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Mammography Screening Disparities Expand During COVID-19


Cancer screening rates drop more significantly among women in racial and ethnic minority groups, as well as those living in rural locations.

Screening mammography utilization dropped the most during the pandemic for women in racial and ethnic minority groups, as well as those who live in rural communities and those who have a lower socioeconomic status.

In the first study to examine how race and socioeconomic factors impacted mammography use during the COVID-19 outbreak, a team of investigators from Washington State University Health Sciences Spokane showed that the number of women foregoing these screenings outpaced their white counterparts. They published their findings May 24 in JAMA Network Open.

“Our findings suggest another inequity in the COVID pandemic due to greater reduction in utilization of cancer screening services for women with low socioeconomic status, who are in underserved racial/ethnic groups, and live in rural communities,” said the team led by Ofer Amram, assistant professor in the Washington State University Elson S. Floyd College of Medicine.

Given the importance of early identification in the successful treatment of breast cancer, identifying what pushes patients away and what draws them in for services is critical, 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,” he said.

For this study, Amram’s team examined the number of screening mammograms that occurred both in 2019 and 2020 in MultiCare, a not-for-profit health system comprised of 230 primary, specialty, and urgent care clinics, as well as eight hospitals. What they discovered was a 49-percent drop in screening mammography services – a plummet from 55,678 in 2019 to 27,522 in 2020.

But, the more telling finding was how this reduction in screenings played out among women in racial and ethnic minority groups, those from rural locations, and those in a lower socioeconomic group, he said. The number of women in these populations who skipped their screening far exceeded white women who did so.

The team identified the most significant change among Hispanic women – a 64.2-percent decline from 1,727 to 619 scans. In addition, American Indian/Alaska Native women saw a 60.9-percent drop from 215 to 84 scans; mixed race women experienced a 56.2-percent reduction from 1,892 to 828 scans; Native Hawaiian/Pacific Islander and Asian women saw a 54.5-percent drops from 365 to 166 scans and 2,779 to 1,265 scans, respectively; and Black women experienced a 53.9-percent decline from 2,320 to 1,069 scans.

But, the team discovered, race wasn’t the only factor that contributed to whether women got their screening mammogram. Their data analysis showed a 59-percent drop among women living in rural areas while utilization among urban women decreased by 50 percent. Insurance type also played a role – women with Medicaid or those who paid out-of-pocket for services were less likely to get screened than women who had commercial or other government health plans.

“We know that the COVID-19 virus has had disproportionate impacts on certain populations, including racial and ethnic minority groups,” said senior author Pablo Monsivais, Ph.D., MPH, associate professor in the Washington State University Elson S. Floyd College of Medicine. “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.”

There are other factors that could have contributed to this drop-off in cancer screening services, though. Job loss, loss of employer-provided health insurance, caregiver stress due to school or daycare closures, and overall fear of contracting the virus could all have played a part in keeping women away from their mammograms, the team said. It’s also possible that women simply could have forgotten about their mammogram if they didn’t have an appointment with a primary care provider who would have reminded them.

Now, the team said, finding ways to reduce and eliminate these barriers to cancer screenings is the next step. They plan to conduct a follow-up study that will shed light on which of these social and economic factors interfered with cancer screening access during the pandemic. In addition, they will examine existing barriers to virtual care that could also have disproportionately impacted these groups during the outbreak.

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