Another COVID Inequity: Pandemic-related Decline in Mammography Not Evenly Distributed

Results reported today in JAMA Network Open show that the pandemic-related decline in screening mammograms was steeper among Hispanic, American Indian-Alaska Native and Black women than among white women. The investigators reporting the results say the findings suggest yet another healthcare inequity in the COVID-19 pandemic.

Ofer Amram, Ph.D., an assistant professor at Washington State University’s Elson S. Floyd College of Medicine and his colleagues, also found that women in rural areas were less likely to get mammograms than those in rural areas and that the fall off in screening was greater among women who paid for screening themselves or were covered by Medicaid than women with other kinds of insurance coverage.

The general decline in routine, often preventive healthcare last year, including cancer screening, because of the pandemic has been well documented from multiple angles. Now researchers are adding layers of specificity and nuance with studies such as this.

Related: U.S. Cancer Diagnoses Fell by 50% in 2020 Amid the Pandemic, says NCI Director Sharpless

Amram and his co-investigators conducted their study using data from an unnamed statewide nonprofit community healthcare system in Washington State. They compared mammograms during April through December 2019 to the same period in 2020.

Overall, the number fell by about half (49%): 55,678 in 2019 compared with 27,522 in 2020, and among white women, the number of mammograms fell by nearly the proportion, 49.2% (45,572 versus 23,163). But among Hispanic women, it decreased by 64.2% (1,727 versus 619); among American Indian/Alaska Native women, by 60.9% (215 versus 84); and among Black women, by 53.9% (2,320 versus 1,069).

A study of services offered by a single healthcare system may not paint a complete picture; Amram and his colleagues note, for example, that the demographics of the women in their study were less diverse than Washington State as a whole. It is also possible that some of the decline might be explained by women getting mammograms elsewhere, although Amram and his colleagues say that it is unlikely because the healthcare system’s data they studied is one of the largest in the state.