[COVID-19 and breast cancer screening in Brazil: a comparative analysis of the pre-pandemic and pandemic periods]. / COVID-19 e rastreamento do câncer de mama no Brasil: uma análise comparativa dos períodos pré-pandêmico e pandêmico.

The scope of this study was to evaluate the impacts of COVID-19 on breast cancer screening in Brazil. Data were collected from the Ambulatory Information System relating to "bilateral screening mammography" from January/2015 to December/2021. Analyses were performed by region and for Brazil. The average of exams in each month of the year was calculated based on 2015-2019 data, which was compared, monthly, with the number of exams in 2020 and 2021, obtaining the gross and percentage difference between these values. The same analysis was performed for the total number of exams in 2020 and 2021, individually, and for the two years combined. In 2020 there were reductions in the number of exams, which ranged from 25% (North) to 48% (Northeast), resulting in 1.749 million fewer exams than expected in the country (a drop of 44%). In 2021, the Midwest region presented a number of exams 11% higher than expected, while the other regions presented drops between 17% (North) and 27% (Southeast/South), resulting in 927 thousand exams fewer than expected in Brazil (reduction of 23%). In the joint analysis (2020/2021), reductions varied by region from 11% (Midwest) to 35% (Southeast/South), culminating in 2.676 million exams fewer than expected in Brazil (reduction of 33%).

Objetivou-se avaliar os impactos da COVID-19 no rastreamento do câncer de mama no Brasil. Coletaram-se dados do Sistema de Informações Ambulatoriais referentes a "mamografia bilateral para rastreamento" de janeiro/2015 a dezembro/2021. As análises foram feitas por região e para o Brasil. Calculou-se a média de exames em cada mês do ano com base nos dados de 2015 a 2019, a qual foi comparada, mensalmente, com o quantitativo de exames em 2020 e 2021, obtendo-se a diferença bruta e percentual entre esses valores. A mesma análise foi realizada para o número total de exames em 2020 e 2021, individualmente, e para os dois anos em conjunto. Em 2020 houve quedas no número de exames que variaram de 25% (Norte) a 48% (Nordeste), culminando em 1,749 milhão de exames a menos no país (queda de 44%). Em 2021, a região Centro-Oeste apresentou quantitativo de exames 11% superior ao esperado, enquanto as demais regiões apresentaram quedas entre 17% (Norte) e 27% (Sudeste/Sul), culminando em negativo de 927 mil exames no país (redução de 23%). Na análise conjunta (2020/2021), encontraram-se reduções que variaram de 11% (Centro-Oeste) a 35% (Sudeste/Sul), culminando em negativo de 2,676 milhões de procedimentos no Brasil (queda de 33%).

Race and Ethnicity-Adjusted Age Recommendation for Initiating Breast Cancer Screening.

Importance: Breast cancer (BC) is the second leading cause of cancer death in women, and there is a substantial disparity in BC mortality by race, especially for early-onset BC in Black women. Many guidelines recommend starting BC screening from age 50 years; however, the current one-size-fits-all policy to start screening all women from a certain age may not be fair, equitable, or optimal. Objective: To provide race and ethnicity-adapted starting ages of BC screening based on data on current racial and ethnic disparities in BC mortality. Design, Setting, and Participants: This nationwide population-based cross-sectional study was conducted using data on BC mortality in female patients in the US who died of BC in 2011 to 2020. Exposures: Proxy-reported race and ethnicity information was used. The risk-adapted starting age of BC screening by race and ethnicity was measured based on 10-year cumulative risk of BC-specific death. Age-specific 10-year cumulative risk was calculated based on age group-specific mortality data without modeling or adjustment. Main Outcomes and Measures: Disease-specific mortality due to invasive BC in female patients. Results: There were BC-specific deaths among 415 277 female patients (1880 American Indian or Alaska Native [0.5%], 12 086 Asian or Pacific Islander [2.9%], 62 695 Black [15.1%], 28 747 Hispanic [6.9%], and 309 869 White [74.6%]; 115 214 patients died before age 60 years [27.7%]) of any age in the US in 2011 to 2020. BC mortality per 100 000 person-years for ages 40 to 49 years was 27 deaths in Black females, 15 deaths in White females, and 11 deaths in American Indian or Alaska Native, Hispanic, and Asian or Pacific Islander females. When BC screening was recommended to start at age 50 years for all females with a 10-year cumulative risk of BC death of 0.329%, Black females reached this risk threshold level 8 years earlier, at age 42 years, whereas White females reached it at age 51 years, American Indian or Alaska Native and Hispanic females at age 57 years, and Asian or Pacific Islander females 11 years later, at age 61 years. Race and ethnicity-adapted starting ages for Black females were 6 years earlier for mass screening at age 40 years and 7 years earlier for mass screening at age 45 years. Conclusions and Relevance: This study provides evidence-based race-adapted starting ages for BC screening. These findings suggest that health policy makers may consider a risk-adapted approach to BC screening in which individuals who are at high risk are screened earlier to address mortality due to early-onset BC before the recommended age of mass screening.

