Breast Cancer Screening Patterns Following National Crises: Experience from a Lebanese Tertiary Center.

BACKGROUND

Lebanon's recent compounded crises-including economic collapse, the COVID-19 pandemic, and the Beirut Port explosion-have disrupted healthcare access, including breast cancer (BC) screening. This study assesses adherence to BC screening after the onset of these crises and evaluates associated imaging outcomes.

METHODS

This retrospective, single-center study included women aged ≥40 who underwent screening mammography (± ultrasound) at Lebanese Hospital Geitaoui (LHG) between October 2018 and October 2019, during the year that preceded the crisis. Exclusions included known BC, symptomatic imaging, and age <40. Data were extracted from the Picture Archiving and Communication System (PACS) and pathology records, including demographic, clinical, and imaging variables. Participants were stratified into two groups: Group Loyal (prior LHG screening) and Group New (no prior LHG screening). Imaging, histopathologic, and follow-up data (2019-2022) were analyzed. Non-adherent Group Loyal subjects were contacted via survey to explore screening barriers.

RESULTS

Among 642 women screened, 461 met inclusion criteria (Group Loyal: 247; Group New: 214). Group Loyal had a higher family history of BC (31.6% vs. 21.5%, p = 0.005) and lower baseline BI-RADS scores. Overall, 191/461 (41.4%) underwent follow-up screening, with significantly higher adherence in Group Loyal (54.6%) than Group New (26.2%, p < 0.001). Among 44 Group Loyal non-adherent respondents, 47% cited crisis-related barriers. Nine women had increased BI-RADS over time; one was diagnosed with infiltrative ductal carcinoma. Baseline biopsies confirmed four malignancies, yielding a cancer detection rate of 8.6 per 1,000.

CONCLUSION

Post-crisis BC screening adherence declined significantly, particularly among women without prior institutional screening. Continued follow-up was associated with more stable BI-RADS outcomes and earlier-stage cancer detection. Sustained public health strategies are needed to mitigate the impact of national emergencies on cancer prevention.