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Socioeconomic and Racial Inequities in Breast Cancer Screening During the COVID-19 Pandemic in Washington State

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

The COVID-19 pandemic has disrupted preventive care, including cancer screening. Studies from the United States and Europe have shown that cancer screening dropped dramatically during the pandemic,1,2 with breast cancer screening and diagnostic mammograms falling by 58% and 38%, respectively.1,2 A United Kingdom modeling study estimated that delayed and missed screenings would likely increase breast cancer deaths, a leading cancer among women, by 7.9% to 9.6%.2,3 The adverse impact of COVID-19 on screening may differ among sociodemographic groups, given the disproportionate impact the pandemic has had on underserved racial and ethnic groups and other vulnerable population groups.4 In this report, we used clinical data to examine differences in breast cancer screenings before and during the COVID-19 pandemic overall and among sociodemographic population groups.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: March 29, 2021.

Published: May 24, 2021. doi:10.1001/jamanetworkopen.2021.10946

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Amram O et al. JAMA Network Open.

Corresponding Author: Ofer Amram, PhD, Washington State University, 412 E Spokane Falls Blvd, Spokane, WA 99202 (ofer.amram@wsu.edu).

Author Contributions: Dr Amram had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Amram, Robison, Amiri, Roll, Monsivais.

Acquisition, analysis, or interpretation of data: Amram, Robison, Amiri, Pflugeisen, Monsivais.

Drafting of the manuscript: Amram, Robison, Amiri, Monsivais.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Amram, Amiri, Monsivais.

Obtained funding: Amram, Amiri, Monsivais.

Administrative, technical, or material support: Robison, Pflugeisen.

Supervision: Amram, Robison.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by a grant from the Andy Hill Care Fund, Washington State’s Cancer Research Endowment. Dr Monsivais received support from the Health Equity Research Center, a strategic research initiative of Washington State University.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

References
1.
Song  H , Bergman  A , Chen  AT ,  et al.  Disruptions in preventive care: mammograms during the COVID-19 pandemic.   Health Serv Res. 2021;56(1):95-101. doi:10.1111/1475-6773.13596PubMedGoogle ScholarCrossref
2.
Maringe  C , Spicer  J , Morris  M ,  et al.  The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study.   Lancet Oncol. 2020;21(8):1023-1034. doi:10.1016/S1470-2045(20)30388-0PubMedGoogle ScholarCrossref
4.
Centers for Disease Control and Prevention. COVID-19 racial and ethnic health disparities. Published February 11, 2020. Accessed March 21, 2021. https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/index.html
5.
Gezici  A , Ozay  O. How race and gender shape COVID-19 unemployment probability. Social Science Research Network. Published August 17, 2020. Accessed April 12, 2021. doi:10.2139/ssrn.3675022
6.
Jewett  PI , Gangnon  RE , Elkin  E ,  et al.  Geographic access to mammography facilities and frequency of mammography screening.   Ann Epidemiol. 2018;28(2):65-71.e2. doi:10.1016/j.annepidem.2017.11.012PubMedGoogle ScholarCrossref
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