Breast and Cervical Cancer Screenings Decline at the Beginning of the Pandemic

Breast cancer and cervical cancer screening tests in the United States dropped significantly when COVID-19 cases spiked, according to CDC health scientists.

Introduction

In the United States, over the past years, the incidence of breast cancer and cervical cancer has been on a downward trend, thanks to focused efforts on prevention. Mammograms and Pap tests can detect breast and cervical cancers in the early stages. For cancer, prevention is key and screenings are important for prompt diagnosis and treatment to improve outcomes¹.

National Breast and Cervical Cancer Early Detection Program

The CDC created the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) after Congress approved the Breast and Cervical Cancer Mortality Prevention Act of 1990^2,3. The program’s goal is to increase preventative and life-saving health services in populations with barriers to access. Underinsured, uninsured, and lower-income women benefit from NBCCEDP screening, diagnostic, and treatment services².

Since 1991, the program has served over 5.9 million women². However, a study found a marked decrease in the number of people screened for breast cancer and cervical cancers in 2020.

The Study

In the study, published in Preventive Medicine, CDC researchers found that cancer screening tests from January to June 2020 in the NBCCEDP fell below the 5-year average. In April 2020, breast cancer and cervical cancer screenings each dipped by over 80% compared to the 5-year average⁴.

“This study highlights a decline in cancer screening among women of racial and ethnic minority groups with low-incomes when their access to medical services decreased during the pandemic,” said lead author and CDC health scientist Amy De Groff in a press release⁵.

The CDC funds health departments and affiliate organizations throughout the United States, its territories, and tribal organizations that implement NBCCEDP. Currently, 70 organizations receive grants to operate their respective programs⁴.

Study scientists used CDC-funded NBCCEDP program data to examine the average screening tests volumes from 2015 to 2020. For the months of January to June for each year, the researchers assessed the number of mammograms, Pap and HPV test performed. The authors categorized data across 10 U.S. regions, rurality, and race or ethnicity. Besides clinical data, the authors evaluated each awardee’s yearly surveys and budgets⁴.

Findings

From January to June 2015-2020, the funded programs facilitated 630,264 breast cancer screening tests and 594,566 cervical cancer screening tests. However, the total number of tests dropped during March-June 2020 with the least amount of test performed in April 2020. During that month, breast cancer and cervical cancer screening tests were down 87% and 84%, respectively.

While the significant dip in screening tests corresponded with the emergence of COVID-19 cases in 2020, the program awardees reported issues with the following:

• inadequate staffing
• program staff redeployment for COVID-19 response
• test site closures
• program suspensions
• reductions in services
• cancellation of community outreach activities

By June 2020, the NDCCEDP saw an uptick in cancer screening tests. Unfortunately, breast cancer and cervical cancer screenings were still down from the five-year average in the same month by 39% and 40%⁴.

Possible Consequences

The authors contend that the decline in screening tests in early 2020 may cause late-stage cancer diagnosis, treatment, and mortality. However, the immediate downstream effects of the decline in NDCCEDP screenings remain to be seen.

Besides programmatic barriers to providing services, clients were also reluctant to enter healthcare facilities for worry of contracting the virus. Women in need of NBCCEDP services can trust that clinics and healthcare facilities prioritize their safety⁴.

Ensuring Safety

Women in need of NBCCEDP services can trust that clinics and healthcare facilities prioritize their safety. By following CDC safety precautions, clients and healthcare staff can diminish the spread of COVID-19 during routine medical visits.

For cancer screening appointments, women can expect to follow protective measures by wearing facemasks, completing a pre-arrival symptoms assessment, and temperature checks.

As an added infection control measure, clinics and healthcare facility staff perform frequent hand washing, regular cleaning of care areas, and disinfection of exam rooms in between patients. These practices help minimize the risk of getting COVID-19 in healthcare settings⁶.

Final Thoughts

"The NBCCEDP can play an important role in encouraging women with low incomes to resume cancer screening if it can be provided in a safe environment where COVID-19 transmission is minimized," the authors advise⁴.

Have you or your patients been reluctant to get routine preventative health screens because of safety concerns? Share your thoughts in the comments.

References

¹National Institutes of Health: National Cancer Institute: About Cancer

²CDC: National Breast and Cervical Cancer Early Detection Program (NBCCEDP)

³US Government Publishing Office: 104 Stat. 409 - Breast and Cervical Cancer Mortality Prevention Act of 1990

⁴Science Direct: COVID-19 impact on screening test volume through the National Breast and Cervical Cancer early detection program, January–June 2020, in the United States

⁵CDC: Sharp Declines in Breast and Cervical Cancer Screening

⁶CDC: Managing Healthcare Operations During COVID-19