Fears about contracting and spreading COVID-19 led to delays in lung, breast, and colorectal cancer screening during the pandemic among Asian American women, researchers have found.
The study results underscore the importance of helping patients experience "medical and psychological safety" when it comes to cancer screening, wrote a team led by Chau Vo, MD, of Massachusetts General Hospital (MGH) in Boston. Study senior authors included Ruth Carlos, MD, editor-in-chief of the Journal of the American College of Radiology (JACR), and Efrén Flores, MD, associate editor of the journal. The findings were published January 7 in the JACR.
"[We found that] delays in cancer screenings were associated with fears of contracting and spreading the virus," the group noted. "[And] although perceived discrimination was not significantly linked to screening delays … discrimination might heighten patients' concerns and potentially reduce timely cancer screening."
Over the last 20 years, the Asian population in the U.S. has grown by 72%, and cancer is the leading cause of mortality among it, the team noted. Although Asian American women have traditionally been considered low risk for adverse cancer outcomes, studies have demonstrated "greater exposure to environmental carcinogens and lower cancer screening rates compared with other groups," Vo and colleagues explained.
"Understanding disparities among various Asian American subgroups is crucial to overcoming barriers to cancer preventive services," they wrote. "These disparities have been compounded by the effects of the pandemic due to discontinuity in nonurgent care and increased discrimination against several populations, resulting in significant delays in cancer screening."
Vo's group investigated any links between pandemic-related health concerns and cancer screening among 166 Asian American women via a two-phase study. The first phase consisted of a survey distributed to Asian American women eligible for lung, breast, or colorectal cancer screening to assess delays during the pandemic, concerns about contracting COVID-19, barriers to care, and experiences of discrimination. The second phase consisted of four focus group discussions in which participants were stratified by age and history of delayed cancer screening. Of the study cohort, 67% were first-generation Americans, 65% were employed, and 67% held a master's degree or higher.
Overall, the researchers found that 40% of study participants reported delays in cancer screening, although they did not discover any association between discrimination and delayed cancer screening.
Phase I of the study showed that factors linked to screening delays included concern about contracting COVID-19 (adjusted odds ratio [OR], 2.57, with 1 as reference; p = 0.038) and spreading it to family or friends (adjusted OR, 5.78; p = 0.011).
Phase II of the study showed that first-generation Asian American women who delayed screening "faced barriers due to a fear of infection and perceived discrimination," and that "perceived discrimination affected daily behaviors and sense of safety," the team noted.
What can be learned from these results? Making screening "psychologically safe" is key, according to Vo and colleagues.
"Radiology practices [can] lead collaborative efforts with other specialties and public health initiatives on screening campaigns that emphasize the importance of early detection and promote a sense of belonging by fostering medical and psychological safety," they urged.
The complete study can be found here.
