Effect of the COVID-19 pandemic on disparities in stage of breast cancer diagnosis

Background: African American (AA) women historically present with more advanced breast cancer (BC) stages. The 2019 novel Coronavirus (COVID-19) stressed healthcare systems, leading to the reduction of resources for non-urgent care, including cancer screening. Limiting screening access may worsen existing delays in cancer screening and potentially widen racial disparities in BC diagnosis stages.Methods: We conducted a retrospective cohort study of 321 self-identified AA and 2841 White women aged 18 and over with invasive BC at The Ohio State University Comprehensive Breast Center between 2018 and 2021 to evaluate differences in the stage of BC at presentation. Variables of interest included time (pre-COVID [2018-2019] and COVID era [2020-2021]), sociodemographic factors, neighborhood socioeconomic composition (low [1-33], medium [34-66], and high [67-100] Yost tertiles), and tumor receptor status (ER, PR, HER2). Data were analyzed using chi-square, Fisher’s Exact tests, Wilcoxon Two Sample tests, and logistic regression.Result: Significant predictors of late-stage diagnosis included higher age at diagnosis, ER, PR, HER2 receptors, and medium vs. high Yost Index Score. Race and time were not significant predictors of late-stage diagnosis.Discussion: The clinical impact of COVID-19 on healthcare delivery will continue to be observed, and how the pandemic affects existing BC inequalities requires exploration.