Purpose
SARS-CoV-2 raised the question of whether it was appropriate to continue breast cancer screening during the pandemic. As early as March 26, 2020, the American College of Radiology, American Society of Breast Surgeons, Society of Breast Imaging, and the Centers for Medicare and Medicaid Services, recommended that screening mammography be delayed. Additionally, state-wide mandates called for a temporary halt on elective and screening healthcare services. The objective of this study is to compare changes in screening mammography practice patterns between urban and rural facilities during the COVID-19 pandemic. We hypothesized that COVID-19 related screening mammography practices and safety standards would differ in rural versus urban areas.

Materials and Methods
This study was deemed exempt by our institution’s IRB. We performed a statewide, cross-sectional, observational survey of screening mammography facilities. Survey participants were identified through the online FDA mammography facility database. Two study team members contacted 188 screening mammography centers by telephone and invited facility leaders to complete an anonymous, voluntary survey via telephone or email. We measured demographic characteristics and asked twelve questions (binary yes/no) pertaining to screening mammography practice changes during the pandemic. Our primary outcomes was facility’s self-identified decrease in screening mammography scheduling due to the pandemic. We classified each screening mammography facility as rural or urban using the Rural-Urban Continuum Codes (RUCC), as defined by the United States Department of Agriculture, Economic Research Service. We compared outcomes between urban and rural mammographic facilities using Pearson’s chi-squared test.

Results
The overall response rate was 32% (72/188), with 15 rural facilities and 57 urban facilities participating. Complete demographic characteristics were documented. Urban mammography facilities more frequently indicated limiting the number of screening mammograms performed daily as a result of the pandemic (p=0.048). Rural and urban mammography centers were otherwise similar in their practice changes during the pandemic.

Conclusion
Urban mammography centers more frequently indicated limiting the number of screening mammograms performed daily during the pandemic. Otherwise, urban and rural facilities implemented similar practice changes including requiring staff to wear masks, patients to wear masks, and disinfecting equipment.

Katie M. Davis DO

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