington State University Health Sciences Spokane in partnership with MultiCare. MultiCare is a not-for-profit health care system that encompasses 230 clinics and eight hospitals across Washington.

The number of completed screening mammograms in Washington state fell from 55,678 in 2019 to 27,522 in 2020, a 49 percent decrease. The researchers analyzed the data by race as well, and observed significantly larger decreases in non-white women.

Breast cancer screening declined by 64 percent in Hispanic women and 61 percent in American Indian and Alaska Native women.

The researchers also looked at geographical location and found that screenings in rural women were reduced by almost 59 percent, whereas the number of mammograms completed in urban women fell by about 50 percent.

The research team then analyzed the data by insurance type and found that screening reductions were greater in women using Medicaid or who self-paid for treatment, compared to women who were on commercial or government-run health insurance plans.

The research team used medical record data from MultiCare patients who had screening mammograms completed between April and December of 2019 and during the same months in 2020, after the World Health Organization declared COVID-19 a global pandemic in March 2020.

“We know that the COVID-19 virus has had disproportionate impacts on certain populations, including racial and ethnic minority groups,” said senior author on the study, Pablo Monsivais. “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 examined missed cancer screenings during the pandemic, Monsivais said this study is the first to examine racial and socioeconomic differences. The goal of the research team is to eliminate barriers when it comes to cancer screenings, which would help reduce cancer-related health disparities.

A follow-up study, identifying which social and economic factors interfered with access to cancer screening during the pandemic is the next step of the research team. In addition to breast cancer, the follow-up study will also look at colon cancer and lung cancer missed screenings in both men and women.

Factors that may have played a role in reduced cancer screening include job loss, loss of employer-provided health insurance, and caregiver stress due to school or daycare closures or other circumstances. Another factor could be fear of contracting COVID-19, said study co-author Jeanne Robison, an oncology nurse practitioner and lead researcher on this project with MultiCare Cancer and Blood Specialty Centers in Spokane, Washington.

“One of the things we have seen this past year is that women who were pretty good about keeping up with screening remained fearful about going in even after health care facilities had opened back up for routine screening,” Robison said. “I’ve had to talk some of my patients into coming in, however, because even when protocols were in place to safely offer breast cancer screening, there remained a perceived risk.”

A fall in primary care visits during the pandemic could also be a factor, she said, as primary care providers often play a key role in reminding women of the timing and importance of breast cancer screening.

There has been increased virtual access to primary care advisors, due to the pandemic, though there may be barriers to virtual care delivery that disproportionately impact certain groups of people, which is what the researchers aim to analyze in their follow-up study.

In addition to Amram, Monsivais, and Robison, authors on the paper included Solmaz Amiri and John Roll at the WSU Elson S. Floyd College of Medicine and Bethann Pflugeisen with the MultiCare Institute for Research & Innovation.

The study was supported by a grant from the Andy Hill Cancer Research Endowment Fund.