Impact of the COVID-19 pandemic on breast cancer screening indicators in a Spanish population-based program: a cohort study

  1. Guillermo Bosch
  2. Margarita Posso  Is a corresponding author
  3. Javier Louro
  4. Marta Roman
  5. Miquel Porta
  6. Xavier Castells
  7. Francesc Macià
  1. Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Spain
  2. Preventive Medicine and Public Health Training Unit PSMar-ASPB-UPF, Spain
  3. Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Spain
  4. Universitat Autònoma de Barcelona, Spain
  5. Hospital del Mar Institute of Medical Research (IMIM PSMar), Spain
  6. Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Spain
5 figures, 5 tables and 2 additional files

Figures

Adjusted odds ratios of pre–post COVID-19 models for participation.
Adjusted odds ratios of pre–post COVID-19 models for recall, false positives, and cancer detection in participants.
Adjusted odds ratios of pre–post COVID-19 models for cancer detection according to histology.
Author response image 1
Author response image 2

Tables

Table 1
Baseline characteristics of women invited to the PSMAR breast cancer screening program in the BHA (Basic Health Areas) affected by the COVID-19 pandemic in the area of reference of Parc de Salut Mar (PSMAR), in Barcelona, Spain in the period 2012–2021 by screening round.
Pre-COVID 4 roundPre-COVID 3 roundPre-COVID 2 roundPre-COVID 1 roundPre-COVID totalPost-COVID +1 roundDifference post–preDif
(2012–2013)(2014–2015)(2016–2017)(2018–2019)(2012–2019)(2020–2021)
n%n%n%n%n%n%
Age group50–54910331.79949532.55945132.25901331.4137,06232.00874330.17−1.83^
55–59715324.98734525.18756925.83763126.5929,69825.65789927.261.61^
60–64668723.36657322.53669222.84666623.2326,61822.99683123.570.59^
65–70568819.87575619.73559319.09538718.7722,42419.36550418.99−0.37
Socioeconomic index levelLow445815.57447215.33437114.92437115.2317,67215.26453615.650.39
23038.0423568.0823297.9523388.1593268.0525068.650.59^
Middle-high15,20953.1215,66853.7115,86454.1315,55754.2162,29853.8015,60053.840.04
High666123.26667322.88674123.00643122.4126,50622.89633521.86−1.03^
Type of screening
PrevalentFirst invitation440915.40457115.67427114.57383113.3517,08214.75511417.652.90^
Previous nonparticipant849729.68863929.62904930.88901231.4035,19730.39845629.18−1.21^
Total12,90645.0813,21045.2913,32045.4512,84344.7552,27945.1513,57046.831.69
IncidentRegular participant13,41046.8413,47846.2113,49546.0513,39046.6653,77346.4413,07045.10−1.33^
Irregular participant23158.0924818.5124908.5024648.5997508.4223378.07−0.35
Total15,72554.9215,95954.7115,98554.5515,85455.2563,52354.8515,40753.17−1.69
Total28,631100.0029,169100.0029,305100.0028,697100.00115,802100.0028,977100.00
  1. Pre-COVID totals calculated as the sum of the four pre-COVID screening rounds. Percentages show the distribution for the columns of each variable. p values obtained with chi-square test comparing the total pre- and post-COVID proportions <0.001 for all variables. Dif = '^' indicates a statistically significant difference of p < 0.05 between columns of the respective category.

Table 2
Baseline characteristics of participants of the PSMAR breast cancer screening program in the BHA affected by the COVID-19 pandemic in the area of reference of Parc de Salut Mar (PSMAR), in Barcelona, Spain in the period 2012–2021 by screening round.
Pre-COVID 4 roundPre-COVID 3 roundPre-COVID 2 roundPre-COVID 1 roundPre-COVID totalPost-COVID +1 roundDifference post–preDif
(2012–2013)(2014–2015)(2016–2017)(2018–2019)(2012–2019)(2020–2021)
n%n%n%n%n%n%
Age group50–54455029.22459629.50454629.39443428.5618,12629.17407327.53−1.64%^
55–59391225.12390125.04398525.77408926.3415,88725.57403827.291.73%^
60–64378424.30372923.94371023.99378024.3515,00324.14366424.770.62%
65–70332521.35335221.52322520.85322020.7413,12221.12302020.41−0.71%
Socioeconomic index levelLow328221.08322320.69320120.70322620.7812,93220.81306520.72−0.10%
Middle-low160310.29161210.35162010.47163010.50646510.40158610.720.31%
Middle-high836353.71853754.80850855.01862655.5734,03454.77816455.180.41%
High232314.92220614.16213713.82204113.15870714.01198113.39−0.62%^
Type of screening
PrevalentFirst invitation205813.22195712.56187612.13185011.92774112.46213314.421.96%^
Previous nonparticipant8125.217714.957504.857634.9230964.988025.420.44%^
Total287018.43272817.51262616.98261316.8310,83717.44293519.842.40%
IncidentRegular participant12,00377.0912,11677.7812,09578.2012,09877.9448,31277.7511,16675.47−2.28%^
Irregular participant6984.487344.717454.828125.2329894.816954.70−0.11%
Total12,70181.5712,85082.4912,84083.0212,91083.1751,30182.5611,86180.17−2.39%
MenopauseYes12,06977.5212,35879.3412,21278.9812,26779.0348,90678.7111,68378.97−0.18%
No198612.76197312.67209513.54210613.56816013.13197813.370.18%
Unknown15169.7412478.0011597.4911507.4150728.1611347.66
Breast cancer family historyYes275517.69291518.71303919.65321320.7011,92219.19320721.672.53%^
No12,79282.1512,63381.1012,39080.1112,26579.0150,08080.5911,53277.94−2.53%^
Unknown240.15300.19370.24450.291360.22560.38
Education levelPrimary or lower464129.81402425.83337021.79277617.8814,81123.84203213.73−11.78%^
Middle level615639.54636740.87657542.51737147.4826,46942.60794153.6714.31%^
University240515.45265817.06293018.94277717.8910,77017.33221314.96−2.53%^
Unknown236915.21252916.23259116.75259916.7410,08816.23260917.63
Total15,571100.0015,578100.0015,466100.0015,523100.0062,138100.0014,795100.00
  1. Dif = '^' indicates a statistically significant difference of p<0.05 between columns of the respective category.

