Disparities in Breast Cancer Screening and Diagnosis: Urban-Suburban Contrasts in the Wake of the COVID-19 Pandemic

Purpose: We aim to compare the impact and recovery from the COVID-19 pandemic on breast cancer screening and diagnosis in urban and suburban communities.

Methods/Materials: This is a retrospective cohort study which analyzed the number of screening and diagnostic mammograms, breast biopsies, and cancer diagnoses from 1/1/2019 to 12/31/2022 with subset comparison of urban and suburban sites from 1/1/2019 to 12/31/2021.

Results: In our hospital system, 26152 screening mammograms performed in 2019 dropped to 22576 in 2020, a decrease of 1.6% at suburban sites and 23.9% at urban sites. In 2021, screening volume at suburban and urban sites surpassed pre-pandemic levels by 31.0% and 2.6% and continued rising through 2022. Total diagnostic mammograms in 2020 decreased from 8627 in 2019 to 6521, a decrease of 21.4% at suburban and 26.4% at urban sites. Further decline occurred in 2021 at urban sites to 28.5% below pre-pandemic levels, and while volume increased at suburban sites, the total was 16.9% less than 2019. In 2022 at all sites, diagnostic volume remained 21.7% below pre-pandemic levels. Similarly, total breast biopsies in 2020 decreased to 942 from 1307 in 2019, a decrease of 20.8% at suburban and 32.4% at urban sites. In 2021, suburban and urban biopsy volume increased yet remained below pre-pandemic levels by 14.7% and 15.1%. Volume continued to improve in 2022, but biopsies at all sites were 5.6% less than 2019. Out of the 760 biopsies performed at urban sites in 2021, there were greater proportions of invasive ductal carcinoma and ductal carcinoma in situ by 16.3% and 15.9% compared to 2019. Conversely, out of 378 biopsies at suburban sites in 2021, these decreased by 24.9% and 57.4%.

Conclusions: Screening and diagnostic mammograms as well as breast biopsies decreased during the COVID-19 pandemic with disproportionate effect at urban sites, including greater volume loss, weaker resurgence, and larger proportions of cancer post-pandemic. At all sites, diagnostic mammograms and biopsies remain below pre-pandemic levels. Improving access to breast health services, including addressing radiology staff shortage, is essential to mitigate the pandemic’s impact on cancer detection, especially for urban patients.