Guillermo Bosch1,2, Margarita Posso1,3, Javier Louro1,3, Marta Roman1,3, Miquel Porta4,5,6, Xavier Castells1,3,4, Francesc Macià1,3. 1. Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. 2. Preventive Medicine and Public Health Training Unit PSMar-ASPB-UPF, Barcelona, Spain. 3. Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain. 4. Universitat Autònoma de Barcelona, Barcelona, Spain. 5. Hospital del Mar Institute of Medical Research (IMIM PSMar), Barcelona, Spain. 6. Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, 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 multilevel logistic regression models, we estimated the adjusted odds ratios (aORs) 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 47,571women. 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 grants PI19/00007 and PI21/00058, funded by Instituto de Salud Carlos III (ISCIII) and cofunded 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).
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 multilevel logistic regression models, we estimated the adjusted odds ratios (aORs) 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 47,571women. 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 grants PI19/00007 and PI21/00058, funded by Instituto de Salud Carlos III (ISCIII) and cofunded 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).
Keywords:
COVID-19; breast neoplasm; early detection of cancer; epidemiology; global health; human; nonrandomized controlled trials; quality indicators
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