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

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According to a study of CDC’s National Breast and Cervical Cancer Early Detection Program data, the number of women that use the preventative services declined dramatically during the early months of the pandemic. While the downstream effect of the decrease in screenings is yet to be known, missed opportunities for timely diagnoses and interventions could affect thousands of women.

by Kimberly Madison Kimberly Madison, BSN, MSN (New)

Specializes in Analytics, Quality, Trauma, Clinical Registries. Has 13 years experience.

Are you or your patients reluctant to get routine preventative health screens because of safety concerns?

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 19902,3. 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

 

Kimberly Madison is an RN with over 12 years of experience in telemetry, med-surg, acute rehabilitation, orthopedics, emergency medicine, trauma, pediatrics, quality, analytics, and performance improvement. She has an MS in Advance Clinical Management and Leadership.

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2 Comment(s)

Ado Annie, ASN, RN

Specializes in Med/Surg. Has 11 years experience. 244 Posts

I'm reluctant to get preventive care because I don't want to go to out anywhere. Not out of fear of the virus. I'm vaccinated and I mask up and I'm reasonably careful. But I just hate using my time off to go to doctors! The fact that we do get out less frequently due to the pandemic does seem to make me more hesitant to go out. It feeds my natural introversion, maybe.

Leader25, ASN, BSN, RN

Specializes in NICU. Has 39 years experience. 1,239 Posts

Just hate going out,nothing good out there,,feels like PTSD.