Impact of COVID-19 on Time to Treat Breast Cancer and Racial Disparities Among Women in the Military Health System From FY2018-2022.
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BACKGROUND: Breast cancer is the most diagnosed cancer among women in the United States, and early identification and initiation of treatment are critical to improving outcomes. This study aims to investigate the breast cancer time to treat trends among women in the Military Health System before and during the COVID-19 pandemic and if racial or socioeconomic disparities existed in timely treatment. METHODS: A retrospective cohort study of all female MHS beneficiaries ages 18-63 years during fiscal years 2018-2022. Incident breast cancer was defined as one inpatient or three outpatient diagnoses of breast cancer within a 90-day period and no previous breast cancer diagnosis in the 3 years prior. Time to treatment was calculated in days and timely treatment was identified if received within 90 days (surgical intervention) or 120 days (chemotherapy and radiation) after initial diagnosis. Study analyses included a t-test and Kaplan-Meier curve for time to treatment and an adjusted modified Poisson regression for the relative risk of timely treatment. RESULTS: A cohort of 14,286 women with incident breast cancer was identified; 94% received timely treatment. The average time to treatment was greater during the pandemic period (47.7 days, 95% CI = 46.6-48.7) compared to the pre-pandemic period (44.8 days, 95% CI = 43.7-45.9). Regression results indicated no difference in the likelihood of timely treatment in the pandemic period (0.99 aRR, 0.98-1.01 95% CI), no racial or socioeconomic disparities, and timely treatment was more likely to be received in the direct care setting (aRR = 1.04, 95% CI = 1.01-1.07). CONCLUSION: Despite facing access to care challenges compounded by the COVID-19 pandemic, the MHS was able to provide timely treatment to women for incident breast cancer. In addition, this study observed no racial or socioeconomic disparities in the timely treatment of breast cancer in a population with equal access to care.