Reflecting on the global battle against breast cancer, an issue that continues to top the list of most commonly diagnosed cancers, North America stands out for its success in keeping death rates comparatively low. This success is largely attributed to the early detection practices, such as mammography screenings. Ontario, the bustling heart of Canada with its diverse population, leads this charge with the Ontario Breast Screening Program (OBSP). This public initiative, welcoming average-risk women of middle to older age, alongside a special program for those at high risk, showcases Ontario’s dedication to catching breast cancer early. However, the sudden emergence of COVID-19 threw a wrench in the works, halting all cancer screenings in the wake of a provincial emergency declaration. This necessary but severe step ignited worries about the long-term effects on breast cancer detection rates and the possibility of widening the gap in access to these crucial screenings.

In the thick of the COVID-19 pandemic, a pivotal study spearheaded by Dr. Rui Fu and Dr. Antoine Eskander, from the University of Toronto, together with their esteemed team, casts a spotlight on the notable decline in breast cancer screenings across Ontario, Canada. Published in the Preventive Medicine Reports, their investigation dives into the repercussions of the pandemic on mammography rates among women of middle to older age, pinpointing the aggravation of already existing gaps based on various demographic aspects.

The pandemic’s arrival led to a significant fall in screening activities, a situation that slowly saw improvements yet didn’t rebound to pre-pandemic levels. Dr. Fu remarks, “Although there seems to be no difference in the profiles of OBSP participants in Ontario, studies from around the world have indicated that specific groups of women saw a more pronounced drop in screening activities during the pandemic.” This brings to light the distinct hurdles faced by women from varied backgrounds, especially those deemed low-risk or living in less populated areas.

Dr. Eskander elaborates, “Our goal was to measure the total impact of the pandemic on weekly mammography rates for average-risk women of middle to older age and to investigate if COVID-19 further highlighted disparities.” Their detailed method of collecting and analyzing data week by week uncovers not just the immediate fallout of the pandemic but also its potential long-term effects on public health strategies.

To gauge the impact accurately, the team adopted a straightforward approach that speaks to both medical professionals and the layperson. They required participants to have an active Ontario postal code at the week’s beginning, enabling a precise calculation of factors like community remoteness and economic accessibility. “The end date for data collection reflects the most current information from the OBSP at the time of our analysis,” Dr. Fu explains, showcasing the thorough and thoughtful approach taken to understand the pandemic’s real effect on mammography rates. This critical research not only brings to light the stark realities faced by the healthcare sector during the pandemic but also underscores the need for focused efforts to mend the disparities revealed. As Ontario, and indeed the entire globe, forges ahead in the post-COVID era, the insights from Dr. Fu and Dr. Eskander’s study are invaluable. They lay the groundwork for crafting more inclusive and accessible cancer screening programs, ensuring that every woman has the support she needs in the fight against breast cancer.


Rui Fu, Jill Tinmouth, Qing Li, Anna Dare, Julie Hallet, Natalie Coburn, Lauren Lapointe-Shaw, Nicole J. Look Hong, Irene Karam, Linda Rabeneck, Monika Krzyzanowska, Rinku Sutradhar, Antoine Eskander, “COVID-19 pandemic impact on the potential exacerbation of screening mammography disparities: A population-based study in Ontario, Canada,” Preventive Medicine Reports, 2024.



Antoine Eskander, MD, ScM, FRCSC

Dr. Eskander is a head and neck oncologist (including thyroid and cutaneous oncology) and reconstructive surgeon with an interest in health services research, clinical epidemiology and quality improvement. He has extensively studied cancers in Ontario and published an ICES epidemiological atlas in conjunction with Ontario Health-Cancer Care Ontario.

Rui Fu PhD

Dr. Fu is a Postdoctoral Fellow in Evaluative Clinical Sciences at Sunnybrook Research Institute, University of Toronto. As a health services researcher, she has broad research interests in health economics, clinical epidemiology, and machine learning.