COVID-19 impacts on the breast cancer care pathway among systemically marginalized communities in Ontario.

Publication date: Sep 24, 2025

Healthcare system pauses occurred worldwide due to COVID-19, and may have worsened pre-existing disparities in breast cancer care. In this population-based, retrospective cohort study, we investigated indicators of breast cancer care (i. e., adherence to screening guidelines, early vs. late-stage diagnosis, and mastectomy vs. breast-conserving surgery) before and after COVID-19 lockdowns in Ontario, with an emphasis on immigrant women. We had three binary outcomes and corresponding cohorts, and each outcome/cohort was ascertained relative to two time periods: April 1, 2018-March 31, 2020 (“pre-pandemic”) and April 1, 2020-March 31, 2022 (“pandemic”): i) up to date on screening, ii) early vs late stage of breast cancer diagnosis, and iii) mastectomy vs breast-conserving surgery at any time after diagnosis for women who were diagnosed at stages I-III during each two-year time period. We conducted descriptive analyses, and used logistic regression, both unadjusted and adjusted, to determine odds ratios for our dichotomous outcomes. Breast cancer screening rates dropped from 59. 4% to 51. 0%, and the number of women diagnosed dropped from 18,821 to 14,269, in the pre-pandemic vs pandemic period. In multivariable analyses, screening significantly dropped (AOR = 0. 69 [95% CI (0. 69-0. 69)]), there was no significant difference for diagnostic stage (AOR = 0. 99 [95% CI (0. 92-1. 05)]), and the use of mastectomy vs breast-conserving surgery was higher in the pandemic period (AOR = 1. 14 [95% CI (1. 08-1. 20)]). Women from the Caribbean had lower odds of early-stage diagnosis in the pre-pandemic period despite a screening advantage. Future work should further explore the reasons for these findings and potential system-level solutions.

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