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

Figures
Tables
Additional files

5 figures, 5 tables and 2 additional files

Figures

Figure 1

Download asset Open asset

Adjusted odds ratios of pre–post COVID-19 models for participation.

Figure 2

Download asset Open asset

Adjusted odds ratios of pre–post COVID-19 models for recall, false positives, and cancer detection in participants.

Figure 3

Download asset Open asset

Adjusted odds ratios of pre–post COVID-19 models for cancer detection according to histology.

Author response image 1

Download asset Open asset

Author response image 2

Download asset Open asset

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 round		Pre-COVID 3 round		Pre-COVID 2 round		Pre-COVID 1 round		Pre-COVID total		Post-COVID +1 round		Difference post–pre	Dif
		(2012–2013)		(2014–2015)		(2016–2017)		(2018–2019)		(2012–2019)		(2020–2021)
		n	%	n	%	n	%	n	%	n	%	n	%
Age group	50–54	9103	31.79	9495	32.55	9451	32.25	9013	31.41	37,062	32.00	8743	30.17	−1.83	^
	55–59	7153	24.98	7345	25.18	7569	25.83	7631	26.59	29,698	25.65	7899	27.26	1.61	^
	60–64	6687	23.36	6573	22.53	6692	22.84	6666	23.23	26,618	22.99	6831	23.57	0.59	^
	65–70	5688	19.87	5756	19.73	5593	19.09	5387	18.77	22,424	19.36	5504	18.99	−0.37
Socioeconomic index level	Low	4458	15.57	4472	15.33	4371	14.92	4371	15.23	17,672	15.26	4536	15.65	0.39
		2303	8.04	2356	8.08	2329	7.95	2338	8.15	9326	8.05	2506	8.65	0.59	^
	Middle-high	15,209	53.12	15,668	53.71	15,864	54.13	15,557	54.21	62,298	53.80	15,600	53.84	0.04
	High	6661	23.26	6673	22.88	6741	23.00	6431	22.41	26,506	22.89	6335	21.86	−1.03	^
Type of screening
Prevalent	First invitation	4409	15.40	4571	15.67	4271	14.57	3831	13.35	17,082	14.75	5114	17.65	2.90	^
	Previous nonparticipant	8497	29.68	8639	29.62	9049	30.88	9012	31.40	35,197	30.39	8456	29.18	−1.21	^
	Total	12,906	45.08	13,210	45.29	13,320	45.45	12,843	44.75	52,279	45.15	13,570	46.83	1.69
Incident	Regular participant	13,410	46.84	13,478	46.21	13,495	46.05	13,390	46.66	53,773	46.44	13,070	45.10	−1.33	^
	Irregular participant	2315	8.09	2481	8.51	2490	8.50	2464	8.59	9750	8.42	2337	8.07	−0.35
	Total	15,725	54.92	15,959	54.71	15,985	54.55	15,854	55.25	63,523	54.85	15,407	53.17	−1.69
Total		28,631	100.00	29,169	100.00	29,305	100.00	28,697	100.00	115,802	100.00	28,977	100.00

