The Impact of the COVID-19 Pandemic on Breast Cancer Screening and Treatment in Shiraz: A Cross-sectional Study in Southern Iran

Abstract

Background: Timely breast cancer diagnosis and treatment are crucial for patient survival. The COVID-19 pandemic disrupted healthcare access, worsening outcomes in diseases like cancer. Objectives: This study compared breast cancer screening and treatment before and after the pandemic in Shiraz, Iran. Methods: This cross-sectional study used breast cancer screening (mammography) data from 2019 to 2022, collected from health insurance and Social Security records in Fars province. Data from breast cancer surgeries at one referral hospital in Fars province were also included. The study compared pre- (2019) and post-COVID-19 (2020 - 2022) periods. A checklist was developed to collect demographic and clinical data. In total, 2,460 patient records were analyzed. Statistical analysis, which included a one-sample t-test and chi-square test, was performed using SPSS software version 22 with a significance level of 0.05. Results: Between 2019 and 2022, the total number of mammography procedures significantly declined during the COVID-19 pandemic, dropping from 31,965 in 2019 to 17,819 in 2020 and further to 10,217 in 2021, before partially recovering to 30,988 in 2022 (P = 0.001). This downward trend was observed in both bilateral and unilateral mammography. Concurrently, patient outcomes were adversely affected, with mortality rates increasing from 2.4% in 2019 to 4.7% in 2020, peaking at 6% in 2021, and then decreasing to 4.1% in 2022, a statistically significant change (P = 0.004). Additionally, the mean age of deceased patients was significantly higher than that of discharged patients across both periods (P < 0.001). There were no significant differences in gender distribution (P = 0.650) or marital status (P = 0.330) between deceased and discharged groups. However, disease stage distribution differed significantly (P = 0.002), with early-stage breast cancer (stages I and II) being more common among deceased patients, particularly during the pandemic. Conclusions: This study shows that COVID-19 significantly affected patient diagnosis and outcomes. Reduced diagnostic mammograms likely led to delayed diagnoses and higher mortality. Older age and widowhood were linked to worse outcomes, highlighting the need for targeted healthcare planning.