A rapid review of COVID-19’s global impact on breast cancer screening participation rates and volumes from January to December 2020
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Curated by eLife
eLife assessment
This study presents important evidence of the impact of the covid pandemic on breast cancer screening globally but with important variations by healthcare setting. The data analysis is comprehensive, using solid systematic review methods. The results will be of interest to public health policymakers and health care and cancer control practitioners and researchers across the globe.
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Abstract
COVID-19 has strained population breast mammography screening programs that aim to diagnose and treat breast cancers earlier. As the pandemic has affected countries differently, we aimed to quantify changes in breast screening volume and uptake during the first year of COVID-19 . We systematically searched Medline, the World Health Organization (WHO) COVID-19 database, and governmental databases. Studies covering January 2020 to March 2022 were included. We extracted and analyzed data regarding study methodology, screening volume, and uptake. To assess for risk of bias, we used the Joanna Briggs Institute (JBI) Critical Appraisal Tool. Twenty-six cross-sectional descriptive studies (focusing on 13 countries/nations) were included out of 935 independent records. Reductions in screening volume and uptake rates were observed among eight countries. Changes in screening participation volume in five nations with national population-based screening ranged from –13 to –31%. Among two countries with limited population-based programs, the decline ranged from –61 to –41%. Within the USA, population participation volumes varied ranging from +18 to –39%, with suggestion of differences by insurance status (HMO, Medicare, and low-income programs). Almost all studies had high risk of bias due to insufficient statistical analysis and confounding factors. The extent of COVID-19-induced reduction in breast screening participation volume differed by region and data suggested potential differences by healthcare setting (e.g., national health insurance vs. private healthcare). Recovery efforts should monitor access to screening and early diagnosis to determine whether prevention services need strengthening to increase the coverage of disadvantaged groups and reduce disparities.
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eLife assessment
This study presents important evidence of the impact of the covid pandemic on breast cancer screening globally but with important variations by healthcare setting. The data analysis is comprehensive, using solid systematic review methods. The results will be of interest to public health policymakers and health care and cancer control practitioners and researchers across the globe.
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Reviewer #1 (Public Review):
The COVID-19 pandemic strained population-level mammography screening programs, but to what quantitative degree is unclear. Through a rapid review, the authors quantified the changes in breast screening volume and uptake during the first year of the COVID-19 pandemic, compared to a prior year.
A major strength of this rapid review is that the detail provided by the authors makes this rapid review easily replicated. The detail provided in the time frames used as comparison and the added rigor of using grey literature make this a strong study. The authors nonetheless note that a limitation of this review is that the production of articles is rapid and that newly published articles relevant to the topic could have been missed. However, the authors lay out well how to replicate and strengthen this rapid review …
Reviewer #1 (Public Review):
The COVID-19 pandemic strained population-level mammography screening programs, but to what quantitative degree is unclear. Through a rapid review, the authors quantified the changes in breast screening volume and uptake during the first year of the COVID-19 pandemic, compared to a prior year.
A major strength of this rapid review is that the detail provided by the authors makes this rapid review easily replicated. The detail provided in the time frames used as comparison and the added rigor of using grey literature make this a strong study. The authors nonetheless note that a limitation of this review is that the production of articles is rapid and that newly published articles relevant to the topic could have been missed. However, the authors lay out well how to replicate and strengthen this rapid review to replicate the findings.
The authors found evidence supporting the concern that the COVID-19 pandemic disrupted breast mammography screening on a global scale. They conclude that overall, there were global volume and uptake reductions in breast cancer screening. The volume and uptake reductions varied regionally and there was compelling evidence that these reductions were in part due to health care coverage.
What I found most compelling about this rapid review is the thorough assessment of the included articles and the detailed accounting of the limitations of these articles. This rapid review revealed major deficits in the evidence quality in global assessments of breast mammography screening uptake and volume and future studies that include common and rigorous measures are needed.
In conclusion, the implications of the findings suggest that monitoring patient volume and uptake could be early warning signs to determine if prevention services need strengthening. Especially for those with public vs private insurance and additional markers of social determinants of health.
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Reviewer #2 (Public Review):
The authors undertook a review of studies describing the effects of the COVID-19 pandemic on breast cancer screening in countries across the world. The major strengths of the study are its breadth and the rigour of the literature search and review. The volume of studies included, and their different contexts and designs, make it challenging to summarize succinctly and the authors have done a good job. The weakness of this review, or any like it, is that we have limited data to explain the findings which a likely a complex mix of societal, structural, and personal reasons. The importance of the findings lies in the consistency of the overall trend and what the implications of potential delayed/missed breast cancer screening are and how far into the future these implications will reach.
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