Breast cancer screenings down during the pandemic, especially among women of color and those who live in rural Washington

The pandemic led to a significant drop in women being screened for breast cancer in Washington, a new study from Washington State University researchers shows.

Using mammogram data from more than 200 MultiCare clinics and hospitals in Washington, researchers found a 49% decrease in the number of women accessing mammograms in 2020 compared to the same time period in 2019.

The decrease in women accessing prevention screening for breast cancer was starkest among women of color and those who live in rural settings. Gaps and inequities in access to care existing long before the pandemic were compounded in the last year.

Dr. Ofer Amram, a WSU College of Medicine professor who led the research, was not surprised by these results.

“It’s really, I think, important to show that there’s so many levels of inequities in the system,” Amram said, noting that the research highlights these inequities.

The analysis of MultiCare data focuses on patients who are 50 years old and older. Amram and his team noted breast cancer screenings dropped the most among women who enrolled in Medicaid or considered “self-pay” patients, who pay for care out of pocket.

For Amram, this is in line with the chaos 2020 brought to many families with skyrocketing unemployment claims early in the pandemic. If money is tight, delays in prevention screenings make sense.

The WSU study findings back up international research about the plummeting number of breast cancer screenings in 2020. Those results also confirm the pandemic increased inequities that already existed, Amram said.

“When there is an issue with access to health care, like the pandemic, it impacts those who are most vulnerable or underserved in greater numbers in comparison to white women (in this study),” he said.

Black, Pacific Islander, Native American, Hispanic and Asian women received fewer mammograms in MultiCare health care settings in Washington in 2020 than they did during the same time period in 2019, the study shows.

Women living in rural settings accessed mammograms less than their urban counterparts during the pandemic year as well.

Further research might address whether or not less screenings lead to delayed diagnoses, but Amram said the immediate takeaway from the study is to encourage both providers and patients to schedule routine breast cancer screenings, particularly women who are 50 and older or have a history of breast cancer in their family.

One caveat to Amram’s research was it studied patient data, or women with electronic health records at MultiCare. It excludes women who are uninsured or do not have a primary health care provider. Amram, whose other research focuses on the social determinants of health, said underlying and compounding societal conditions can affect whether or not a person seeks care or a screening.

Having a stable job, health insurance and access to a trusted health care provider are not a given for everyone.

“I think all that is having a direct impact on health,” Amram said.