Disparities in breast cancer screening and diagnosis: Urban-suburban contrasts in the wake of the COVID-19 pandemic

Purpose: Compare the reduction and recovery of breast cancer screening and diagnostic services in urban versus suburban communities during the COVID-19 pandemic to identify opportunities for advancing equitable breast cancer detection. Methods: This retrospective cohort study used the MontageTM data mining system to analyze percent change in the number of screening and diagnostic mammograms, breast biopsies, and breast cancer diagnoses at a single mid-Atlantic institution with urban and suburban sites centered in and around Philadelphia, Pennsylvania from 1/1/2019 to 12/31/2022, with urban-suburban subset comparison from 1/1/2019 to 12/31/2021. Results: In 2020, screening mammogram volume dropped 23.9 % at urban sites and 1.6 % at suburban sites while diagnostic mammogram volume decreased 26.4 % at urban and 21.4 % at suburban sites. In 2021, screening volume at urban and suburban sites was 2.6 % and 31.0 % greater than pre-pandemic levels, and diagnostic volume was 28.5 % and 16.9 % below pre-pandemic levels. That same year, the proportion of invasive ductal carcinoma at urban sites increased by 26.2 %. In 2022, screening volume at all sites surpassed pre-pandemic levels by 19.5 % while diagnostic volume remained 21.7 % less than pre-pandemic levels. Conclusion: The COVID-19 pandemic disproportionately reduced breast cancer screening and diagnostic services in urban communities, who experienced slower recovery and increased invasive breast cancer in the subsequent year. Throughout our institution, screening mammograms surpassed pre-pandemic levels in 2021 and 2022 while diagnostic services remained below pre-pandemic levels through 2022. Considering these findings, we must improve access to breast cancer screening and diagnosis to mitigate the long-term consequences of the pandemic.