Effectiveness of an Educational Program on Awareness of Breast Cancer Risk Factors, Symptoms, and Barriers to Seeking Medical Help among Adolescent Omani School Students-An Interventional Study.

BACKGROUND AND AIM: Women in Oman and low- and middle-income countries (LMICs) are usually diagnosed with BC at a younger age and more advanced stage, with poor five-year survival. This study aims to evaluate the effectiveness of breast cancer (BC) related educational programs among female Omani adolescents. MATERIALS AND METHODS: Six female-only public schools were randomly selected from three governorates of Oman and assigned to the control or interventional group. An Arabic version of the Breast Cancer Awareness Measure questionnaire was used to evaluate students attending grades 10 and 11 at baseline (T0) and after 4 weeks (T1). After T0, the intervention group participated in a one-hour BC education program involving group discussions, a slideshow presentation, leaflets, and online access to program materials and videos. Non-parametric tests were used to compare scores between intervention and control groups and within each group across time (T0 vs. T1). RESULTS: A total of 1106 students participated, of which 547 (49.5%) and 559 (50.5%) were allocated to the control and intervention groups, respectively. Recognition of BC risk factors (Z = 18.67; p < 0.001) and symptoms (Z = 20.01; p < 0.001) increased significantly in the intervention group between T0 and T1 and compared to the control group at T1 (U = 27.27; p < 0.001, and U = 25.75; p < 0.001, respectively). Anticipated time to seeking medical help (Z = 18.67; p < 0.001) and barriers to help-seeking (Z = 7.91; p < 0.001) decreased significantly between T0 and T1 in the intervention group and compared to the control group at T1 (U = 15.78; p < 0.001, and U = 3.44; p = 0.001, respectively). CONCLUSION: The program increased knowledge of BC risk factors and symptoms and promoted early medical help-seeking among Omani female adolescents. Healthcare strategic planners and policy-makers in Oman and low- and middle-income countries should consider incorporating cancer education programs in the national school curriculum to minimize delays in BC diagnosis and improve the survival rate.

Clinical trial-identified inflammatory biomarkers in breast and pancreatic cancers.

