Am J Manag Care. 2022 Apr;28(3 Spec. No.):SP136-SP138. doi: 10.37765/ajmc.2022.88855. Epub 2022 Mar 14.
COVID-19 has caused considerable drops in utilization of breast cancer screening services during the pandemic, especially among certain racial and ethnic groups. Members of the Community Oncology Alliance (COA)-including the COA president, South Carolina oncologist Kashyap Patel, MD-have reported increases in patients, particularly those of color, presenting with stage III and IV cancer at diagnosis. According to data released by the Biden administration, more than 9.5 million recommended cancer screenings had been missed in the United States as a result of the COVID-19 pandemic, as of February 2022. President Joe Biden and First Lady Jill Biden, EdD, aim to address this in the 2022 revitalized Cancer Moonshot Initiative. The findings made by COA as well as by Avalere also suggest that the pandemic has exacerbated existing health care disparities.
Using a multipayer database, we analyzed breast cancer screening rates for 2 periods-March 1 to September 30, 2019, and March 1 to September 30, 2020-among Medicare fee-for-service (FFS), managed Medicaid, and commercial insurance beneficiaries to understand the potential impact of the COVID-19 pandemic on adherence to the US Preventive Services Task Force breast cancer screening recommendations, which are currently undergoing review. Screening rates were evaluated across 5 racial/ethnic groups and by payer type.
Mean monthly mammogram screening rates among eligible White Medicare FFS beneficiaries dropped to 0.6% in April 2020, but these screening rates recovered to 6.5% by June 2020. Screening rates for eligible Black Medicare FFS beneficiaries recovered on a pace slightly slower than that of White beneficiaries, but more rapidly than that of other groups. By comparison, American Indian/Alaska Native beneficiaries had a mean monthly screening rate of 0.5% in April 2020, which recovered to 3.1% in June 2020; these were below 2019 screening rates of 4.2% for April and 3.9% for June. Differences in screening rates by payer type were also observed. Patients with commercial insurance had higher screening rates compared with those covered by Medicare FFS and managed Medicaid.
Our principal finding shows that mean breast cancer screening rates decreased in April 2020 across all payers, but recovery to prepandemic screening levels has occurred more slowly among certain racial and ethnic minority groups. Differences in recovery rates by payer type highlight a strong relationship between income level and screening utilization.
在疫情期间，COVID-19 导致乳腺癌筛查服务的利用率大幅下降，尤其是在某些种族和族裔群体中。社区肿瘤联盟（COA）的成员——包括 COA 主席、南卡罗来纳州肿瘤学家 Kashyap Patel，医学博士——报告称，患者数量增加，尤其是那些有色人种的患者，在诊断时就患有 III 期和 IV 期癌症。根据拜登政府发布的数据，截至 2022 年 2 月，由于 COVID-19 大流行，美国已有超过 950 万人错过了推荐的癌症筛查。乔·拜登总统和第一夫人吉尔·拜登博士，教育博士，旨在解决 2022 年重新启动的癌症登月计划中的这一问题。COA 和 Avalere 的调查结果还表明，疫情加剧了现有的医疗保健差距。
我们使用多付款人数据库，分析了 2019 年 3 月 1 日至 9 月 30 日和 2020 年 3 月 1 日至 9 月 30 日期间，医疗保险费用（FFS）、管理式医疗补助和商业保险受益人的乳腺癌筛查率，以了解 COVID-19 大流行对美国预防服务工作组乳腺癌筛查建议的依从性的潜在影响，目前正在进行审查。根据种族/族裔群体和付款人类型评估了筛查率。
2020 年 4 月，符合条件的白人医疗保险 FFS 受益人的平均每月乳房 X 光筛查率降至 0.6%，但这些筛查率在 2020 年 6 月恢复至 6.5%。符合条件的黑人医疗保险 FFS 受益人的筛查率恢复速度略低于白人受益人的恢复速度，但比其他群体的恢复速度快。相比之下，美洲印第安人/阿拉斯加原住民受益人的平均每月筛查率在 2020 年 4 月为 0.5%，在 2020 年 6 月恢复至 3.1%；这些数字低于 2019 年 4 月 4.2%和 6 月 3.9%的筛查率。不同付款人类型的筛查率也存在差异。商业保险患者的筛查率高于医疗保险 FFS 和管理式医疗补助覆盖的患者。
我们的主要发现表明，所有付款人的平均乳腺癌筛查率在 2020 年 4 月都有所下降，但某些种族和族裔群体的筛查率恢复到疫情前水平的速度较慢。按付款人类型划分的恢复率差异突出了收入水平与筛查利用之间的密切关系。
