Increased socioeconomic vulnerability in breast cancer diagnosis during the COVID-19 pandemic in Brazil

Abstract

Objective: To evaluate the impact of the coronavirus disease (COVID-19) pandemic on the time of breast cancer diagnosis in Brazil and associated socioeconomic factors. Methods: This population-based retrospective study examined breast cancer diagnoses in women between 2019 and 2020 (n = 12,597). Two periods were evaluated: the pre-pandemic (March–December 2019) and pandemic periods (March–December 2020). Logistic regression was performed to calculate odds ratios and 95 % confidence intervals (CIs). Results: There was a 50.2 % reduction (p < 0.01) in the number of diagnoses, and the average time from the first consultation to diagnosis increased from 28 to 36 days during the first six months of the COVID-19 pandemic (p = 0.006). Before the pandemic, the regression model indicated an increased possibility of delay in breast cancer diagnosis in women with lower education levels (OR = 1.30; 95 % CI:1.14–1.48); who were residents in the north, northeast, or midwest regions (OR = 1.56; 95 % CI:1.35–1.81); and who presented staging I or II (OR = 1.96; 95 % CI:1.71–2.24). During the pandemic, there was an increase in the odds ratios for all variables: education, an increase of 10.8 %; region of residence, 20.5 %; and staging, 9.2 %. Conclusion: The COVID-19 pandemic exacerbated pre-existing socioeconomic disparities during the early detection of breast cancer. It is important that, at critical moments in health, interventions be carried out for patients in vulnerable circumstances, thus minimizing the effects of possible delays in diagnosis.

Keywords

• Breast neoplasms
• COVID-19
• Delayed diagnosis
• Socioeconomic factors
• Healthcare disparities