Impact of the COVID-19 pandemic on breast cancer screening indicators in a Spanish population-based program: a cohort study
- Institut Hospital del Mar d'Investigacions Mèdiques, Spain
- Autonomous University of Barcelona, Spain
Abstract
Background: To assess the effect of the COVID-19 pandemic on performance indicators in the population-based breast cancer screening program of Parc de Salut Mar (PSMAR), Barcelona, Spain.
Methods: We conducted a before-and-after, study to evaluate participation, recall, false-positives, the cancer detection rate, and cancer characteristics in our screening population from March 2020 to March 2021 compared with the four previous rounds (2012-2019). Using multi-level logistic regression models, we estimated the adjusted odds ratios (aOR) of each of the performance indicators for the COVID-19 period, controlling by type of screening (prevalent or incident), socioeconomic index, family history of breast cancer, and menopausal status. We analyzed 144,779 invitations from 47,571 women.
Results: During the COVID-19 period, the odds of participation were lower in first-time invitees (aOR=0.90[95%CI=0.84-0.96]) and in those who had previously participated regularly and irregularly (aOR=0.63 [95%CI=0.59-0.67] and aOR=0.95 [95%CI=0.86-1.05], respectively). Participation showed a modest increase in women not attending any of the previous rounds (aOR=1.10 [95%CI=1.01-1.20]). The recall rate decreased in both prevalent and incident screening (aOR=0.74 [95%CI 0.56-0.99] and aOR=0.80 [95%CI 0.68-0.95], respectively). False positives also decreased in both groups (prevalent aOR=0.92 [95%CI 0.66-1.28] and incident aOR=0.72 [95%CI 0.59-0.88]. No significant differences were observed in compliance with recall (OR= 1.26, 95%CI 0.76-2.23), cancer detection rate (aOR=0.91 [95%CI=0.69-1.18]) or cancer stages.
Conclusions: The COVID-19 pandemic negatively affected screening attendance, especially in previous participants and newcomers. We found a reduction in recall and false-positives and no marked differences in cancer detection, indicating the robustness of the program. There is a need for further evaluations of interval cancers and potential diagnostic delays.
Funding: This study has received funding by grantsPI19/00007 and PI21/00058, funded by Instituto de Salud Carlos III (ISCIII) and co-funded by the European Union and Grant RD21/0016/0020 funded by Instituto de Salud Carlos III and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia (MRR).
Data availability
Source data form all tables and figures can be found in the following Dataset:BOSCH, GUILLERMO, 2022, "Breast cancer screening program invitations (2012-2021)", https://doi.org/10.7910/DVN/VVQNWM, Harvard Dataverse, V1, UNF:6:CaW3sEp4tMsg13z2I1eZbQ== [fileUNF]Data from "Impact on covid19 dataset invited women.sav" was used in tables 1 and 2 and figures 1,2 and 3. Data from "cancer characteristics database.tab" was used in table 3.
Article and author information
Author details
Funding
Instituto de Salud Carlos III (PI19/00007)
- Margarita Posso
Instituto de Salud Carlos III (PI21/00058)
- Guillermo Bosch
Instituto de Salud Carlos III (PI21/00058)
- Javier Louro
Instituto de Salud Carlos III (PI21/00058)
- Marta Roman
Instituto de Salud Carlos III (PI21/00058)
- Francesc Macià
The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.
Ethics
Human subjects: Due to the retrospective nature of the study and the absence of direct contact with women, which did not affect their relationship with the program, informed consent was waived by the Ethics Committee of PSMAR, which approved the study (reg.2021/9866). The study guaranteed Spain's legal regulations on data confidentiality (law 15/99 of December 13 on the protection of personal data).
Copyright
© 2022, Bosch et al.
This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.
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Impact of the COVID-19 pandemic on breast cancer screening indicators in a Spanish population-based program: a cohort study
eLife 11:e77434.
https://doi.org/10.7554/eLife.77434
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