Changes in Mammography Use by Women's Characteristics During the First 5 Months of the COVID-19 Pandemic

Brian L Sprague; Kathryn P Lowry; Diana L Miglioretti; Nila Alsheik; Erin J A Bowles; Anna N A Tosteson; Garth Rauscher; Sally D Herschorn; Janie M Lee; Amy Trentham-Dietz; Donald L Weaver; Natasha K Stout; Karla Kerlikowske

doi:10.1093/jnci/djab045

Changes in Mammography Use by Women's Characteristics During the First 5 Months of the COVID-19 Pandemic

J Natl Cancer Inst. 2021 Sep 4;113(9):1161-1167. doi: 10.1093/jnci/djab045.

Authors

Brian L Sprague^{1

2

3}, Kathryn P Lowry⁴, Diana L Miglioretti^{5

6}, Nila Alsheik⁷, Erin J A Bowles⁶, Anna N A Tosteson⁸, Garth Rauscher⁹, Sally D Herschorn^{2

3}, Janie M Lee⁴, Amy Trentham-Dietz¹⁰, Donald L Weaver^{3

11}, Natasha K Stout¹², Karla Kerlikowske^{13

14}

Affiliations

¹ Department of Surgery, Office of Health Promotion Research, University of Vermont Larner College of Medicine, Burlington, VT, USA.
² Department of Radiology, University of Vermont Larner College of Medicine, Burlington, VT, USA.
³ University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT, USA.
⁴ Department of Radiology, University of Washington and Seattle Cancer Care Alliance, Seattle, WA, USA.
⁵ Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA, USA.
⁶ Kaiser Permanente Washington Health Research Institute, Kaiser Permanente WA, Seattle, WA, USA.
⁷ Advocate Caldwell Breast Center, Advocate Lutheran General Hospital, Park Ridge, IL, USA.
⁸ The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
⁹ Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
¹⁰ Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA.
¹¹ Department of Pathology and Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA.
¹² Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.
¹³ Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.
¹⁴ Department of Veterans Affairs, General Internal Medicine Section, University of California, San Francisco, CA, USA.

Abstract

Background: The coronavirus disease 2019 (COVID-19) pandemic led to a near-total cessation of mammography services in the United States in mid-March 2020. It is unclear if screening and diagnostic mammography volumes have recovered to prepandemic levels and whether use has varied by women's characteristics.

Methods: We collected data on 461 083 screening mammograms and 112 207 diagnostic mammograms conducted during January 2019 through July 2020 at 62 radiology facilities in the Breast Cancer Surveillance Consortium. We compared monthly screening and diagnostic mammography volumes before and during the pandemic stratified by age, race and ethnicity, breast density, and family history of breast cancer.

Results: Screening and diagnostic mammography volumes in April 2020 were 1.1% (95% confidence interval [CI] = 0.5% to 2.4%) and 21.4% (95% CI = 18.7% to 24.4%) of the April 2019 prepandemic volumes, respectively, but by July 2020 had rebounded to 89.7% (95% CI = 79.6% to 101.1%) and 101.6% (95% CI = 93.8% to 110.1%) of the July 2019 prepandemic volumes, respectively. The year-to-date cumulative volume of screening and diagnostic mammograms performed through July 2020 was 66.2% (95% CI = 60.3% to 72.6%) and 79.9% (95% CI = 75.4% to 84.6%), respectively, of year-to-date volume through July 2019. Screening mammography rebound was similar across age groups and by family history of breast cancer. Monthly screening mammography volume in July 2020 for Black, White, Hispanic, and Asian women reached 96.7% (95% CI = 88.1% to 106.1%), 92.9% (95% CI = 82.9% to 104.0%), 72.7% (95% CI = 56.5% to 93.6%), and 51.3% (95% CI = 39.7% to 66.2%) of the July 2019 prepandemic volume, respectively.

Conclusions: Despite a strong overall rebound in mammography volume by July 2020, the rebound lagged among Asian and Hispanic women, and a substantial cumulative deficit in missed mammograms accumulated, which may have important health consequences.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Breast Neoplasms / diagnosis*
Breast Neoplasms / psychology
COVID-19 / epidemiology*
COVID-19 / virology
Early Detection of Cancer / statistics & numerical data*
Ethnicity / psychology*
Female
Humans
Mammography / statistics & numerical data*
Middle Aged
Registries / statistics & numerical data*
SARS-CoV-2 / isolation & purification*
United States / epidemiology

Abstract

Publication types

MeSH terms

Grants and funding