Impact of COVID-19 pandemic on breast cancer screening adherence across Europe

Abstract Background Breast cancer has a high health and economic burden in Europe. Screening is an effective intervention, enabling cancer prevention. Trend analysis provides insights for public health planning, particularly for understanding the impact of disruptive events such as the COVID-19 pandemic and then adopting strategies to increase adherence. Methods Data on breast cancer screening adherence from EU and EFTA countries were collected from Eurostat. Seventeen countries with ≥15 years of data between 2000 and 2022 (last data available) were included. Joinpoint regression was used to identify the Annual Percent Change (APC) and Average Annual Percent Change (AAPC) over time. Results Overall, 12 countries had declining screening adherence; 10 had significant reductions (Finland, Germany, Hungary, Iceland, Ireland, Italy, Luxembourg, Netherlands, Norway, Slovakia; AAPC -0.25 to -0.97). Considering the pandemic years, all but two countries (Iceland and Ireland) reported a decrease (between -1.35% and -15.98%). Three trend patterns emerged. Group 1 (Finland, Norway) showed a decline in 2020 (APC -1.3, -12.29) followed by an increase in 2021-2022. Group 2 (Cyprus, Hungary, Netherlands) exhibited accelerated negative trends during the pandemic period. Group 3 (Belgium, Croatia, Czech Republic, Estonia, France, Germany, Iceland, Ireland, Italy, Lithuania, Luxembourg, Slovakia) displayed no statistically significant trend changes. Conclusions Overall, most of the countries reported a decrease in screening adherence. The COVID-19 pandemic coincided with abrupt disruptions in uptake in 5 European countries, while in others it aligned with pre-existing patterns. These heterogeneous impacts highlight the need for research into the factors influencing different healthcare system responses. Strengthening monitoring and adaptability of preventive programs will be critical to sustain equitable access during future health crises. Key messages • Analyzing trends in breast screening uptake provides crucial insights for public health planning, particularly in understanding the impact of major disruptive events. • COVID-19 caused varying impacts on breast cancer screening trends across European countries; understanding health system responses is key to strengthening resilience of screening programs.