The COVID-19 pandemic has rapidly become a major challenge for global health care systems and affected other priorities such as the utilization of population-based cancer screening services. We sought to examine to what extent the COVID-19 pandemic has affected cancer screening utilization in Taiwan, even the use of inreach and outreach screening services for different types of cancer screening and different regions. Using nationwide cervical, breast, colorectal and oral cancer screening data, the percentage changes in screening participants at inreach and outreach services were calculated and compared between January to April 2020 (COVID-19 pandemic) and January to April 2019. The average percentage change declined from 15% to 40% for cervical, breast, and colorectal cancer screening, with a nearly 50% decline in oral cancer screening. There was a greater preference for breast and colorectal cancer screening outreach services, which had greater accessibility and declined less than inreach services in most regions. The screening utilization varied in different regions, especially in eastern Taiwan where the less convenient transportation and lower risk of COVID-19 transmission had a positive change on four types of cancer screening outreach services. The COVID-19 pandemic may have had an effect not only in the utilization of different types of cancer screening but also in the preference between inreach and outreach services, and even in variations in screening services in different regions.

Background: Female cancers, including breast, cervical, uterine, and ovarian cancer, remain among the ten most common cancers among women worldwide, but the relationship between female cancers and abortion from previous studies is inconsistent. This study aimed to investigate risks of incident female cancers among women aged 20 to 45 years who underwent abortion in Taiwan compared with those who did not. Method: A longitudinal observational cohort study was conducted using three nationwide population-based databases in Taiwan, focusing on 20- to 45-year-old women, with 10 years of follow-up. Matched cohorts were identified with propensity score 1-to-3 matching between 269,050 women who underwent abortion and 807,150 who did not. Multivariable Cox proportional hazard modeling was used for analysis after adjusting for covariates including age, average monthly payroll, fertility, diabetes mellitus, polycystic ovarian syndrome, endometrial hyperplasia, endometriosis, hormone-related drugs, and Charlson comorbidity index. Results: We found lower risk of uterine cancer (hazard ratio [HR]: 0.77, 95% CI: 0.70–0.85) and ovarian cancer (HR: 0.81, 95% CI: 0.75–0.88), but no significant difference in risk of breast cancer or cervical cancer, among matched abortion compared with non-abortion cohorts. Regarding subgroup analysis, cervical cancer risk was higher for parous women who underwent abortion, and uterine cancer risk was lower for nulliparous women who underwent abortion compared with non-abortion groups. Conclusions: Abortion was related to lower uterine and ovarian cancer risk but was not associated with risks of incident breast cancer or cervical cancer. Longer follow-up may be necessary to observe risks of female cancers at older ages.

Background: Breast cancer is the leading cause of cancer incidence worldwide and in Taiwan. The relationship between breast cancer and occupational types remains unclear. This study aimed to investigate lifetime breast cancer incidence by different occupational industries among female workers in Taiwan. Methods: A population-based retrospective case–control study was conducted using three nationwide population-based databases. Matched case and control groups were identified with 1-to-4 exact matching among 103,047 female workers with breast cancer diagnosed in 2008–2017 and those without breast cancer. Their lifetime labor enrollment records were tracked using the National Labor Insurance Database, 1950–2017. Conditional logistic regression was used to analyze the association between types of occupational industries and risk of incident breast cancer. Results: Our study found slightly significant breast cancer risk among the following major occupational classifications: manufacturing (OR: 1.027, 95% CI: 1.011–1.043); wholesale and retail trade (OR: 1.068, 95% CI: 1.052–1.084); information and communication (OR: 1.074, 95% CI: 1.043–1.105); financial and insurance activities (OR: 1.109, 95% CI: 1.086–1.133); real estate activities (OR: 1.050, 95% CI: 1.016–1.085); professional, scientific, and technical activities (OR: 1.118, 95% CI: 1.091–1.145); public administration, defense, and social security (OR: 1.054, 95% CI: 1.023–1.087), education (OR: 1.199, 95% CI: 1.168–1.230); and human health and social work activities (OR: 1.125, 95% CI: 1.096–1.156). Conclusions: Greater percentages of industrial occupations (i.e., manufacturing, wholesale and retail, or health professionals) were associated with slightly increased breast cancer risk. Further studies should investigate the possible risk factors among female workers in those industries with slightly higher incidence of breast cancer.

Taiwan implemented the Cancer Screening Quality Improvement Program (CAQIP) in 2010. The program sought to enhance mass breast cancer screening accessibility. This study aimed to examine socioeconomic disparities in outreach screening utilization pre-CAQIP (2005–2009) and post-CAQIP (2010–2014). We conducted a nationwide population-based observational study in Taiwan, analyzing four population databases to evaluate socioeconomic disparities among women aged 50 to 69 years undergoing their first mammography screening pre-CAQIP. Multivariate logistic regression was used to examine changes in utilization of outreach screening pre- and post-CAQIP implementation, and to estimate the Slope Index of Inequity (SII) and Relative Index of Inequity (RII) values. Utilization of outreach screening through mobile mammography units (MMUs) increased from 6.12 to 32.87% between the two periods. Following CAQIP, a higher proportion of screened women were older, less educated, and from suburban or rural areas. The SII and RII for age, income, and urbanization levels decreased post-CAQIP. However, regarding education level, SII was − 0.592 and RII was 0.392 in the pre-CAQIP period, increasing to -0.173 and 0.804 post-CAQIP, respectively. Our study observed that utilization of outreach screening through MMUs increased after CAQIP. The MMUs made outreach screening services more accessible in Taiwan. Expanding outreach screening services and educational programs to promote mammography uptake in local communities could help reduce the potential effect of socioeconomic disparities, and thus may enhance early detection of breast cancer. Further study could focus on the accessibility of outreach screening and breast cancer outcomes.