Common characteristics of women who cancel their screening mammography appointment
The pandemic has resulted in increased risk of older and underserved patients missing their screening mammography appointments, a trend that requires added attention from the specialty, experts charged Thursday.
Numerous studies have charted COVID-19’s impact on breast imaging, with rates dropping precipitously following service shutdowns. Brigham and Women’s Hospital researchers sought to pinpoint which women were most susceptible to cancellations, sharing their findings in the journal Clinical Imaging.
Minority race and ethnicity, Medicare insurance and advanced age were all independently associated with a high risk of missed appointments after reopening from state-mandated shutdowns.
“The effect on ethnic/racial minorities is exacerbated given lower screening mammogram utilization at baseline, tendency to present with later stage disease, and disproportionate number of COVID-19 infection in this subgroup,” radiologist Nita Amornsiripanitch, MD, and colleagues with the Harvard-affiliated institution concluded. “Amplification of our efforts to reschedule missed screening and strategic allocation of resources combined with approaches tailored to the underserved may be steps toward addressing longstanding inequity.”
For their study, scientists reviewed scheduled screening mammograms at their institution from three periods: during state-mandated shutdowns (March-June 2020), the period after services resumed (June-August 2020) and a representative timespan prior to COVID (June-August 2019). Amornsiripanitch et al. found the overall mammography cancellation rate was higher after reopening that before the shutdown (46% versus 37%, respectively). Risk of cancellation after the reopening was higher with age, among Medicare beneficiaries compared to those on Medicaid, and for non-white patients compared to whites.
The 78% rescheduling rate during the COVID shutdowns was higher than prior to the pandemic (61%) or after the reopening (55%). Authors attributed these numbers to a focused efforts to improve rescheduling amid the pandemic. Brigham also found higher cancellation rates and a lower rescheduling tally at inpatient hospitals when compared to outpatient locations.
“This finding may reflect patients' preference to distance themselves from areas where COVID-19 patients may be receiving care,” the authors advised. “This finding can also help guide recuperation initiatives—by realizing patient preferences, resources can be shifted to increase screening availability at outpatient facilities. Furthermore, a change in screening location can be suggested to patients cancelling their exam to encourage rescheduling.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.