Abstract SS2-04: Health maintenance and breast cancer screening during the COVID-19 pandemic
Authors: Naeim Arash , Wenger Neil , Sepucha Karen , Stanton Annette , Baxter-King Ryan , Sabacan Leah , Petruse Antonia , Choy Patricia , Brain Susie , Esserman Laura ,   Wisdom Study and Athena Breast Health Network Investigators and Advocate Partners, Vavreck Lynn 
Published: February 2021

Abstract
Background: WISDOM is a large (target enrollment&gt;40,000) healthy women preference-tolerant, pragmatic study comparing traditional annual screening to personalized risk-based breast screening. Cancer screening, routine health care, and elective procedures were disrupted due to attempts to manage resources during the COVID-19 pandemic. Understanding of the impact on COVID-19 on trial participants is important to gain a broader understanding of the effect of the pandemic on healthcare activities. Methods: Women aged 40-74 years with no history of breast cancer or DCIS, and no previous double mastectomy can join the WISDOM (NCT02620852) study online at wisdomstudy.org. A total of 28,600 women have consented to participate. As part of the trial, each patient completes a baseline and interval surveys through a Salesforce platform. In May, the study IRB was amended to add a COVID specific survey with questions related to participants COVID risk perceptions, coexisting conditions, and receipt of healthcare services in the 2 months prior to the survey. An initial survey was sent May 2020, with follow-up surveys planned every 2 months. In addition, national surveys on a population-based cross section of individuals across the nation will be performed in parallel. Data was collected, de-identified, and then analyzed using basic descriptive analysis, chi-2 analysis, and logit regression. Results: A total of 7,523 individuals in WISDOM responded to the survey (response rate 27%). Of those that responded, the average age at the time of the survey was 59 (range 40-79). The population was 87% Caucasian, 6% Hispanic, and 4% African-American. Only 3.6% of the sample felt they had COVID-19 either by symptoms or through testing. However, 10.0% felt they were at higher risk compared to similar individuals their age to get COVID-19. Of the sample, 29% had some form of high-risk coexisting condition that put them at higher risk for COVID-19. In terms of healthcare utilization in the prior 2 months, 43% had a routine medical visit cancelled by their primary care provider or health system, whereas 26% cancelled an appointment themselves. In terms of breast cancer screening, 16% had their screening visit either cancelled or delayed. Individuals who believed they were at higher risk (and more likely to have shorter interval screening recommendations on this trial) had a higher Odds Ratio (1.66) for a screening cancellation (p&lt;0.001). Those individuals who held the belief that COVID-19 was no more dangerous than the seasonal flu were more likely to have medical visits and routine care in the preceding 2 months than those that did not share that belief. (OR 1.18, p=0.032). Individuals were significantly more worried about COVID-19 than developing breast cancer (43% moderate to severely worried about COVID compared to 8.2% for breast cancer). Those worried about COVID were more likely to have screening cancellation (OR 1.18, P&lt;0.001) and those more worried about breast cancer were less likely to have a screening cancellation (OR. 0.83, P&lt;0.001). Conclusions: Health maintenance, prevention, and specifically breast cancer screening are important, but these health activities have been significantly disrupted due to the COVID-19 pandemic. Given that the pandemic will likely continue for many months until there is either a vaccine, treatment, or herd immunity, it will be important to define the drivers and messages (healthcare and screening) to ensure patients receive proper health maintenance and prevention to reduce the risks associated with other diseases that are not COVID-19. The preliminary data presented as part of this abstract submission are the early results of an effort to develop a predictive model and targeted strategies for communication and intervention for cancer screening during the course of the COVID-19 pandemic.
Citation Format: Arash Naeim, Neil Wenger, Karen Sepucha, Annette Stanton, Ryan Baxter-King, Leah Sabacan, Antonia Petruse, Patricia Choy, Susie Brain, Laura Esserman, Wisdom Study and Athena Breast Health Network Investigators and Advocate Partners, Lynn Vavreck. Health maintenance and breast cancer screening during the COVID-19 pandemic [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SS2-04.