key: cord-0741419-duyd3zjm authors: Wilke, Lee G. title: Creating a healthy community after the pandemic: Reinvigorating routine cancer screening with community support systems date: 2021-08-26 journal: Cancer DOI: 10.1002/cncr.33858 sha: c1739448615cea905cf64872a4634c075609b54f doc_id: 741419 cord_uid: duyd3zjm The recovery to a healthy and sustainable community after the pandemic will require multidisciplinary and diverse support from health care and community partners. Cancer screenings, particularly those for breast cancer, will be an important measure of this recovery, and through novel and supportive community coalitions such as the one supported by the American Cancer Society/National Football League CHANGE grant, individuals, including those from underserved communities, can safely be identified and treated at earlier stages when survival and recovery are the most favorable. Cancer December 1, 2021 first 5 months of the pandemic from 62 breast imaging facilities participating in the Breast Cancer Surveillance Consortium. Key findings included the dramatic decreases to 1.1% of expected screening volumes during April 2020 with a return to 89.7% of the volume of expected screening examinations by July 2020. In this data set, greater disparities were noted in Hispanic and Asian populations versus Black populations, in which screening rates returned to 96.7% of the baseline. The Breast Cancer Surveillance Consortium data, however, report only the volume of scans performed and do not detail the screening rate within the population of interest. Within the ACS Community Health Advocates Implementing Nationwide Grants for Empowerment and Equity (CHANGE) grant program, the imaging centers with a high percentage of Black representation returned to 98% of the 2018 screening baseline and to 88% of the 2019 screening baseline but technically started at a lower than desired screening rate in women aged 50 to 74 years. The cumulative "loss" of screening examinations in this population is, therefore, likely to have a greater impact because of the higher rate of missed cancers both in those who ultimately return for screening and in those who are not represented in the baseline screening volumes before the pandemic. This disparity will likely be exacerbated by the younger age shift for African American women with breast cancer because the volume and screening rate reported currently are limited to guideline recommendations for women over the age of 50 years. 4 A report from a series of academic and community health centers in North Carolina provided a similar picture of a dramatic decrease in screening in the first 3 months of the COVID-19 pandemic with a return to nearly normal volumes by August 2020. 5 The return to screening differed by breast cancer risk and insurance status but not by age or race. Again, however, this study provided comparisons with baseline screening volumes versus population screening rates among racially distinct groups. In a small single-institution study from Italy, a 2-month stop in mammographic screening led to an 11% increase in patients with node-positive breast cancer and a 10% increase in patients with stage III breast cancer presenting for treatment. 6 It is, therefore, estimated that in the coming year, we will see similar reports from larger data sets highlighting the effects of delayed breast cancer screening on populations with anticipated increases in later stage disease for those already at risk for stage disparities. The ACS CHANGE grant outcomes from Fedewa and coauthors, however, provide an indication that targeted community partnerships and education programs will enable a quicker return to baseline screening and, more importantly, to a higher rate than that before the pandemic. It will be vital to "catch up" on the missed screening examinations from the first months of the pandemic and increase baseline screening rates in populations already at risk. The NFL-supported CHANGE program appears to have been able to bolster increased screening adherence through the use of telehealth communication platforms because the average screening rate for the 32 programs did not return to the 2018 baseline. Chen et al 7 recently published an analysis of administrative claims data from Medicare Advantage plan users and identified dramatic declines in breast, colorectal, and prostate cancer screening rates during March through May 2020, with nearly complete recovery of screening rates by July 2020. Although these findings match those published by Sprague et al 3 and Nyante et al, 5 Chen and coauthors found an association between patient utilization of telehealth and receipt of cancer screening, with no differences noted across low and high socioeconomic status groups. It was proposed by these authors that the virtual telehealth appointments may have enabled individuals to still receive medical evaluations for other concerns and also obtain encouragement for rescheduling screening examinations. Innovative navigation and education platforms delivered via mobile or telehealth platforms from trusted health sources will likely emerge as important tools to support increased cancer screening rates across all populations in the postpandemic era. The Screening Working Group of the COVID-19 and Cancer Global Modelling Consortium (CCGMC) recently published a multipronged approach for resumption of cervical cancer screening as the pandemic recedes. Recommended were three primary approaches, risk based screening; awareness campaigns for those in areas of high deprivation and HPV self sampling. 8 Although some cancer screenings could be performed at home in the future (colon cancer screening with stool tests), mammography will remain the mainstay for breast cancer screening for the foreseeable future and will require an in-person breast imaging examination. 9 Multiple societies and organizations as a result are now actively campaigning to reverse their early 2020 recommendations to postpone all cancer screenings. 10 The recovery to a healthy and sustainable community after the pandemic will require multidisciplinary and diverse support from health care and community partners. Cancer screenings, particularly those for breast cancer, will be an important measure of this recovery, and through novel and supportive community coalitions such as the one supported by the ACS/NFL CHANGE grant, individuals, including those from underserved communities, can Cancer December 1, 2021 safely be identified and treated at earlier stages when survival and recovery are the most favorable. No specific funding was disclosed. Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery Changes in breast cancer screening rates among 32 community health centers during the COVID-19 pandemic Changes in mammography utilization by women's characteristics during the first 5 months of the COVID-19 pandemic Racial/ethnicity disparities in invasive breast cancer among younger and older women: an analysis using multiple measures of population health Population-level impact of coronavirus disease 2019 on breast cancer screening and diagnostic procedures Two-month stop in mammographic screening significantly impacts on breast cancer stage at diagnosis and upfront treatment in the COVID era Association of cancer screening deficit in the United States with the COVID-19 pandemic Cervical screening during the COVID-19 pandemic: optimising recovery strategies The future of cancer screening after COVID-19 may be at home Cancer screening, diagnosis, staging, and surveillance Lee G. Wilke is a founder/minority stock owner in Elucent Medical (whose device is not discussed in this editorial), is a research committee chair for the American Society of Breast Surgeons, and is a board member for the Alliance for Clinical Trials.