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. Institut Hospital del Mar d'Investigacions Mèdiques, Spain
  2. Autonomous University of Barcelona, Spain

Abstract

Background: To assess the effect of the COVID-19 pandemic on performance indicators in the population-based breast cancer screening program of Parc de Salut Mar (PSMAR), Barcelona, Spain.

Methods: We conducted a before-and-after, study to evaluate participation, recall, false-positives, the cancer detection rate, and cancer characteristics in our screening population from March 2020 to March 2021 compared with the four previous rounds (2012-2019). Using multi-level logistic regression models, we estimated the adjusted odds ratios (aOR) of each of the performance indicators for the COVID-19 period, controlling by type of screening (prevalent or incident), socioeconomic index, family history of breast cancer, and menopausal status. We analyzed 144,779 invitations from 47,571 women.

Results: During the COVID-19 period, the odds of participation were lower in first-time invitees (aOR=0.90[95%CI=0.84-0.96]) and in those who had previously participated regularly and irregularly (aOR=0.63 [95%CI=0.59-0.67] and aOR=0.95 [95%CI=0.86-1.05], respectively). Participation showed a modest increase in women not attending any of the previous rounds (aOR=1.10 [95%CI=1.01-1.20]). The recall rate decreased in both prevalent and incident screening (aOR=0.74 [95%CI 0.56-0.99] and aOR=0.80 [95%CI 0.68-0.95], respectively). False positives also decreased in both groups (prevalent aOR=0.92 [95%CI 0.66-1.28] and incident aOR=0.72 [95%CI 0.59-0.88]. No significant differences were observed in compliance with recall (OR= 1.26, 95%CI 0.76-2.23), cancer detection rate (aOR=0.91 [95%CI=0.69-1.18]) or cancer stages.

Conclusions: The COVID-19 pandemic negatively affected screening attendance, especially in previous participants and newcomers. We found a reduction in recall and false-positives and no marked differences in cancer detection, indicating the robustness of the program. There is a need for further evaluations of interval cancers and potential diagnostic delays.

Funding: This study has received funding by grantsPI19/00007 and PI21/00058, funded by Instituto de Salud Carlos III (ISCIII) and co-funded by the European Union and Grant RD21/0016/0020 funded by Instituto de Salud Carlos III and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia (MRR).

Data availability

Source data form all tables and figures can be found in the following Dataset:BOSCH, GUILLERMO, 2022, "Breast cancer screening program invitations (2012-2021)", https://doi.org/10.7910/DVN/VVQNWM, Harvard Dataverse, V1, UNF:6:CaW3sEp4tMsg13z2I1eZbQ== [fileUNF]Data from "Impact on covid19 dataset invited women.sav" was used in tables 1 and 2 and figures 1,2 and 3. Data from "cancer characteristics database.tab" was used in table 3.

Article and author information

Author details

  1. Guillermo Bosch

    Department of Epidemiology and Evaluation, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
    Competing interests
    The authors declare that no competing interests exist.
  2. Margarita Posso

    Department of Epidemiology and Evaluation, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
    For correspondence
    mposso@parcdesalutmar.cat
    Competing interests
    The authors declare that no competing interests exist.
    ORCID icon "This ORCID iD identifies the author of this article:" 0000-0002-5053-257X
  3. Javier Louro

    Department of Epidemiology and Evaluation, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
    Competing interests
    The authors declare that no competing interests exist.
  4. Marta Roman

    Department of Epidemiology and Evaluation, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
    Competing interests
    The authors declare that no competing interests exist.
  5. Miquel Porta

    Autonomous University of Barcelona, Barcelona, Spain
    Competing interests
    The authors declare that no competing interests exist.
  6. Xavier Castells

    Department of Epidemiology and Evaluation, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
    Competing interests
    The authors declare that no competing interests exist.
  7. Francesc Macià

    Department of Epidemiology and Evaluation, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
    Competing interests
    The authors declare that no competing interests exist.

Funding

Instituto de Salud Carlos III (PI19/00007)

  • Margarita Posso

Instituto de Salud Carlos III (PI21/00058)

  • Guillermo Bosch

Instituto de Salud Carlos III (PI21/00058)

  • Javier Louro

Instituto de Salud Carlos III (PI21/00058)

  • Marta Roman

Instituto de Salud Carlos III (PI21/00058)

  • Francesc Macià

The funders had no role in study design, data collection and interpretation, or the decision to submit the work for publication.

Reviewing Editor

  1. Talía Malagón, McGill University, Canada

Ethics

Human subjects: Due to the retrospective nature of the study and the absence of direct contact with women, which did not affect their relationship with the program, informed consent was waived by the Ethics Committee of PSMAR, which approved the study (reg.2021/9866). The study guaranteed Spain's legal regulations on data confidentiality (law 15/99 of December 13 on the protection of personal data).

Version history

  1. Received: January 29, 2022
  2. Preprint posted: March 7, 2022 (view preprint)
  3. Accepted: June 9, 2022
  4. Accepted Manuscript published: June 10, 2022 (version 1)
  5. Version of Record published: June 21, 2022 (version 2)

Copyright

© 2022, Bosch et al.

This article is distributed under the terms of the Creative Commons Attribution License permitting unrestricted use and redistribution provided that the original author and source are credited.

Metrics

  • 2,180
    Page views
  • 217
    Downloads
  • 10
    Citations

Article citation count generated by polling the highest count across the following sources: Crossref, PubMed Central, Scopus.

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)

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)

  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

Share this article

https://doi.org/10.7554/eLife.77434

Further reading

    1. Epidemiology and Global Health
    2. Medicine
    3. Microbiology and Infectious Disease
    Edited by Diane M Harper et al.
    Collection

    eLife has published the following articles on SARS-CoV-2 and COVID-19.

    1. Epidemiology and Global Health
    Zhanwei Du, Lin Wang ... Lauren A Meyers
    Short Report

    Paxlovid, a SARS-CoV-2 antiviral, not only prevents severe illness but also curtails viral shedding, lowering transmission risks from treated patients. By fitting a mathematical model of within-host Omicron viral dynamics to electronic health records data from 208 hospitalized patients in Hong Kong, we estimate that Paxlovid can inhibit over 90% of viral replication. However, its effectiveness critically depends on the timing of treatment. If treatment is initiated three days after symptoms first appear, we estimate a 17% chance of a post-treatment viral rebound and a 12% (95% CI: 0%-16%) reduction in overall infectiousness for non-rebound cases. Earlier treatment significantly elevates the risk of rebound without further reducing infectiousness, whereas starting beyond five days reduces its efficacy in curbing peak viral shedding. Among the 104 patients who received Paxlovid, 62% began treatment within an optimal three-to-five-day day window after symptoms appeared. Our findings indicate that broader global access to Paxlovid, coupled with appropriately timed treatment, can mitigate the severity and transmission of SARS-Cov-2.