Breast cancer and pancreatic cancer are two common cancer types characterized by high prevalence and high mortality rates, respectively. However, breast cancer has been more well-studied than pancreatic cancer. This narrative review curated inflammation-associated biomarkers from clinical studies that were systematically selected for both breast and pancreatic cancers and discusses some of the common and unique elements between the two endocrine-regulated malignant diseases. Finding common ground between the two cancer types and specifically analyzing breast cancer study results, we hoped to explore potential feasible methods and biomarkers that may be useful also in diagnosing and treating pancreatic cancer. A PubMed MEDLINE search was used to identify articles that were published between 2015-2022 of different kinds of clinical trials that measured immune-modulatory biomarkers and biomarker changes of inflammation defined in diagnosis and treatment of breast cancer and pancreatic cancer patients. A total of 105 papers (pancreatic cancer 23, breast cancer 82) were input into Covidence for the title and abstract screening. The final number of articles included in this review was 73 (pancreatic cancer 19, breast cancer 54). The results showed some of the frequently cited inflammatory biomarkers for breast and pancreatic cancers included IL-6, IL-8, CCL2, CD8+ T cells and VEGF. Regarding unique markers, CA15-3 and TNF-alpha were two of several breast cancer-specific, and CA19 and IL-18 were pancreatic cancer-specific. Moreover, we discussed leptin and MMPs as emerging biomarker targets with potential use for managing pancreatic cancer based on breast cancer studies in the future, based on inflammatory mechanisms. Overall, the similarity in how both types of cancers respond to or result in further disruptive inflammatory signaling, and that point to a list of markers that have been shown useful in diagnosis and/or treatment method response or efficacy in managing breast cancer could potentially provide insights into developing the same or more useful diagnostic and treatment measurement inflammatory biomarkers for pancreatic cancer. More research is needed to investigate the relationship and associated inflammatory markers between the similar immune-associated biological mechanisms that contribute to breast and pancreatic cancer etiology, drive disease progression or that impact treatment response and reflect survival outcomes.

Breast Cancer Champions: a peer-to-peer education and mobile mammography program improving breast cancer screening rates for women of African heritage.

INTRODUCTION: Nationally, women of African heritage die at higher rates from breast cancer than women of other races or ethnicities. We developed Breast Cancer Champions (BCC) a peer-to-peer education program, which recruited 12 women and deployed them into the community in August 2020 during the height of the COVID pandemic. BCC aims to improve breast cancer screening rates for women of African heritage through peer-to-peer education, which has proven successful for addressing cancer-related health disparities. METHODS: BCC community experts, or "Champions," are peer-to-peer educators that conduct awareness and screening events in their communities. Champion's education activities were tracked by bi-weekly check-in calls, which recorded the activity type, location, and the number of participants for each event. We used spatial and statistical analyses to determine the efficacy of the program at increasing screening rates for women within the area of Champion activity versus women outside of their activity area. RESULTS: Over 15 months, Champions conducted 245 in-person or online events to engage women in their community for screening. More women of African heritage were screened in areas Champions were active during the intervention compared to historical data comparing areas outside of the Champion activity in the prior 15 months (X 2 = 3.0845, p = 0.079). CONCLUSION: BCC successes could be attributed to pivoting to online community building when in-person events were restricted and enabling Champions to design and conduct their own events, which increased outreach possibilities. We demonstrate improved screening outcomes associated with an updated peer-to-peer education program.

The impact of COVID-19 on screening for colorectal, gastric, breast, and cervical cancer in Korea.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has affected the utilization of healthcare services, including participation in cancer screening programs. We compared cancer screening participation rates for colorectal, gastric, breast, and cervical cancers among participants in the National Cancer Screening Program (NCSP) in 2019 and 2020 to address the potential distraction effect of COVID-19 on cancer screening. METHODS: Data from the NCSP for 4 cancer types (stomach, colorectal, breast, and cervical) in 2019 and 2020 were used to calculate cancer screening participation rates by calendar month, gender, age group, and geographical region. Monthly participation rates were analyzed per 1,000 eligible individuals. RESULTS: The screening participation rate decreased in 2020 compared to 2019 for all 4 cancers: colorectal (40.5 vs. 35.3%), gastric (61.9 vs. 54.6%), breast (63.8 vs. 55.8%), and cervical (57.8 vs. 52.2%) cancers. Following 2 major COVID-19 waves in March and December 2020, the participation rates in the 4 types of cancer screening dropped compared with those in 2019. The highest decline was observed in the elderly population aged 80 years and older (percentage change: -21% for colorectal cancer; -20% for gastric cancer; -26% for breast cancer; -20% for cervical cancer). CONCLUSIONS: After the 2 major COVID-19 waves, the screening participation rate for 4 types of cancer declined compared with 2019. Further studies are needed to identify the indirect effects of the COVID-19 pandemic on cancer patients, such as delayed diagnoses of cancer or excess cancer deaths.

