June 3, 2021 synthesis by Dr. C.Bour
Video and interview with V.Prasad, American hematologist-oncologist and health researcher, associate professor at the University of California, San Francisco
An article has just been published in JAMA Network Open entitled "Socioeconomic and Racial Inequities in Breast Cancer Screening during the COVID-19 Pandemic in Washington State."
The authors note the disruption of so-called preventive care, a disruption that has been highlighted by several international studies in Europe and the United States, with a decrease in the uptake of mammography screening.
Yet, while all people suffered from COVID-19, say the authors, it hit harder in some places and disrupted routine care differently.
The authors report the number of women who had mammograms in 2018, 2019 and 2020. And it seems that during COVID-19, there were half as many mammograms as the previous year, namely a reduction of 49%, so almost by half.
This reduction was more likely to affect individuals by racial and socioeconomic status.
Specifically, among Hispanic women there was a greater reduction in mammography usage during COVID-19.
Then, explains Vinay Prasad in the video, Americans Indian were affected, then Asians, then black populations, and finally white populations. Whites had the smallest change in their use of mammographic tests compared to 2019.
Rural areas also experienced a greater decline in mammography screening.
Finally, the authors also looked at insurance status. Those who were forced to pay by themselves for care had a greater decline in screening use, logically enough.
What does it all mean?
The study, according to Prasad, essentially and interestingly shows that cancer prevention service use declined significantly during the pandemic, but that it did not decline equally for everyone.
People are much more likely to decrease their use of so-called preventive care if they are Hispanic, if they pay for it themselves, and if they live in rural areas, he said.
According to V. Prasad, it will be a lot more difficult to disambiguate the effect of mammography screening from the effect of all the other socioeconomic variables that exist and come into play here.
Clearly, it will be very difficult to see any effect of effectiveness or ineffectiveness of screening because of the socio-economic biases that pollute the analysis.
There is evidence that health care is disrupted, and more so along socio-economic and racial dimensions, but, says V. Prasad, once this is noted, it does not mean that women who do not get their mammograms are suffering disproportionately.
Already in May 2020, Gil Welch and V.PRasad wrote an article (CNN opinion) titled "The Unexpected Side Effect of COVID-19," which we discussed on Cancer Rose, and they prophesied this dramatic reduction in routine care that would allow to examine its impact.
Decreasing this routine care would allow, among other things, to examine the effect on overdiagnosis and boldly ask the question: would reducing these preventive tests maybe be better? Is this a bad thing or a good thing?
The Covid-19 pandemic was swift and frightening, and it forces us to rethink what is most important in public health, and obliges us to examine what is valuable and what is not.
Shouldn't we focus on the problems of unequal access to care, depending on geographical area or socio-professional category, and put priority public health problems into perspective?
We must simply think, not always about the 'damage' of not using screening, but rather about the potential bonus of 'non-damage' , thanks precisely to the avoidance of many tests whose effectiveness and relevance are not always proven.
In this context, we should mention a study that is currently underway to evaluate overdiagnosis through the "natural experiment" of reduced screening during the pandemic.