Department of Radiology, Massachusetts General Brigham, Harvard Medical School, 55 Fruit St, Boston, MA 02114.
Department of Surgery, Massachusetts General Brigham, Harvard Medical School, Boston, MA.
AJR Am J Roentgenol. 2022 Jun;218(6):988-996. doi: 10.2214/AJR.21.26890. Epub 2021 Nov 24.
Screening mammography facilities closed during the COVID-19 pandemic in spring 2020. Recovery of screening volumes has varied across patient subgroups and facilities. We compared screening mammography volumes and patient and facility characteristics between periods before COVID-19 and early and later postclosure recovery periods. This retrospective study included screening mammograms performed in the same 2-month period (May 26-July 26) in 2019 (pre-COVID-19), 2020 (early recovery), and 2021 (late recovery after targeted interventions to expand access) and across multiple facility types (urban, suburban, community health center). Suburban sites had highest proportion of White patients and the greatest scheduling flexibility and expanded appointments during initial reopening. Findings were compared across years. For White patients, volumes decreased 36.6% from 6550 in 2019 (4384 in 2020) and then increased 61.0% to 6579 in 2021; for patients with races other than White, volumes decreased 53.9% from 1321 in 2019 (609 in 2020) and then increased 136.8% to 1442 in 2021. The percentage of mammograms in patients with races other than White was 16.8% in 2019, 12.2% in 2020, and 18.0% in 2021. The proportion performed at the urban center was 55.3% in 2019, 42.2% in 2020, and 45.9% in 2021; the proportion at suburban sites was 34.0% in 2019, 49.2% in 2020, and 43.5% in 2021. Pre-COVID-19 volumes were reached by the sixth week after reopening for suburban sites but were not reached during early recovery for the other sites. The proportion that were performed on Saturday for suburban sites was similar across periods, whereas the proportion performed on Saturday for the urban site was 7.6% in 2019, 5.3% in 2020, and 8.8% in 2021; the community health center did not offer Saturday appointments during recovery. After reopening, screening shifted from urban to suburban settings, with a disproportionate screening decrease in patients with races other than White. Initial delayed access at facilities serving underserved populations exacerbated disparities. Interventions to expand access resulted in late recovery volumes exceeding prepandemic volumes in patients with races other than White. Interventions to support equitable access across facilities serving diverse patient populations may mitigate potential widening disparities in breast cancer diagnosis during the pandemic.
在 2020 年春季 COVID-19 大流行期间，乳腺 X 线筛查设施关闭。在不同的患者亚组和设施中，筛查量的恢复情况各不相同。我们比较了 COVID-19 之前、早期和后期关闭恢复期间的筛查乳腺 X 线摄影量以及患者和设施特征。这项回顾性研究包括在 2019 年（COVID-19 之前）、2020 年（早期恢复）和 2021 年（在扩大获取途径的有针对性的干预措施之后的后期恢复）同一两个月期间（5 月 26 日至 7 月 26 日）在多个设施类型（城市、郊区、社区卫生中心）进行的筛查乳腺 X 线摄影。郊区站点的白人患者比例最高，初始重新开放期间具有最大的调度灵活性和扩大的预约。比较了各年的结果。对于白人患者，数量从 2019 年的 6550 例减少了 36.6%（2020 年为 4384 例），然后增加了 61.0%，达到 2021 年的 6579 例；对于非白人患者，数量从 2019 年的 1321 例减少了 53.9%（2020 年为 609 例），然后增加了 136.8%，达到 2021 年的 1442 例。非白人患者的乳腺 X 线摄影比例从 2019 年的 16.8%降至 2020 年的 12.2%，再升至 2021 年的 18.0%。2019 年，城市中心进行的手术比例为 55.3%，2020 年为 42.2%，2021 年为 45.9%；郊区站点进行的手术比例从 2019 年的 34.0%增加到 2020 年的 49.2%和 2021 年的 43.5%。郊区站点在重新开放后的第六周就达到了 COVID-19 之前的数量，但其他站点在早期恢复期间没有达到。郊区站点周六进行手术的比例在各个时期相似，而城市站点周六进行手术的比例从 2019 年的 7.6%降至 2020 年的 5.3%和 2021 年的 8.8%；社区卫生中心在恢复期间不提供周六预约。重新开放后，筛查从城市转移到郊区，非白人患者的筛查量大幅下降。最初在服务不足人群的设施中获得的服务延迟加剧了差距。扩大服务范围的干预措施导致在非白人患者中，后期恢复的数量超过了大流行前的数量。支持服务多样化患者群体的公平获取机会的干预措施可能会减轻大流行期间乳腺癌诊断方面潜在的扩大差距。