Delayed Diagnosis and Prognostic Impact of Breast Cancer During the COVID-19 Pandemic.

BACKGROUND: Breast screening services were suspended for several months owing to the coronavirus disease 2019 (COVID-19) pandemic. We estimated the potential impact on breast cancer mortality using long-term global observations. However, the magnitude of the impact may vary across countries; therefore, we conducted an analysis and modeling study of this impact in Japan. PATIENTS AND METHODS: We compared the clinicopathological features of breast cancers between the nonpandemicgroup (April 1, 2019 to October 31, 2019) and the pandemic group (April 1, 2020 to October 31, 2020). We also compared the estimated 10-year survival rates between the two groups based on the weighted average of the 10-year survival rate by clinical stage and site (2004-2007). RESULTS: Results...Pandemic-related disruption decreased the number of breast cancer cases from296 to 249 during both 7-month periods. The percentage of patients with stage IIB or higher disease was significantly higher in the pandemic group than in the non-pandemic group (22.0% vs. 31.3%, P = 0.0133). The percentage of cases with a Ki-67 labeling index higher than 20% tended to be higher in the pandemic group than in the non-pandemic group (62.2% vs. 54.4%). The estimated 10-year survival rate was lower in the pandemic group than in the non-pandemic group (83.9% vs. 87.9%, 95% confidence interval of the difference: 0.87-8.8, P > 0.05). CONCLUSION: We found more aggressive and advanced disease afterthe suspension of breast cancer screening services owing to the COVID-19 pandemic. This may have affected the long-term clinical outcomes of patients with breast cancer.

Optimising the delivery of breast cancer risk assessment for women aged 30-39 years: A qualitative study of women's views.

BACKGROUND: Identifying women aged 30-39 years at increased risk of developing breast cancer could allow them to consider screening and preventive strategies. Research is underway to determine the feasibility of offering breast cancer risk assessment to this age group. However, it is unclear how best to deliver and communicate risk estimates to these women, in order to avoid potential harms such as undue anxiety and increase benefits such as informed decision-making. OBJECTIVES: This study aimed to investigate women's views on, and requirements for, this proposed novel approach to risk assessment. DESIGN: A cross-sectional qualitative design was used. METHODS: Thirty-seven women aged 30-39 years with no family history or personal history of breast cancer participated in seven focus groups (n = 29) and eight individual interviews. Data were analysed thematically using a framework approach. RESULTS: Four themes were developed. Acceptability of risk assessment service concerns the positive views women have towards the prospect of participating in breast cancer risk assessment. Promoting engagement with the service describes the difficulties women in this age group experience in relation to healthcare access, including mental load and a lack of cultural awareness, and the implications of this for service design and delivery. Impact of receiving risk results focuses on the anticipated impacts of receiving different risk outcomes, namely, complacency towards breast awareness behaviours following low-risk results, an absence of reassurance following average-risk results and anxiety for high-risk results. Women's information requirements highlights women's desire to be fully informed at invite including understanding why the service is needed. In addition, women wanted risk feedback to focus on plans for management. CONCLUSION: The idea of breast cancer risk assessment was received favourably among this age group, providing that a risk management plan and support from healthcare professionals is available. Determinants of acceptability of a new service included minimising effort required to engage with service, co-development of invitation and risk feedback materials and the importance of educational campaigning about the potential benefits of participation in risk assessment.

Women's perception about the discovery of breast cancer amid the covid-19 pandemic.

