Abstract B045: Effect of the COVID-19 pandemic on disparities in stage of breast cancer diagnosis
Authors: Rumano Ruvarashe P. , Owusu-Brackett Nicci , Clarke Akia , Tamer Robert , Ghias Elizabeth , Plascak Jesse , Paskett Electra D. , Oppong Bridgett A. 
Published: December 2023

Abstract
Background Black women historically present with more advanced stages of breast cancer (BC). The 2019 novel Coronavirus (COVID-19) led to stressors on healthcare systems resulting in reduction of resources for non-urgent care needs including screening. Limiting screening access may further exacerbate already existing delays in cancer screening and potentially widen racial differences in stage of BC at diagnosis. We examined our institutional data to evaluate differences in the stage of BC at presentation between Black and White women before and during the COVID-19 pandemic. Methods This was a retrospective cohort study of self-identified Black and White women aged 18 and over with invasive BC at The Ohio State University Stefanie Spielman Comprehensive Breast Center between 2018 and 2021. Demographic and clinicopathological characteristics were obtained from medical records with geocoding based on census tract level used to generate a Yost index of neighborhood socioeconomic composition. Study variables included socio-demographic factors (race, age, education) and breast tumor information such as receptor status and clinical stage group early (Stages I and II) vs. late stage (III and IV). Categorical variables were analyzed by chi-square test or Fisher’s Exact test. Continuous variables were analyzed by Wilcoxon Two Sample tests. Logistic regression was used to assess associations between time (pre-COVID (2018-2019) vs. COVID era (2020-2021)) and sociodemographic factors, socioeconomic composition categorized by Yost index (categorized as low (1-33), medium (34-66), and high (67-100)), tumor status, and clinical stage group. Results The total sample included 3162 women (321 Black and 2831 White). More White women (35.2%) had a higher Yost index compared to Black women (16.7%) (P&lt;0.001, indicating higher socioeconomic composition). Pre-pandemic, 81.8% of Black women vs. 86.4% of White women were diagnosed with early stage BC (P=0.489) and 18.2% of Black women vs. 13.6% of White women with late stage BC (P=0.489). During the pandemic, 86.4% of Black vs. 86.7% of White women presented with early stage BC and 13.6% of Black (P=0.489) vs. 13.3% of White women with late stage BC (P=0.489). Results of the multivariate analysis show participants with a medium Yost index had a higher probability of a late-stage diagnosis compared to those with a high Yost index (P=0.0410). Significant predictors of the probability of a late-stage diagnosis included higher age at diagnosis (P=0.0002) and positive estrogen (P=0.0013), progesterone (P&lt;0.0001) and HER2 receptors (P=0.0032). Race and time (pre vs mid-COVID) were not significant predictors of late stage diagnosis. Conclusion Given the novel nature of the coronavirus pandemic, the clinical implications and effects on healthcare delivery will continue to be observed. It is reassuring that we found no significant change in the differences in the stage of BC diagnosis between Black and White women at our institution. On a national scale, how the pandemic will impact existing BC inequalities requires exploration.
Citation Format: Ruvarashe P. Rumano, Nicci Owusu-Brackett, Akia Clarke, Robert Tamer, Elizabeth Ghias, Jesse Plascak, Electra D. Paskett, Bridgett A. Oppong. Effect of the COVID-19 pandemic on disparities in stage of breast cancer diagnosis [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B045.