Table 3
Participation according to Baseline characteristics of participants of the PSMAR breast cancer screening program in the BHA affected by the COVID-19 pandemic in the area of reference of Parc de Salut Mar (PSMAR), in Barcelona, Spain in the period 2012–2021 by screening round.

Pre-COVID 4 roundPre-COVID 3 roundPre-COVID 2 roundPre-COVID 1 roundPre-COVID totalPost-COVID +1 roundDifference post–prep valor
(2012–2013)(2014–2015)(2016–2017)(2018–2019)(2012–2019)(2020–2021)
n%n%n%n%n%n%
Age group50–54455049.98459648.40454648.10443449.2018,12648.91407346.59−2.32%<0.001*
55–59391254.69390153.11398552.65408953.5815,88753.50403851.12−2.37%<0.001*
60–64378456.59372956.73371055.44378056.7115,00356.36366453.64−2.73%<0.001*
65–70332558.46335258.23322557.66322059.7713,12258.52302054.87−3.65%<0.001*
Socioeconomic index levelLow328273.62322372.07320173.23322673.8012,93273.18306567.57−5.61%<0.001*
Middle-low160369.60161268.42162069.56163069.72646569.32158663.29−6.03%<0.001*
Middle-high836354.99853754.49850853.63862655.4534,03454.63816452.33−2.30%<0.001*
High232334.87220633.06213731.70204131.74870732.85198131.27−1.58%0.016*
Type of screening
PrevalentFirst invitation205846.68195742.81187643.92185048.29774145.32213341.71−3.61%<0.001*
Previous nonparticipant8129.567718.927508.297638.4730968.808029.480.69%0.05*
Total287022.24272820.65262619.71261320.3510,83720.73293521.630.90%0.024*
IncidentRegular participant12,00389.5112,11689.8912,09589.6312,09890.3548,31289.8411,16685.43−4.41%<0.001*
Irregular participant69830.1573429.5874529.9281232.95298930.6669529.74−0.92%0.38
Total12,70180.7712,85080.5212,84080.3312,91081.4351,30180.7611,86176.98−3.78%<0.001*
Total15,57154.3915,57853.4115,46652.7815,52354.0962,13853.6614,79551.06−2.60%<0.001*
  1. Pre-COVID totals calculated as the sum of the four pre-COVID screening rounds. Percentages show the proportion of participants among women invited for each category. p values obtained with chi-square test comparing the total pre- and post-COVID proportions. * indicates statistical significance, with a p-value < of equal to 0.05.

Table 4
Compliance with further assessment among patients assessed for recall in the BHAs affected by the COVID-19 pandemic in the area of reference of Parc de Salut Mar (PSMAR), in Barcelona, Spain from 2012 to 2021 by screening round.
Pre-COVID −4 (2012–2013)Pre-COVID −3 (2014–2015)Pre-COVID −2(2016–2017)Pre-COVID −1 (2018–2019)Pre-COVID total(2012–2019)Post-COVID(2020–2021)OR (95% CI)
n%n%n%n%n%n%
Compliance with recallNo364.57323.08111.42101.61892.76162.201.26 (0.76–2.23)
Yes75295.43100896.9276698.5861398.39313997.2471097.80
  1. Pre-COVID totals were calculated as the sum of the four pre-COVID screening rounds. OR represent the crude odds ratios for compliance with further assessment for the post- vs. total pre-COVID-19 rounds.

Table 5
Staging of cancers detected in each screening round in the BHA affected by the COVID-19 pandemic in the area of reference of Parc de Salut Mar (PSMAR), in Barcelona, Spain in the period 2012–2021 by screening round.
Pre-COVID totalPost-COVID +1 roundDifference post–pre
(2012–2019)(2020–2021)
n%n%
TIn situ5115.45811.27−4.76%
121063.644766.200.48%
24313.031318.314.92%
382.4222.820.32%
430.9100.00−0.95%
Unknown154.5511.41
N025476.975881.691.97%
14714.241014.08−0.68%
282.4222.820.31%
351.5200.00−1.59%
Unknown164.8511.41
M030793.036895.770.97%
130.9100.00−0.97%
Unknown206.0634.23
Clinical stageIn situ5015.15811.27−4.47%
I17553.034259.154.95%
II6218.791622.543.40%
III185.4522.82−2.90%
IV30.9100.00−0.97%
Unknown226.6734.23
Total330100.0071100.00
  1. Pre-COVID totals calculated as the sum of the four pre-COVID rounds. Difference post–pre calculated comparing the post and the total pre-COVID percentages. Percentages show the distribution in the columns of each variable. p value of the distribution of each variable calculated with the exact test of Fisher. Dif = '^' indicates a significant difference of p > 0.05 between columns of the respective category.

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  1. Guillermo Bosch
  2. Margarita Posso
  3. Javier Louro
  4. Marta Roman
  5. Miquel Porta
  6. Xavier Castells
  7. Francesc Macià
(2022)
Impact of the COVID-19 pandemic on breast cancer screening indicators in a Spanish population-based program: a cohort study
eLife 11:e77434.
https://doi.org/10.7554/eLife.77434