BACKGROUND: Breast cancer is considered a health problem at a worldwide level. In Brazil, the South and Southeast regions have the highest mortality rates. Understanding how they dealt with the diagnostic of a stigmatized disease amid the COVID-19 pandemic and its potential repercussions, may enable healthcare professionals to of life. Thus, this study is aimed at understanding the perception of women about the discovery of breast cancer and the impact of the disease on their lives. METHODS: A qualitative study, with the participation of forty women with breast cancer, under chemotherapy treatment. It was performed in a hospital specialized in oncology, in Juiz de Fora, Brazil, in 2020 and 2021. Data collection was carried out with semi-structured interviews, which were analyzed with Bardin Content Analysis. RESULTS: Based on the central theme "Discovery of the disease", these categories were developed: "Discovery" and "Impact of the disease". A large part of women noticed a change in the breast, even before routine checks. Upon the impact of cancer diagnosis, negative feelings arise, then going through a process of acceptance and coping. Some barriers were faced due to the COVID-19 pandemic, which caused delays in the diagnostic and impact caused by social isolation. Family, friends, and healthcare professionals integrated an important supporting network in order to help coping with the disease. CONCLUSION: The consequences of a breast cancer diagnosis can be devastating. It is necessary that healthcare professionals know and embrace the feelings, beliefs, and values as a part of the aspects related to health. Valuing the supporting network of women suffering from the disease may favor the process of accepting and coping with the neoplasm. The COVID-19 pandemic is highlighted as an obstacle to be overcome specially when it comes to diagnostic assistance and availability of a support network. In that sense, it is worth mentioning the importance of a healthcare team able to offer full assistance, with quality. The need of further studies to determine the impact of the pandemic in the long run.

The New Coronavirus Pandemic and the Trend of Breast Cancer Diagnosis according to Age-Group: Total and Interrupted Time Series Study.

OBJECTIVE: There is a lack of studies evaluating the COVID-19 pandemic effect on breast cancer detection according to age-group. This study aimed to assess the pandemic impact on the trend of mammograms, breast biopsies, and breast cancer stage at diagnosis according to age-group. METHODS: This was an ecological time series study by inflection point regression model. We used data from women aged between 30 and 49, 50 and 69, and 70 years or more available in an open-access dataset of the Brazilian public healthcare system (2017-2021). We analyzed the trend of the variables in the pre-pandemic and the pandemic effect on the total time series. RESULTS: The decreasing or stationary trend of mammograms in the pre-pandemic has changed to a decreasing trend in the total time series in all age-groups. Before the pandemic, the increasing trend of breast biopsies has changed to stationary in the total time series in all age-groups. The increasing trend of tumors at stages 0 to II in the pre-pandemic has changed to decreasing or stationary in the total time series. Finally, the increasing trend of tumors at stage III or IV remained increasing in the total time series in all age-groups. CONCLUSION: The pandemic has changed the stationary or increasing trend to a decreasing or stationary trend of mammograms, breast biopsies, and tumors at stages 0 to II but has not influenced the increasing trend of tumors at stages III and IV in all age-groups.

COVID-19 and Breast Cancer in Brazil.

Objectives: This study aimed to evaluate COVID-19 effects on breast cancer screening and clinical stage at diagnosis in patients of 50-69 years of age receiving care within the public healthcare network (SUS) in 2013-2021 in Brazil and its macro-regions. Methods: This ecological study used Poisson regression to analyze trends in screening and staging. A secondary database was formed using SUS sources: outpatient data system of the SUS network and Oncology-Brazil Panel. Results: There was a reduction in screening, with an annual percent change of -5.9 (p < 0.022). The number of notified cases fell by 31.5% in 2020-2021 compared to 2018-2019. There was a 10.7% increase in the proportion of stage III/IV cases (p < 0.001) in 2020-2021 compared to 2013-2019, now surpassing the number of cases of early stage breast cancer. Conclusion: COVID-19 led to a reduction in breast cancer screening and an expressive increase in advanced tumors in users of the public healthcare network. Urgent interventions in public policies are required as the negative effects of the pandemic on the diagnosis/treatment of breast cancer are becoming apparent even earlier than expected.

