Health maintenance and breast cancer screening during the COVID-19 pandemic
Authors: A. Naeim, N. Wenger, K. Sepucha, A. Stanton, R. Baxter-King, L. Sabacan, A. Petruse, P. Choy, S. Brain, L. Esserman
Journal: Cancer Research (2021)

Background: WISDOM is a large (target enrollment>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-riskcoexisting condition that put them at higher risk for COVID-19  In terms of healthcare utilization in the prior 2months, 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 eithercancelled or delayed  Individuals who believed they were at higher risk (and more likely to have shorter intervalscreening recommendations on this trial) had a higher Odds Ratio (1 66) for a screening cancellation (p<0 001) Those individuals who held the belief that COVID-19 was no more dangerous than the seasonal flu were more likelyto 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 weremore likely to have screening cancellation (OR 1 18, P<0 001) and those more worried about breast cancer wereless likely to have a screening cancellation (OR  0 83, P<0 001)  Conclusions: Health maintenance, prevention,and specifically breast cancer screening are important, but these health activities have been significantly disrupteddue to the COVID-19 pandemic  Given that the pandemic will likely continue for many months until there is either avaccine, treatment, or herd immunity, it will be important to define the drivers and messages (healthcare andscreening) to ensure patients receive proper health maintenance and prevention to reduce the risks associated withother diseases that are not COVID-19  The preliminary data presented as part of this Abstract submission are theearly results of an effort to develop a predictive model and targeted strategies for communication and interventionfor cancer screening during the course of the COVID-19 pandemic