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

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.

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.

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.

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.