Impact of COVID-19 pandemic on breast and cervical cancer screening in Denmark: A register-based study.

Background: Denmark was one of the few countries where it was politically decided to continue cancer screening during the COVID-19 pandemic. We assessed the actual population uptake of mammography and cervical screening during this period. Methods: The first COVID-19 lockdown in Denmark was announced on 11 March 2020. To investigate possible changes in cancer screening activity due to the COVID-19 pandemic, we analysed data from the beginning of 2017 until the end of 2021. A time series analysis was carried out to discover possible trends and outliers in the screening activities in the period 2017-2021. Data on mammography screening and cervical screening were retrieved from governmental pandemic-specific monitoring of health care activities. Results: A brief drop was seen in screening activity right after the first COVID-19 lockdown, but the activity quickly returned to its previous level. A short-term deficit of 43% [CI -49 to -37] was found for mammography screening. A short-term deficit of 62% [CI -65 to -58] was found for cervical screening. Furthermore, a slight, statistically significant downward trend in cervical screening from 2018 to 2021 was probably unrelated to the pandemic. Other changes, for example, a marked drop in mammography screening towards the end of 2021, also seem unrelated to the pandemic. Conclusions: Denmark continued cancer screening during the pandemic, but following the first lockdown a temporary drop was seen in breast and cervical screening activity. Funding: Region Zealand (R22-A597).

A modelled evaluation of the impact of COVID-19 on breast, bowel, and cervical cancer screening programmes in Australia.

Australia introduced COVID-19 infection prevention and control measures in early 2020. To help prepare health services, the Australian Government Department of Health commissioned a modelled evaluation of the impact of disruptions to population breast, bowel, and cervical cancer screening programmes on cancer outcomes and cancer services. We used the Policy1 modelling platforms to predict outcomes for potential disruptions to cancer screening participation, covering periods of 3, 6, 9, and 12 mo. We estimated missed screens, clinical outcomes (cancer incidence, tumour staging), and various diagnostic service impacts. We found that a 12-mo screening disruption would reduce breast cancer diagnoses (9.3% population-level reduction over 2020-2021) and colorectal cancer (up to 12.1% reduction over 2020-21), and increase cervical cancer diagnoses (up to 3.6% over 2020-2022), with upstaging expected for these cancer types (2, 1.4, and 6.8% for breast, cervical, and colorectal cancers, respectively). Findings for 6-12-mo disruption scenarios illustrate that maintaining screening participation is critical to preventing an increase in the burden of cancer at a population level. We provide programme-specific insights into which outcomes are expected to change, when changes are likely to become apparent, and likely downstream impacts. This evaluation provided evidence to guide decision-making for screening programmes and emphasises the ongoing benefits of maintaining screening in the face of potential future disruptions.

Socio-economic variations of breast cancer treatment and discontinuation: a study from a public tertiary cancer hospital in Mumbai, India.

BACKGROUND: The study examined the socio-economic variation of breast cancer treatment and treatment discontinuation due to deaths and financial crisis. METHODS: We used primary data of 500 patients with breast cancer sought treatment at India's one of the largest cancer hospital in Mumbai, between June 2019 and March 2022. This study is registered on the Clinical Trial Registry of India (CTRI/2019/07/020142). Kaplan-Meier method and Cox-hazard regression model were used to calculate the probability of treatment discontinuation. RESULTS: Of the 500 patients, three-fifths were under 50 years, with the median age being 46 years. More than half of the patients were from outside of the state and had travelled an average distance of 1,044 kms to get treatment. The majority of the patients were poor with an average household income of INR15,551. A total of 71 (14%) patients out of 500 had discontinued their treatment. About 5.2% of the patients died and 4.8% of them discontinued treatment due to financial crisis. Over one-fourth of all deaths were reported among stage IV patients (25%). Patients who did not have any health insurance, never attended school, cancer stage IV had a higher percentage of treatment discontinuation due to financial crisis. Hazard of discontinuation was lower for patients with secondary (HR:0.48; 95% CI: 0.27-0.84) and higher secondary education (HR: 0.42; 95% CI: 0.19-0.92), patients from rural area (HR: 0.79; 95% CI: 0.42-1.50), treated under general or non-chargeable category (HR: 0.60; 95% CI:0.22-1.60) while it was higher for the stage IV patients (HR: 3.61; 95% CI: 1.58-8.29). CONCLUSION: Integrating breast cancer screening in maternal and child health programme can reduce delay in diagnosis and premature mortality. Provisioning of free treatment for poor patients may reduce discontinuation of treatment.

