Abstract A119: Disparities in mammography screening adherence throughout phases of the COVID-19 Pandemic: Results from the 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System
Authors: Chang C Chang Gregory , Fisher James L. , Paskett Electra D. 
Published: September 2024

Abstract
Background Early detection of breast cancer through mammography screening reduces mortality risk. Disruptions during the COVID-19 pandemic in the United States worsened disparities in mammography use, and it is unclear if the impact persisted after the rollout of COVID-19 vaccine in 2021. We aim to describe disparities among minority and underserved women in breast cancer screening before and during the initial phase of the COVID-19 pandemic and assess any changes in screening patterns following the rollout of COVID-19 vaccines in the United States. Methods We used Behavioral Risk Factor Surveillance System (BRFSS) data for years before (2018), during (2020), and after (2022) the COVID-19 vaccine rollout in the United States. We estimated the proportion of women aged 50–74 years who were non-adherent to the United States Preventive Services Taskforce screening guidelines (no mammography in the past two years) by select sociodemographic and behavioral factors. Weighted frequencies, Chi-square tests with Rao-Scott correction, and log-binomial regression models with a Poisson family were used to estimate prevalence ratios (PR) for non-adherence by selected factors to identify sub-populations more likely to be non-adherent. Results A total of 116,756, 102,778, and 110,456 women were included in the analytic samples from 2018, 2020, and 2022, respectively. The prevalence of non-adherence to breast cancer screening guidelines was 21.1%, 20.6%, and 21.6%, in 2018, 2020, and 2022, respectively. Comparing 2018 to 2022, the proportion of non-adherent women significantly increased among those who did not graduate high school (26.7% vs 34.7%), those without health insurance (45.3% vs 61.9%), and women with incomes below $15,000 (28.1% vs 35.1%). Insurance status had the largest impact on screening adherence, with uninsured women more than twice as likely to be non-adherent compared to insured women both before (PR = 2.15, 95% CI: 1.94, 2.38) and after the COVID-19 vaccine rollout (2.24, 95% CI: 2.05, 2.45). Prevalence ratios of nonadherence significantly increased between 2018 and 2020, then returned back to pre-pandemic levels in 2022 among those living in non-metropolitan versus metropolitan areas, never married versus married, self-employed versus employed, and those reporting poor versus excellent health. Hispanics were more likely than non-Hispanics to be non-adherent in 2020 and 2022, but no difference was seen in 2018. Conclusions Persistent disparities in breast cancer screening adherence among eligible women in the United States were observed throughout the phases of the COVID-19 pandemic. Although overall adherence remained stable, certain subgroups, such as those with lower education, no health insurance, Hispanic, rural residence, and lower income, experienced worsening adherence. Health insurance status was the most significant factor associated with non-adherence, highlighting the need for targeted interventions among those who are uninsured.
Citation Format: Gregory Chang C Chang, James L. Fisher, Electra D. Paskett. Disparities in mammography screening adherence throughout phases of the COVID-19 Pandemic: Results from the 2018, 2020, and 2022 Behavioral Risk Factor Surveillance System [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr A119.