Abstract P4-03-25: Patient-level predictors of skipping screening mammograms during the COVID-19 pandemic at a large tertiary care center in Texas
Authors: Shafaee Maryam Nemati , Rosales Omar , Kirby Randall Parker , Ortiz-Perez Tamara , Gilman Luke , Hardeman Ashley , Bhakta Preeya Bhavsar , Amos Chris , Oluyomi Abiodun 
Published: March 2023

Abstract
Background: Following the declaration of the COVID-19 national emergency, screening mammograms (SM) abruptly dropped across the United States. Stay-at-home orders discourage cancer patients from seeking care, and cancer screenings and surgeries were postponed. Upon resumption of screening services, rates of screening were slow to recover. At Baylor St. Luke’s CHI (BSL), one of the largest tertiary care centers providing comprehensive cancer screening in Houston, we investigated patient level predictors, including comorbidities and area deprivation index (ADI), and the risk of skipping SM in the first year of the COVID-19 Pandemic.
Methods: We used the local PENRAD database to retrieve the monthly gross number of SM performed at all BSL sites from 02/2018 to 01/2021. We obtained patient level data through EPIC, including address and demographics, comorbid conditions e.g., diabetes, hypertension, obesity (BMI30), chronic kidney disease and cardiovascular diseases (CVD). We identified ADI associated with patient addresses. We included patient who received at least one SM between 02/2018 to 01/2020. We compared patients did not get a mammogram in the first year of the pandemic; 02/2020 to 01/2021, to those who maintained screening during the pandemic. We performed a logistic regression analysis to assess the influence of age, 0 to +3 comorbid conditions, and ADI in quartiles on the odds ratio of skipping SM in the first year of the pandemic. Statistical significance was set at p&lt; 0.05. The study was IRB approved.
Results: Out of the 4591 women that screened in 2018 and/or 2019, only 1628 came back for SM in 2020 (35.5%). Women who obtained SM during the pandemic vs those who did not were slightly older, mean age 58 vs 56 (P&lt; 0.001), were less likely to be living in the most deprived neighborhood, Q4 of ADI, 23.8% vs. 25.6%, more likely to be obese 39% vs. 35% (P&lt; 0.001), more likely to have diabetes 48% vs. 41% (P&lt; 0.001), more likely to have CVD, 16% vs. 13% (P&lt; 0.001), and more likely to have hypertension 80% vs. 71% (P&lt; 0.001). On multivariate logistic regression, living in Q4 ADI was associated with 22% higher risk of skipping SM in 2020 (95% CI 1.02-1.42), having one vs. two vs. three comorbid conditions increased the likelihood of obtaining SM in 2020 by 25% (95% CI 0.62-0.91) vs. 30% vs (95% CI 0.58-0.85), 42% (95% CI 0.48-0.7) compared to no comorbid conditions.
Conclusion: Women living in Q4 of the ADI (most deprived neighborhood) were more likely to miss 2020 screening when compared with the Q1 women (least deprived neighborhood). The more chronic diseases women had, the less likely they were to skip 2020 screening when compared with those that had no chronic disease. This could because women with many health issues have to frequent health facilities at higher rates and thus less likely to miss mammograms.

Citation Format: Maryam Nemati Shafaee, Omar Rosales, Randall Parker Kirby, Tamara Ortiz-Perez, Luke Gilman, Ashley Hardeman, Preeya Bhavsar Bhakta, Chris Amos, Abiodun Oluyomi. Patient-level predictors of skipping screening mammograms during the COVID-19 pandemic at a large tertiary care center in Texas [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-03-25.