Background: The COVID-19 pandemic disrupted healthcare utilization in the US, with cancer screening being severely impacted. Little is known about the impact COVID-19 had nationally on breast cancer screening. The objective of this study was to examine the potential impact of the COVID-19 pandemic on breast cancer screening rates. Methods: Commercial Fully Insured and Medicare members of large national health plan meeting the Healthcare Effectiveness Data and Information Set (HEDIS) inclusion and exclusion criteria for the measurement years 2019, 2020 and 2021 were included in the study. Member demographic data were linked to race, zip code, socioeconomic status and region information. The pre-COVID period was defined as measurement year 2019, peak-COVID was defined as measurement year 2020 and post-peak-COVID-19 was defined as measurement year 2021. Screening incidence rate differences (IRD) and ratios (IRR) were calculated between the three time periods. Logistic regression was conducted to control for socio-demographic confounders. All analyses were conducted in Python; a p-value less than 0.05 was significant. Results: This study included 324,707, 400,740 and 532,879 members in pre-COVID, peak-COVID and post-peak-COVID periods, respectively. The screening IRD between pre-COVID and peak-COVID periods was -3.1% (95% confidence interval [CI] -3.5% to -2.7%; p < 0.001) and the IRR was 0.961 (95% CI 0.956 – 0.966; p < 0.001). Between the peak-COVID and post-peak-COVID periods, the IRD was -0.33% (95% CI -0.68% to 0.02%; p = 0.0675) and the IRR was 0.996 (95% CI 0.991-1.000; p = 0.0667). Comparing the pre-COVID to the post-peak-COVID period revealed a significant IRD (-3.4% [95% CI -3.8% to -3.0%]; p < 0.0001) and IRR (0.956 [95%CI 0.952-0.961]; p < 0.0001). Controlling for other confounders, the pre-COVID period was associated with significantly higher odds of receiving a screening mammogram compared to the peak-COVID period (odds ratio [OR]: 1.19 [95% CI 1.17-1.2], p < 0.0001). Additionally, the post-peak-COVID period was associated with lower odds compared to the peak-COVID period (OR: 0.98 [95% CI 0.97-0.99], p < 0.0001). Additional results are shown in Table 1. Conclusions: The COVID-19 pandemic resulted in significantly lower screening mammogram rates when compared to the pre-COVID period. Additionally, this decrease appeared to be durable into the post-peak-COVID period after controlling for other confounders for screening. Further follow up studies are warranted to characterize the potential rebound of screenings.

Controlling for region, race, zip code density.