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 round		Pre-COVID 3 round		Pre-COVID 2 round		Pre-COVID 1 round		Pre-COVID total		Post-COVID +1 round		Difference post–pre	Dif
		(2012–2013)		(2014–2015)		(2016–2017)		(2018–2019)		(2012–2019)		(2020–2021)		Difference post–pre	Dif
		n	%	n	%	n	%	n	%	n	%	n	%
Age group	50–54	4550	29.22	4596	29.50	4546	29.39	4434	28.56	18,126	29.17	4073	27.53	−1.64%	^
	55–59	3912	25.12	3901	25.04	3985	25.77	4089	26.34	15,887	25.57	4038	27.29	1.73%	^
	60–64	3784	24.30	3729	23.94	3710	23.99	3780	24.35	15,003	24.14	3664	24.77	0.62%
	65–70	3325	21.35	3352	21.52	3225	20.85	3220	20.74	13,122	21.12	3020	20.41	−0.71%
Socioeconomic index level	Low	3282	21.08	3223	20.69	3201	20.70	3226	20.78	12,932	20.81	3065	20.72	−0.10%
	Middle-low	1603	10.29	1612	10.35	1620	10.47	1630	10.50	6465	10.40	1586	10.72	0.31%
	Middle-high	8363	53.71	8537	54.80	8508	55.01	8626	55.57	34,034	54.77	8164	55.18	0.41%
	High	2323	14.92	2206	14.16	2137	13.82	2041	13.15	8707	14.01	1981	13.39	−0.62%	^
Type of screening
Prevalent	First invitation	2058	13.22	1957	12.56	1876	12.13	1850	11.92	7741	12.46	2133	14.42	1.96%	^
	Previous nonparticipant	812	5.21	771	4.95	750	4.85	763	4.92	3096	4.98	802	5.42	0.44%	^
	Total	2870	18.43	2728	17.51	2626	16.98	2613	16.83	10,837	17.44	2935	19.84	2.40%
Incident	Regular participant	12,003	77.09	12,116	77.78	12,095	78.20	12,098	77.94	48,312	77.75	11,166	75.47	−2.28%	^
	Irregular participant	698	4.48	734	4.71	745	4.82	812	5.23	2989	4.81	695	4.70	−0.11%
	Total	12,701	81.57	12,850	82.49	12,840	83.02	12,910	83.17	51,301	82.56	11,861	80.17	−2.39%
Menopause	Yes	12,069	77.52	12,358	79.34	12,212	78.98	12,267	79.03	48,906	78.71	11,683	78.97	−0.18%
	No	1986	12.76	1973	12.67	2095	13.54	2106	13.56	8160	13.13	1978	13.37	0.18%
	Unknown	1516	9.74	1247	8.00	1159	7.49	1150	7.41	5072	8.16	1134	7.66
Breast cancer family history	Yes	2755	17.69	2915	18.71	3039	19.65	3213	20.70	11,922	19.19	3207	21.67	2.53%	^
	No	12,792	82.15	12,633	81.10	12,390	80.11	12,265	79.01	50,080	80.59	11,532	77.94	−2.53%	^
	Unknown	24	0.15	30	0.19	37	0.24	45	0.29	136	0.22	56	0.38
Education level	Primary or lower	4641	29.81	4024	25.83	3370	21.79	2776	17.88	14,811	23.84	2032	13.73	−11.78%	^
	Middle level	6156	39.54	6367	40.87	6575	42.51	7371	47.48	26,469	42.60	7941	53.67	14.31%	^
	University	2405	15.45	2658	17.06	2930	18.94	2777	17.89	10,770	17.33	2213	14.96	−2.53%	^
	Unknown	2369	15.21	2529	16.23	2591	16.75	2599	16.74	10,088	16.23	2609	17.63
Total		15,571	100.00	15,578	100.00	15,466	100.00	15,523	100.00	62,138	100.00	14,795	100.00

