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Showing content from https://pubmed.ncbi.nlm.nih.gov/36735262/ below:

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

. 2023 Feb 1;6(2):e2255589. doi: 10.1001/jamanetworkopen.2022.55589. Breast and Lung Cancer Screening Among Medicare Enrollees During the COVID-19 Pandemic

Affiliations

¹ Department of Medicine, University of Texas Medical Branch, Galveston.
² Sealy Center on Aging, University of Texas Medical Branch, Galveston.

PMID: 36735262
PMCID: PMC9898823
DOI: 10.1001/jamanetworkopen.2022.55589

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

Christopher Doan et al. JAMA Netw Open. 2023.

. 2023 Feb 1;6(2):e2255589. doi: 10.1001/jamanetworkopen.2022.55589. Affiliations

¹ Department of Medicine, University of Texas Medical Branch, Galveston.
² Sealy Center on Aging, University of Texas Medical Branch, Galveston.

PMID: 36735262
PMCID: PMC9898823
DOI: 10.1001/jamanetworkopen.2022.55589

Item in Clipboard

Abstract

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.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors reported grants from Cancer Prevention and Treatment Institute of Texas Comparative Effectiveness Research on Cancer in Texas (RP160674) and other from UTMB Claude Pepper Center National Institute on Aging (P30AG024832) during the conduct of the study. No other disclosures were reported.

Figures
Figure 1.. Rates of Monthly Mammography Screening…

Figure 1.. Rates of Monthly Mammography Screening From January 2017 Through July 2022 for Women…
Figure 1.. Rates of Monthly Mammography Screening From January 2017 Through July 2022 for Women Aged 50 to 74 Years With Fee-for-Service Medicare

Monthly national COVID-19 infection rates from January 2020 through July 2022 are also shown. The monthly rates were adjusted to reflect 30 days per month. The dotted prediction line was generated from the 38 months from January 2019 through February 2020. The slope from January 2017 to February 2020 was 0.00838% (95% CI, −0.0015% to 0.01830%) per month, not significantly different from 0. There were no significant changes in slope over that same period by joinpoint analyses. There were increases in rates each October, corresponding to Breast Cancer Awareness Month. After the initial fall in rates in March, April, and May of 2020, there were periodic decreases in screening rates, corresponding to increases in national COVID-19 case rates.

Figure 2.. Monthly Rates of Low-Dose Computed…

Figure 2.. Monthly Rates of Low-Dose Computed Tomographic (LDCT) Lung Cancer Screening Among Medicare Fee-for-Service…
Figure 2.. Monthly Rates of Low-Dose Computed Tomographic (LDCT) Lung Cancer Screening Among Medicare Fee-for-Service Beneficiaries Aged 55 to 79 Years, From January 2017 to July 2022

We adjusted the monthly LDCT rates to 30 days/mo. The dotted prediction line was generated from the 38 months from January 2017 through February 2020. There were no significant changes in slope over that same period by joinpoint analyses. National COVID-19 infection rates are given starting in 2020. The slope of the regression line was an increase in 17.81 (95% CI 15.65-19.96) LDCTs per million enrollees per month. As with the mammography rates, there were periodic decreases in LDCT screening rates corresponding to increases in national COVID-19 care rates.