We Must Increase Breast Cancer Screening with Mammograms in Underserved Communities

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By Dr. Edith Perez and Tawana Thomas-Johnson

December 10, 2021

Guest Opinion - HEALTH. One of the many consequences of the COVID-19 pandemic is that many preventive health care visits, including recommended cancer screenings, have been skipped or postponed. The data related to the impact of this pandemic on breast cancer screening is sobering – in early 2020, there was an 85 percent decline in breast cancer screening rates, and the challenges continue.

Breast cancer is the most common cancer in American women, except for skin cancers – and the pandemic-driven delays and cancelations of routine screenings are anticipated to result in excess deaths from breast cancer in the US.

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Adding to these setbacks is the fact that certain vulnerable populations – already experiencing disproportionate health and economic outcomes related to the pandemic – saw some of the most dramatic drops in breast cancer screening rates.

Data from The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) showed that in April 2020, breast cancer screenings declined across the board when compared with the five-year average for 2015-2019, but most especially among certain communities. Specifically, they declined by 98 percent among American Indian and Alaska Native (AIAN) women (the most significant decrease across populations), 97 percent among Asian/Pacific Islander women, 94 percent for multi-racial women, and 90 percent among Black women, compared with an 87 percent decline among white women.

A May 2021 JAMA article reported data collected between April 2018 and December 2020 on breast cancer screening rates in Washington State. The study found that amid the pandemic in this state, the number of screening mammograms dropped by 61 percent in AIAN women and by 64 percent in Hispanic women, compared to a 49 percent drop among white women. And ultimately, inequities are not just limited to breast cancer screenings – Black women are 40 percent more likely to die of breast cancer, despite having similar incidence rates compared to white women.

We know regular screenings (like mammograms) increase the chance of finding certain cancers at an early stage. Fewer screenings mean women in these communities are less likely to receive an early-stage diagnosis, when breast cancer may be easier to treat. We can and must help change this trend by increasing awareness of, and access to, cancer screenings.

Besides restrictions due to the COVID-19 pandemic, what drives these trends in decreased screening rates? The answer is complicated and driven by multiple factors – economic (income inequality), access to care, and health literacy, to name a few.

A study conducted by the CDC found that socioeconomic and insurance status impact a woman’s likelihood to get recommended screenings. The study noted that those who have more limited economic means and no health insurance have screening rates up to 26-39 percent lower than those with insurance and higher incomes. Additionally, a recent survey conducted on behalf of the Cancer Screen Week initiative found that 75 percent of Hispanic/Latino adults reported concerns about the cost of cancer screenings as a barrier to getting screened.

Cancer is a complex disease – and screenings are just one piece of the puzzle. But by acknowledging these social determinants of health, improving health literacy, and connecting marginalized communities to needed resources, we can help create a more equitable health system and potentially save lives.

The American Cancer Society, Genentech, Optum, and Stand Up To Cancer are working to spread awareness of the importance of cancer screenings through the Cancer Screen Week program. Visit CancerScreenWeek.org for resources, low- and no-cost screening options for the uninsured, and screening locations (available in both English and Spanish).

While the statistics are concerning and the challenges are many, you can support our efforts to help save lives by spreading the word and encouraging those around you to get screened! Join us by sharing screening resources in your community during Cancer Screen Week, Dec. 6-10, as well as year-round.

About Dr. Edith Perez:

Edith A. Perez, MD, is Professor of Medicine at Mayo Clinic College of Medicine and the chief medical officer of Bolt Biotherapeutics; she also serves as chair for Stand Up To Cancer’s Health Equity Committee and vice-chair of Stand Up To Cancer’s Scientific Advisory Committee. Dr. Perez is a cancer specialist and an internationally known translational researcher. Her roles have extended nationally, including group vice chair of the Alliance for Clinical Trials in Oncology and other positions within the American Association for Cancer Research, the American Society of Clinical Oncology, and the National Cancer Institute.

About Tawana Thomas-Johnson:

Tawana Thomas Johnson the Senior Vice President and Chief Diversity Officer for The American Cancer Society (ACS) and serves on the CEO’s executive team. In her mission-critical role, she heads up our stand-alone Diversity, Equity, and Inclusion team and is ultimately responsible for leading efforts to design and implement strategies that drive diversity, equity, and inclusion to meet mission, revenue, and talent goals. Thomas-Johnson also serves in leadership capacities with several national organizations including the African Heritage Studies Association, The Links, Incorporated, and the NAACP. She also serves on several boards, including the Oprah Winfrey Network OWN Your Health advisory board.