ImportanceCancer screening deficits during the first year of the COVID-19 pandemic were found to persist into 2021. Cancer-related deaths over the next decade are projected to increase if these deficits are not addressed.ObjectiveTo assess whether participation in a nationwide quality improvement (QI) collaborative, Return-to-Screening, was associated with restoration of cancer screening.Design, Setting, and ParticipantsAccredited cancer programs electively enrolled in this QI study. Project-specific targets were established on the basis of differences in mean monthly screening test volumes (MTVs) between representative prepandemic (September 2019 and January 2020) and pandemic (September 2020 and January 2021) periods to restore prepandemic volumes and achieve a minimum of 10% increase in MTV. Local QI teams implemented evidence-based screening interventions from June to November 2021 (intervention period), iteratively adjusting interventions according to their MTVs and target. Interrupted time series analyses was used to identify the intervention effect. Data analysis was performed from January to April 2022.ExposuresCollaborative QI support included provision of a Return-to-Screening plan-do-study-act protocol, evidence-based screening interventions, QI education, programmatic coordination, and calculation of screening deficits and targets.Main Outcomes and MeasuresThe primary outcome was the proportion of QI projects reaching target MTV and counterfactual differences in the aggregate number of screening tests across time periods.ResultsOf 859 cancer screening QI projects (452 for breast cancer, 134 for colorectal cancer, 244 for lung cancer, and 29 for cervical cancer) conducted by 786 accredited cancer programs, 676 projects (79%) reached their target MTV. There were no hospital characteristics associated with increased likelihood of reaching target MTV except for disease site (lung vs breast, odds ratio, 2.8; 95% CI, 1.7 to 4.7). During the preintervention period (April to May 2021), there was a decrease in the mean MTV (slope, −13.1 tests per month; 95% CI, −23.1 to −3.2 tests per month). Interventions were associated with a significant immediate (slope, 101.0 tests per month; 95% CI, 49.1 to 153.0 tests per month) and sustained (slope, 36.3 tests per month; 95% CI, 5.3 to 67.3 tests per month) increase in MTVs relative to the preintervention trends. Additional screening tests were performed during the intervention period compared with the prepandemic period (170 748 tests), the pandemic period (210 450 tests), and the preintervention period (722 427 tests).Conclusions and RelevanceIn this QI study, participation in a national Return-to-Screening collaborative with a multifaceted QI intervention was associated with improvements in cancer screening. Future collaborative QI endeavors leveraging accreditation infrastructure may help address other gaps in cancer care.

A 31-year-old black woman presented with a several month history of painless palpable thickening and erythema of her upper outer right breast. The patient's past medical history was significant for lupus panniculitis but did not reveal signs or symptoms of systemic lupus erythematosus (SLE). Based on her history, lupus mastitis was suspected as the cause of her current breast complaints and the patient was referred to our breast center for imaging. Digital mammography ( Fig. 1) revealed severe rightsided skin thickening and increased subjacent stromal density. Lymphadenopathy was present. No focal masses were identified and no calcifications were seen as is usually reported in association with lupus mastitis. A right breast ultrasound (Fig. 2) demonstrated skin thickening and subcutaneous hyperechogenicity without a focal mass. Contrast-enhanced magnetic resonance imaging (MRI) was then obtained (Fig. 3). Extensive skin thickening in the right upper outer breast was noted with moderate persistent and plateau enhancement (Type I ⁄ II kinetics) of the underlying subcutaneous tissues. A discrete mass was not seen. Bilateral axillary adenopathy was also noted, extending into the subpectoral region on the right. There were additional areas of subclinical, subcutaneous involvement evident in the upper inner quadrants of both breasts.Although the presumptive diagnosis was lupus mastitis, because the patient did not have systemic lupus and the imaging findings differed from that described in the literature for lupus mastitis, both a skin punch biopsy as well as a subcutaneous ultrasound guided core biopsy were performed. Pathology was consistent with lupus mastitis (Fig. 4). No neoplastic tissue was evident. Several months following core biopsy, the patient has had no adverse sequelae from the procedure and the site of biopsy has completely healed.Lupus panniculitis is a chronic inflammatory reaction of subcutaneous fat that occurs in a small percentage of patients with SLE. Inflammation affecting the subcutaneous fat of the breast is termed lupus Figure 1. MLO view of the right breast demonstrates severe skin thickening and subjacent stromal density with adenopathy. No masses or calcifications are seen.