COVID-19 pandemic interruption of breast cancer screening is linked to clinical upstaging at presentation: the roles of demographics, socioeconomic status and unmet social needs.

Background: COVID-19 pandemic-related disruptions of mammography screening, breast cancer diagnosis, staging, and treatment options are not well understood with respect to social determinants of health, especially three years post-pandemic.

Methods: This retrospective observational study included patients screened by mammography or diagnosed with breast cancer from January 2019 to February 2023 in the urban population in the Bronx.

Results: Screening and diagnostic mammography, and breast cancer diagnoses from April to August 2020 dropped by 61%, 47%, and 42%, respectively, compared to pre-pandemic (Jan 2019-Mar 2020) and largely recovered by September 2020. Compared to pre-pandemic baseline, patients diagnosed with breast cancer from September 2020 to January 2021 were 1.48 times (95% CI [1.03, 2.13]) more likely to present with clinical stage 2-4, and 1.47 [1.04-2.08] times more likely to present with T stage 2-4. Black patients experienced a more significant increase in odds of presenting with clinical stage 2-4 (4.41 [1.36, 14.24]) and nodal involvement (4.61 [1.27, 16.82]) compared to non-Hispanic Whites from Apr 2020 to Jan 2021.

Conclusion: Interruption of breast cancer screening during the pandemic coincided with increased proportions of patients presenting with more advanced disease, especially among Black patients. The results underscore the need for targeted public health interventions to address health disparities among these populations.