Racial Disparities in Breast Cancer Screening Persist During Coronavirus Pandemic

Racial disparities that existed prior to the pandemic remained problematic in the first year of the public health emergency, according to a new study.

Breast cancer screening disparities persisted in the first year of the coronavirus pandemic, and screening of some minority groups did not bounce back as well as it did for White women, according to a new study.

Breast cancer screening has the potential to detect disease at its earliest stages, when it can be treated most effectively. Racial disparities in breast cancer screening rates have been shown in earlier research. For example, data published before the passage of the Affordable Care Act showed that Black and Hispanic women without insurance were less likely to have access to mammography.

The new study, which was published online by the journal Evidence-Based Oncology, analyzes breast cancer screening rates for two periods: March 1 to Sept. 30, 2019, and March 1 to Sept. 30, 2020. The research features data from more than 14 million patient records in a multipayer database that included Medicare fee-for-service, managed Medicaid, and commercial insurance beneficiaries. The study was conducted for the nonprofit Community Oncology Alliance (COA).

The researchers examined data for five racial groups: White, Black/African American, Hispanic/Latino, Asian/Native Hawaiian/Pacific Islander, and American Indian/Alaskan Native.

The study includes several key data points.

• In 2019, mammogram utilization among Asian, Hispanic, and American Indian/Alaskan Native beneficiaries was lower than utilization among White beneficiaries.
   
• At the peak of the first COVID-19 wave in April 2020, mean monthly screening rates for White Medicare fee-for-service patients plummeted to 0.6% of eligible beneficiaries. The screening rate recovered to 6.5% of eligible beneficiaries by June 2020, which was above the pre-pandemic level of about 6.1%.
   
• Asian, Hispanic, and American Indian/Alaskan Native women did not experience a rebound in screening rates until September 2020.
   
• American Indian/Alaska Native women experienced the most striking screening disparities. In June 2020, screening rates for American Indian/Alaska Native women were less than half of White women. At the peak of the first COVID-19 wave in April 2020, screening rates for American Indian/Alaska Native women fell to 0.5% of eligible beneficiaries and only recovered to 3.1% in June 2020.
   
• Pre-pandemic mammogram utilization disparities remained in September 2020 among Black (6.2%), Hispanic (4.3%), and Asian (4.5%) women.

The lead author of the study said the research is troubling for breast cancer care in general and minority women in particular. “What’s worrisome is that the combined two-year lag in screenings we are reporting will translate into not only more and more severe breast cancer cases, but that the cancer health disparities we already knew existed have remained stubbornly unmoved,” Debra Patt, MD, PhD, MBA, executive vice president at Texas Oncology and secretary of COA, said in a prepared statement.

Healthcare providers should be encouraging their patients to get routine cancer screenings, Kashyap Patel, MD, a practicing oncologist who is a co-author of the study and president of COA told HealthLeaders.

“We can have multiple interventions. At Community Oncology Alliance, we have a program called Time to Screen. Every Community Oncology Alliance practice is trying to do their best to make their patients aware of cancer screening when they come to the office. We ask about their spouses and other family members to see whether they need cancer screening,” he says.

Linguistic barriers are an issue, Patel says. “For patients for whom English is not the main language, they need explanations about cancer screening in their own language. Community Oncology Alliance has started multi-linguistic approaches, including through social media. We are trying to use a multi-pronged approach to educate patients as much as we can to make them aware about the need for screening and consequences of not getting screened.”