Skin color women, rural women hardest hit by lack of breast cancer screening during a pandemic WSU Insider


SPOKANE, Washington. – Breast cancer screening has been severely impacted during the COVID-19 pandemic. This suggests new research showing the number of screening mammograms done on a large group of women in Washington state has decreased by nearly half. Published today in JAMA Network Open, The study found the steepest declines in women with skin color and in rural communities.

“Detecting breast cancer early increases the chances of successful treatment dramatically,” said lead study author Ofer Amram, an assistant professor at Washington State University’s Elson S. Floyd College of Medicine, whose research focuses on health inequalities. “Our study results suggest that healthcare providers need to redouble their efforts to maintain prevention services and reach these underserved populations, who faced significant health disparities prior to the pandemic.”

The study was conducted by researchers from Washington State University Health Sciences Spokane in collaboration with MultiCare, a nonprofit healthcare system that includes 230 clinics and eight hospitals across Washington state. The research team used medical records from MultiCare patients who had screening mammograms taken between April and December 2019 and the same months of 2020 after the World Health Organization declared COVID-19 a global pandemic in March 2020.

The researchers saw the number of screening mammograms completed across Washington state decreased from 55,678 in 2019 to 27,522 in 2020, a decrease of 49%. When analyzing the data by race, they found a similar decrease in screening of 49% for white women, but observed a significantly larger decrease in non-white women. For example, breast cancer screening decreased 64% in Hispanic women and 61% in Native American and Native women in Alaska. The researchers also looked at the geographic location and found that screening of mammograms in rural women was reduced by nearly 59%, while the number of mammograms in urban women decreased by about 50%.

Additionally, the research team analyzed the data by type of insurance and found that when compared to women who had commercial or state health insurance, the screening reductions were higher in women who used Medicaid or paid for treatment themselves, which was loud Amram indicators are of lower socio-economic status.

“We know the COVID-19 virus had a disproportionate impact on certain populations, including racial and ethnic minorities,” said Pablo Monsivais, lead author on the study and associate professor at WSU’s Elson S. Floyd College of Medicine. “Our study adds that some of the secondary effects of the COVID-19 pandemic are disproportionately affecting these populations too, making it a double blow.”

While previous studies have looked at missed cancer screening during the pandemic, Monsivais said this study is the first to look at racial and socioeconomic differences in particular. The research team’s goal is to find ways to remove barriers to cancer screening that would help reduce cancer-related health inequalities. Your next step is to conduct a follow-up study to determine what social and economic factors were affecting access to cancer screening during the pandemic. In addition to breast cancer, this study also looks at screening for absent colon cancer and lung cancer in women and men.

Factors that may have played a role in reducing cancer screening include loss of jobs, loss of employer-provided health insurance, and the stress of caregivers from school or daycare closings or other circumstances. Fear of getting COVID-19 may also have contributed, said study co-author Jeanne Robison, an oncology nurse and lead researcher on this project with the MultiCare Cancer and Blood Specialty Centers in Spokane, Washington.

“One of the things we’ve seen over the past year is that women who were pretty good at keeping up with screening were scared even after health facilities reopened for routine screening,” Robison said . “I had to persuade some of my patients to come in because even with protocols in place to offer safe breast cancer screening, there was a perceived risk.”

A decrease in visits to primary care during the pandemic could also have been a factor, she said, as first responders often play a key role in reminding women of the timing and importance of breast cancer screening. And while improved access to virtual visits may have mitigated this decline, there may have been barriers to the delivery of virtual care that disproportionately affected certain groups of people, as can be determined from the researchers’ follow-up study.

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

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

Media contacts:

  • Ofer Amram, WSU Elson S. Floyd College of Medicine, 509-368-6863, [email protected]
  • Judith Van Dongen, WSU’s Spokane Research Office for Health Sciences, 509-358-7524, [email protected]


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