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 round		Pre-COVID 3 round		Pre-COVID 2 round		Pre-COVID 1 round		Pre-COVID total		Post-COVID +1 round		Difference post–pre	p valor
		(2012–2013)		(2014–2015)		(2016–2017)		(2018–2019)		(2012–2019)		(2020–2021)
		n	%	n	%	n	%	n	%	n	%	n	%
Age group	50–54	4550	49.98	4596	48.40	4546	48.10	4434	49.20	18,126	48.91	4073	46.59	−2.32%	<0.001*
	55–59	3912	54.69	3901	53.11	3985	52.65	4089	53.58	15,887	53.50	4038	51.12	−2.37%	<0.001*
	60–64	3784	56.59	3729	56.73	3710	55.44	3780	56.71	15,003	56.36	3664	53.64	−2.73%	<0.001*
	65–70	3325	58.46	3352	58.23	3225	57.66	3220	59.77	13,122	58.52	3020	54.87	−3.65%	<0.001*
Socioeconomic index level	Low	3282	73.62	3223	72.07	3201	73.23	3226	73.80	12,932	73.18	3065	67.57	−5.61%	<0.001*
	Middle-low	1603	69.60	1612	68.42	1620	69.56	1630	69.72	6465	69.32	1586	63.29	−6.03%	<0.001*
	Middle-high	8363	54.99	8537	54.49	8508	53.63	8626	55.45	34,034	54.63	8164	52.33	−2.30%	<0.001*
	High	2323	34.87	2206	33.06	2137	31.70	2041	31.74	8707	32.85	1981	31.27	−1.58%	0.016*
Type of screening
Prevalent	First invitation	2058	46.68	1957	42.81	1876	43.92	1850	48.29	7741	45.32	2133	41.71	−3.61%	<0.001*
	Previous nonparticipant	812	9.56	771	8.92	750	8.29	763	8.47	3096	8.80	802	9.48	0.69%	0.05*
	Total	2870	22.24	2728	20.65	2626	19.71	2613	20.35	10,837	20.73	2935	21.63	0.90%	0.024*
Incident	Regular participant	12,003	89.51	12,116	89.89	12,095	89.63	12,098	90.35	48,312	89.84	11,166	85.43	−4.41%	<0.001*
	Irregular participant	698	30.15	734	29.58	745	29.92	812	32.95	2989	30.66	695	29.74	−0.92%	0.38
	Total	12,701	80.77	12,850	80.52	12,840	80.33	12,910	81.43	51,301	80.76	11,861	76.98	−3.78%	<0.001*
Total		15,571	54.39	15,578	53.41	15,466	52.78	15,523	54.09	62,138	53.66	14,795	51.06	−2.60%	<0.001*

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	%	OR (95% CI)
Compliance with recall	No	36	4.57	32	3.08	11	1.42	10	1.61	89	2.76	16	2.20	1.26 (0.76–2.23)
Compliance with recall	Yes	752	95.43	1008	96.92	766	98.58	613	98.39	3139	97.24	710	97.80

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 total		Post-COVID +1 round		Difference post–pre
		(2012–2019)		(2020–2021)		Difference post–pre
		n	%	n	%
T	In situ	51	15.45	8	11.27	−4.76%
	1	210	63.64	47	66.20	0.48%
	2	43	13.03	13	18.31	4.92%
	3	8	2.42	2	2.82	0.32%
	4	3	0.91	0	0.00	−0.95%
	Unknown	15	4.55	1	1.41
N	0	254	76.97	58	81.69	1.97%
	1	47	14.24	10	14.08	−0.68%
	2	8	2.42	2	2.82	0.31%
	3	5	1.52	0	0.00	−1.59%
	Unknown	16	4.85	1	1.41
M	0	307	93.03	68	95.77	0.97%
	1	3	0.91	0	0.00	−0.97%
	Unknown	20	6.06	3	4.23
Clinical stage	In situ	50	15.15	8	11.27	−4.47%
	I	175	53.03	42	59.15	4.95%
	II	62	18.79	16	22.54	3.40%
	III	18	5.45	2	2.82	−2.90%
	IV	3	0.91	0	0.00	−0.97%
	Unknown	22	6.67	3	4.23
Total		330	100.00	71	100.00

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.

Additional files

Transparent reporting form: https://cdn.elifesciences.org/articles/77434/elife-77434-transrepform1-v2.pdf
Download elife-77434-transrepform1-v2.pdf
Supplementary file 1 Crude logistic-regression models.: https://cdn.elifesciences.org/articles/77434/elife-77434-supp1-v2.docx
Download elife-77434-supp1-v2.docx

Download links

A two-part list of links to download the article, or parts of the article, in various formats.

Downloads (link to download the article as PDF)

Article PDF

Open citations (links to open the citations from this article in various online reference manager services)

Mendeley

Cite this article (links to download the citations from this article in formats compatible with various reference manager tools)

Guillermo Bosch
Margarita Posso
Javier Louro
Marta Roman
Miquel Porta
Xavier Castells
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

Share this article

Cite this article

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.

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.

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.

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.

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.

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.

Transparent reporting form

Supplementary file 1

Downloads (link to download the article as PDF)

Open citations (links to open the citations from this article in various online reference manager services)

Cite this article (links to download the citations from this article in formats compatible with various reference manager tools)