Determinants of Breast Cancer Screening Adherence During the COVID-19 Pandemic in a Cohort at Increased Inherited Cancer Risk in the United States
- PMID: 39420801
- PMCID: PMC11489983
- DOI: 10.1177/10732748241272727
Determinants of Breast Cancer Screening Adherence During the COVID-19 Pandemic in a Cohort at Increased Inherited Cancer Risk in the United States
Abstract
Background: We examined neighborhood characteristics concerning breast cancer screening annual adherence during the COVID-19 pandemic.
Methods: We analyzed 6673 female patients aged 40 or older at increased inherited cancer risk in 2 large health care systems (NYU Langone Health [NYULH] and the University of Utah Health [UHealth]). Multinomial models were used to identify predictors of mammogram screening groups (non-adherent, pre-pandemic adherent, pandemic period adherent) in comparison to adherent females. Potential determinants included sociodemographic characteristics and neighborhood factors.
Results: Comparing each cancer group in reference to the adherent group, a reduced likelihood of being non-adherent was associated with older age (OR: 0.97, 95% CI: 0.95, 0.99), a greater number of relatives with cancer (OR: 0.80, 95% CI: 0.75, 0.86), and being seen at NYULH study site (OR: 0.42, 95% CI: 0.29, 0.60). More relatives with cancer were correlated with a lesser likelihood of being pandemic period adherent (OR: 0.89, 95% CI: 0.81, 0.97). A lower likelihood of being pre-pandemic adherent was seen in areas with less education (OR: 0.77, 95% CI: 0.62, 0.96) and NYULH study site (OR: 0.35, 95% CI: 0.22, 0.55). Finally, greater neighborhood deprivation (OR: 1.47, 95% CI: 1.08, 2.01) was associated with being non-adherent.
Conclusion: Breast screening during the COVID-19 pandemic was associated with being older, having more relatives with cancer, residing in areas with less educational attainment, and being seen at NYULH; non-adherence was linked with greater neighborhood deprivation. These findings may mitigate risk of clinically important screening delays at times of disruptions in a population at greater risk for breast cancer.
Keywords: COVID-19; cancer screening; education; electronic health records; health inequities; inherited risk; mammograms; neighborhood barriers; racial disparities; structural barriers.
Plain language summary
Breast Cancer Screening Adherence in the US During COVID-19: We examined predictors of breast cancer screening adherence during COVID-19 at two large healthcare systems. Adherence was associated with older age, having more relatives with a cancer history, and living in areas with less educational attainment. Nonadherence was associated with greater neighborhood deprivation.
Conflict of interest statement
Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Kensaku Kawamoto reports honoraria, consulting, sponsored research, licensing, or co-development outside the submitted work in the past 3 years with Hitachi, Pfizer, RTI International, the University of California at San Francisco, Indiana University, the Korean Society of Medical Informatics, the University of Nebraska, NORC at the University of Chicago, the Regenstrief Foundation, Elsevier, the University of Pennsylvania, MD Aware, Security Risk Solutions, Custom Clinical Decision Support, and Yale University in the area of health information technology. Kensaku Kawamoto was also an unpaid board member of the non-profit Health Level 7 International health IT standard development organization, he is an unpaid member of the U.S. Health Information Technology Advisory Committee, and he has helped develop a number of health IT tools which may be commercialized to enable wider impact. None of these relationships have direct relevance to the manuscript but are reported in the interest of full disclosure.
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