Changes in Stage at Presentation among Lung and Breast Cancer Patients During the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic altered access to healthcare by decreasing the number of patients able to receive preventative care and cancer screening. We hypothesized that, given these changes in access to care, radiologic screening for breast and lung cancer would be decreased, and patients with these cancers would consequently present at later stages of their disease. STUDY DESIGN: This is a retrospective cross-sectional study of 2017 to September 2021 UMass Memorial Tumor Registry data for adult breast and lung cancer patients. Changes in stage at presentation of breast and lung cancer during the COVID-19 pandemic were measured, defined as before and during COVID-19. RESULTS: There were no statistically significant changes in the overall stage of presentation before or during the COVID-19 pandemic for either breast or lung cancer patients. Analysis of case presentation and stage during periods of COVID-19 surges that occurred during the time of this study compared with prepandemic data demonstrated a statistically significant decrease in overall presentation of breast cancer patients in the first surge, with no other statistically significant changes in breast cancer presentation. A nonstatistically significant decrease in lung cancer presentation was seen during the initial surge of COVID-19. There was also a statistically significant increase in early-stage presentation of lung cancer during the second and third COVID-19 surges. CONCLUSIONS: In the 2 years after the COVID-19 pandemic, we were not able to demonstrate stage migration at presentation of breast and lung cancer patients to later stages despite decreases in overall presentation during the initial 2 years of the COVID pandemic. An increase in early-stage lung cancer during the second and third surges is interesting and could be related to increased chest imaging for COVID pneumonia.

Racial Disparities in Breast Cancer Presentation and Diagnosis in COVID-Era Central Texas.

INTRODUCTION: The COVID-19 pandemic has significantly impacted the diagnosis of breast cancer (BC). With a large Hispanic/Latinx population, early revocation of mask mandates, and lower vaccination rate than many other states, this study explores the relationship between COVID-19 and the presentation and diagnosis of BC patients in the unique socio-politico-economic context of Central Texas. METHODS: This study is a retrospective review of the Seton Medical Center Austin tumor registry for BC patients from March 1, 2019 to March 2, 2021. We compared demographics, insurance status, clinical and pathologic stage, and time from diagnosis to intervention between "pre-COVID" (March 1, 2019- March 1, 2020) and "post-COVID" (March 2, 2020-March 2, 2021). We utilized descriptive, univariate, and multivariable logistic regression statistics. RESULTS: There were 781 patients diagnosed with BC, with 113 fewer post-COVID compared to pre-COVID. The proportion of Black patients diagnosed with BC decreased post-COVID compared with pre-COVID (10.1%-4.5%, P = 0.002). When adjusting for other factors, uninsured and underinsured patients had increased odds of presenting with late-stage BC (odds ratio:5.40, P < 0.001). There was also an association between presenting with stage 2 or greater BC and delayed time-to-intervention. CONCLUSIONS: Although fewer women overall were diagnosed with BC post-COVID, the return to baseline diagnoses has yet to be seen. We identified a pandemic-related decrease in BC diagnoses in Black women and increased odds of late-stage cancer among uninsured patients, suggesting a disparate relationship between COVID-19 and health care access and affordability. Outreach and screening efforts should address strategies to engage Black and uninsured patients.

