Ethnic and Racial Inequities in Cancer Screening During the COVID-19 Pandemic: a multi-site observational study in the United States

Abstract

The total impact of the current COVID-19 pandemic on cancer screenings and diagnostic procedures by race and ethnicity has not yet been fully characterized. In this study, we compared the ethnic and racial differences in cancer screening for breast, colon, and prostate cancer and compared them to population-level SARS-CoV2 infection rates in the United States between January 2019 and January 2021. A significant reduction in all screening activities was observed between March and May of 2020, with the largest relative decline in April during the initial SARS-CoV2 surge. In that month, screening mammography declined by 80% overall, with the relative largest decline among Black individuals (90%). A higher proportion of Black individuals received diagnostic mammography in April 2020. However, between June 2020 and January 2021, there was a relative increase in diagnostic mammograms observed across all groups. There was also a relative reduction in colon cancer screening, with the largest decline in April 2020 among Black individuals (75%). The largest relative reduction in PSA screening was in Hispanic individuals (66%). During the examined study period, surgical resections for breast, colon, and prostate resections were reduced and remained lower than baseline through 2020. The reduction in breast, colon, and prostate cancer screening coincided with the first surge of the SARS-CoV2 infections, but not with the second. There was a small reduction in breast and colon cancer screening with the third surge. Differential inequities in cancer screening and diagnoses were observed by race and ethnicity and corresponded primarily to the initial surge of SARS-CoV2.