The Covid-19 pandemic caused millions of women—especially Hispanic women and those with lower incomes—to forgo breast and cervical cancer screenings in 2020, according to researchers from the American Cancer Society, who suggested obstacles such as financial difficulties and broader social and economic factors during the pandemic may have played a role in the reduced rates.
More than 2 million fewer women reported having a breast cancer screening in 2020 compared to 2018, a 6% decrease, while the number of women who reported completing a cervical cancer screening dropped 11% in 2020, according to the Journal of the American Medical Association study.
Screenings fell 80% at the beginning of the pandemic in March and April 2020, with many catching up later in 2020, but overall, “the COVID-19 pandemic kept screenings down over the course of the entire year,” Ahmedin Jemal, senior author of the study and senior vice president of surveillance and health equity science at the American Cancer Society, said in a statement.
Breast cancer screenings decreased more among Hispanic, Asian and Native American women compared to white women, according to the study, which used survey data from the national Behavioral Risk Factor Surveillance System.
The number of Asian and Pacific Islander women who reported completing a breast cancer screening also dropped by 27%, the largest decrease for any race.
Non-high school graduates were less likely than college graduates to complete breast and cervical cancer screenings, with a 17.7% decrease in cervical cancer screenings in 2020 for those who hadn’t completed high school compared to a 9.5% drop for college graduates.
What We Don’t Know
How these lower rates of screenings will affect potential cancer diagnoses and survival, according to Jemal, though researchers know cancer screenings save lives. Researchers will need to monitor the issue closely to “understand the impact of lower screening rates on cancer outcomes among people of color” and lower income people, while working to improve “access to health care and cancer screenings for everyone,” Jemal said.
Colorectal cancer screenings among men and women remained steady in 2020 compared to 2018 because patients were able to replace colonoscopy procedures with at-home stool testing, researchers found.
Routine screenings have helped cut cervical cancer deaths in the U.S. in half over the last 30 years, while mammograms prevent 12,000 deaths annually, according to the New York Department of Health.
The Covid-19 pandemic led to significant disruptions in access to health care, with many delaying elective and preventative procedures due to safety concerns and overburdened health-care systems. According to the Kaiser Family Foundation, women were more likely than men to have gone without health care—including preventative services—during the pandemic, and lower income women were more likely to experience worsening health issues as a result of skipping those services. Overall rates of cancer screenings are lower among Black, Hispanic, Asian and Native American populations compared to white people, leading to disparities in cancer outcomes, according to Kaiser. Researchers have also found people of color are more likely than their white counterparts to be uninsured and encounter other barriers to accessing health care. The JAMA study is the first to evaluate the impact of the coronavirus pandemic on cancer screenings on a national level using population-based data.