Breast and Cervical Cancer Screenings Dropped Sharply Early in the Pandemic

A doctor explains screening results to a patient
A doctor explains screening results to a patient
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During the early months of the COVID-19 pandemic, health services across the U.S. sharply declined as resources were shifted to fight the disease and as people stayed home to socially distance themselves. A new study from the Centers for Disease Control and Prevention examined the impact these factors had on the breast and cervical cancer screening services and rates for women with low incomes and of racial and ethnic minority groups. The results were published in a special issue of Preventive Medicine featuring the COVID-19 pandemic’s impact on various cancer screenings. 

In the U.S., minority women are disproportionately affected by breast and cervical cancer.

  • While the average annual rate of breast cancer in Black women is similar to that of white women, more Black women die of the disease (death rate of 27.3 per 100,000 for Black women compared to a death rate of 19.6 per 100,000 for white women). Also, Black women are more likely to be diagnosed with triple-negative breast cancer, a type of breast cancer that grows and spreads quickly, has fewer treatment options, and a worse outlook (prognosis).
  • Rates of cervical cancer are higher in Black women (8.6 per 100,000) and Hispanic women (9.3 per 100,000) compared with white women (7.5 per 100,000). The death rate due to cervical cancer is also higher in minority women (3.3 and 2.6 per 100,000 for Black and Hispanic women, respectively) compared to white women (2.1 per 100,000).       

There has been concern that health disparities worsened during the COVID-19 pandemic. For this study, the scientists examined data from the National Breast and Cervical Cancer Early Detection Program (Early Detection Program), which provides cancer screening services to women with low incomes and/or who lack health insurance. Effective screening programs can decrease cancer rates and deaths, and the Early Detection Program was created to reduce the healthcare inequalities related to cancer experienced by minority women with low incomes and no health insurance.

Using the Early Detection Program data, researchers looked at the average number of breast cancer screenings (mammograms) and cervical cancer screenings (Pap smear and/or HPV tests) that took place from January to June over a five year period preceding the pandemic (2015 to 2019). They compared this 5-year average to the number of the same screenings performed from January to June 2020 as the pandemic worsened in the U.S.

The scientists noted a steep decline in the number of breast and cervical cancer screenings conducted by the Early Detection Program during the months of March and April 2020 compared to the prior 5-year average for the same months, with April 2020 having the lowest number of screening tests performed. 

  • In April 2020, mammograms decreased overall by 87%. Decreases ranged from 84% percent for Hispanic women to 98% for American Indian and Alaskan Native women.
  • In that same month, cervical cancer screening tests decreased overall by 84%. Decreases ranged from 82% for Black women to 92% for Asian American and Pacific Islander women.
  • These cancer screenings began to rebound in May, yet in June 2020, mammograms remained 39% below the average for the previous 5 years. 
  • Similarly, in June 2020, cervical cancer screening tests were 40% below the average for the previous 5 years.

The authors note that similar patterns have been observed among women with health insurance coverage. Factors affecting all women and contributing to the delays in screening include health facilities closing and cancer screening services being postponed, as well as patients staying at home following public health officials’ recommendations and/or out of fear of getting COVID-19.

Even though screening rates have begun to recover, missed or delayed screening may result in women being diagnosed with cancer at later stages, when the cancer may have spread and is harder to treat. This may further increase health disparities for minority women with low incomes, according to the CDC study. More research is needed to assess the impact of the pandemic on screening rates during the later months of 2020, and the effects of screening delays on cancer incidence and deaths remains to be seen.   

 “This study highlights a decline in cancer screening among women of racial and ethnic minority groups with low incomes when their access to medical services decreased at the beginning of the pandemic,” Amy DeGroff, PhD, MPH, CDC health scientist and lead author said in a press release. Healthcare providers can help minimize further delays by continuing to perform routine cancer screenings while observing COVID-19 precautions. 

“The Early Detection Program can help women overcome barriers to health equity by educating them about the importance of routine screening, addressing their concerns about COVID-19 transmission, and helping them to safely access screening . . . ,” added Dr. DeGroff. 

Sources

DeGroff, A, et.al, COVID-19 impact on screening test volume through the National Breast and Cervical Cancer early detection program, January–June 2020, in the United States, Preventive Medicine, Volume 151, 2021. Accessed July 21, 2021. https://www.sciencedirect.com/science/article/pii/S0091743521001432

(June 30, 2021) Sharp Declines in Breast and Cervical Cancer Screening, CDC Press Release. Accessed July 21, 2021. https://www.cdc.gov/media/releases/2021/p0630-cancer-screenings.html

(January 27, 2021) Triple-negative Breast Cancer, American Cancer Society. Accessed July 21, 2021. https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/types-of-breast-cancer/triple-negative.html

National Cancer Institute, Cancer Stat Facts: Female Breast Cancer, U.S. 2014–2018. Accessed July 21, 2021. https://seer.cancer.gov/statfacts/html/breast.html

National Cancer Institute, Cancer Stat Facts: Cervical Cancer, U.S. 2014–2018. Accessed July 21, 2021. https://seer.cancer.gov/statfacts/html/cervix.html