Age, race, and insurance all factor in to whether women got their annual exams.
One of the first things to be side-lined during the early days of the pandemic was the screening mammogram. Delays, re-scheduling, and outright appointment cancellations have been common for the past 18 months-plus. It would make sense that all women have been affected equally – but that’s not the case.
As with many other healthcare disparities, new research shows that women who are older and those from under-served groups missed their screening mammogram appointments more often.
In a study published recently in Clinical Imaging, a team of investigators from Brigham & Women’s Hospital attempted to identify whether the women who missed their screening mammograms had any shared characteristics.
Based on their research, the team led by Nita Amornsiripanitch, M.D., a radiologist with Brigham & Women’s, determined that, once breast imaging centers began to re-open, older age, Medicare insurance coverage, and minority race and ethnicity were all independently associated with a missed screening. Their findings are in contrast with previous cancellation rates – prior to the pandemic, younger women were more likely to cancel their appointments.
“The effect on ethnic/racial minorities is exacerbated given lower screening mammogram utilization at baseline, tendency to present with later stage disease, and disproportionate number of COVID-19 infection in this subgroup,” the team said. “Amplification of our efforts to reschedule missed screening and strategic allocation of resources combined with approaches tailored to the underserved may be steps toward addressing longstanding inequity.”
To identify any similarities, the team took a look at the screening mammogram appointments from their hospital, focusing on three time periods during the pandemic: March 2020 to June 2020 (the state-wide shut-down), June 2020 to August 2020 (when services resumed), and June 2019 to August 2019 (a control time-period).
Based on their comparison, the team determined that overall cancellation rates were highest during the re-opening period – 46 percent compared with 37 percent during the shutdown. They found that being older and having Medicare insurance increased cancellation risk, as did being a member of a racial or ethnic minority group.
But, there was some good news in their analysis. The re-scheduling rate was 17 percent higher during the shutdown period than it had been before the pandemic was even identified – 78 percent versus 61 percent, respectively. The team postulated that this higher rate was a result of more concerted efforts to bring women back in for their annual screening mammograms.
“Possibly due to this focused effort, overall rescheduling rate during state-mandated shutdown exceeded that of pre-COVID-19 period for all patients, including minorities, those with Medicaid, and those with chronic disease,” the team said. “Although we do not currently have data to confirm that all re-scheduled exams were performed, a more rigorous endeavor to reschedule missed exams may be a small step towards increasing adherence to screening mammogram guidelines.”
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