Breast Cancer Screening, Diagnosis, and Surgery during the Pre- and Peri-pandemic: Experience of Patients in a Statewide Health Information Exchange.

BACKGROUND: Measures taken to address the COVID-19 pandemic interrupted routine diagnosis and care for breast cancer. The aim of this study was to characterize the effects of the pandemic on breast cancer care in a statewide cohort. PATIENTS AND METHODS: Using data from a large health information exchange, we retrospectively analyzed the timing of breast cancer screening, and identified a cohort of newly diagnosed patients with any stage of breast cancer to further access the information available about their surgical treatments. We compared data for four subgroups: pre-lockdown (preLD) 25 March to 16 June 2019; lockdown (LD) 23 March to 3 May 2020; reopening (RO) 4 May to 14 June 2020; and post-lockdown (postLD) 22 March to 13 June 2021. RESULTS: During LD and RO, screening mammograms in the cohort decreased by 96.3% and 36.2%, respectively. The overall breast cancer diagnosis and surgery volumes decreased up to 38.7%, and the median time to surgery was prolonged from 1.5 months to 2.4 for LD and 1.8 months for RO. Interestingly, higher mean DCIS diagnosis (5.0 per week vs. 3.1 per week, p < 0.05) and surgery volume (14.8 vs. 10.5, p < 0.05) were found for postLD compared with preLD, while median time to surgery was shorter (1.2 months vs. 1.5 months, p < 0.0001). However, the postLD average weekly screening and diagnostic mammogram did not fully recover to preLD levels (2055.3 vs. 2326.2, p < 0.05; 574.2 vs. 624.1, p < 0.05). CONCLUSIONS: Breast cancer diagnosis and treatment patterns were interrupted during the lockdown and still altered 1 year after. Screening in primary care should be expanded to mitigate possible longer-term effects of these interruptions.

Breast and Lung Cancer Screening Among Medicare Enrollees During the COVID-19 Pandemic.

Importance: Several studies reported sharp decreases in screening mammography for breast cancer and low-dose computed tomographic screening for lung cancer in the early months of the COVID-19 pandemic, followed by a return to normal or near-normal levels in the summer of 2020. Objective: To determine the observed vs expected mammography and low-dose computed tomographic scan rates from the beginning of the pandemic through April 2022. Design, Setting, and Participants: In this retrospective cohort study assessing mammography and low-dose computed tomography rates from January 2017 through April 2022, data for January 2016 to February 2020 were used to generate expected rates for the period March 2020 to April 2022. The study included a 20% national sample of Medicare fee-for-service enrollees among women aged 50 to 74 years for mammography, and men and women aged 55 to 79 years for low-dose computed tomographic scan. Main Outcomes and Measures: Receipt of screening mammography or low-dose computed tomographic scan. Results: The yearly cohorts for the mammography rates included more than 1 600 000 women aged 50 to 74 years, and the cohorts for the low-dose computed tomographic scan rates included more than 3 700 000 men and women aged 55 to 79 years. From January 2017 through February 2020, monthly mammography rates were flat, whereas there was a monotonic increase in low-dose computed tomographic scan rates, from approximately 500 per million per month in early 2017 to 1100 per million per month by January 2020. Over the period from March 2020 to April 2022, there were episodic drops in both mammography and low-dose computed tomographic scan rates, coincident with increases in national COVID-19 infection rates. For the periods from March 2020 to February 2020 and March 2021 to February 2022, the observed low-dose computed tomographic scan rates were 24% (95% CI, 23%-24%) and 14% (95% CI, 13%-15%) below expected rates, whereas mammography rates were 17% (95% CI, 17%-18%) and 4% (95% CI, 4%-3%) below expected. Conclusions and Relevance: In this cohort study, the decreases in cancer screening during the early phases of the COVID-19 pandemic did not resolve after the initial pandemic surges. Successful interventions to improve screening rates should address pandemic-specific reasons for low screening participation.