Stable Treatment Remained in Early Breast Cancer Diagnosis During Pandemic

Woman undergoing cancer therapy wearing surgical mask | Image Credit: Pixel-Shot - stock.adobe.com

Despite an increase in women presenting with palpable tumors, no significant disruptions or delays in breast cancer treatment were observed during the COVID-19 pandemic, suggesting that stage distribution did not change over time and that the challenges imposed by the public health crisis did not impact breast cancer care, according to a recent Italian study.

The cross-sectional study included all consecutive patients treated at the Veneto Institute of Oncology, a large tertiary-level cancer center in Padua, Italy. The study focused on the first points of contact (POC), defined as the initial consultation with a breast cancer specialist of the breast unit while first treatment was described as either upfront surgery or neoadjuvant chemotherapy (NACT). The first POC observed patients in the 6 months preceding the multidisciplinary team (MDT) meeting and initiating a treatment within 6 months from the POC.

After reviewing electronic medical records of patients with an MDT report during 2019 to 2021, 431 were eligible for the study requirements. Of the 431 patients, 144 accounted for 2019, 127 for 2020, and 150 for 2021, with median ages being 61 years in 2010, 60 in 2020, and 63 in 2021.

Tumor detection was presented in patient screenings in 59%, 44%, and 63% in 2019, 2020, and 2021, respectively. Regardless of the year, surgeons were the most common POC with 61% in 2019, 72% in 2020, and 58% in 2021. However, radiologists served for 35%, 23%, and 37% of patients’ POC for the same years.

In 2019 and 2021, around 90 patients were both first seen by a surgeon while those referred to a radiologist in 2020 (n = 29) were half the number of those in 2019 and 2021 (n = 51 and 55, respectively).

A greater proportion of patients (52%-57%) had 2 cm tumors or smaller when compared with tumors from 2.1 cm up to 5 cm (27%-32%). Less than 10% of the patient population represented any affect by in situ tumors, tumors larger than 5 cm, or locally advanced. In general, in situ tumors were less common in 2020 (n = 7) when compared with 2019 or 2021 (n = 10 and 14, respectively).

Most patients (67%-70%) were node-negative or had no lymph node involvement. Fewer patients (18%-27%) had 1 to 3 lymph nodes involved, and less than 10% had 4 or more lymph nodes involved.

In 2019 and 2021, 76% of patients received upfront surgery as first POC while 77% received upfront surgery in 2020. After adjusting for the type of POC, symptoms, treatment type, tumor stage, nodal stage, and EBC subtype, the odds ratio treatment delay was 0.87 for 2020 vs 2019 (95% CI, 0.5-1.53) and 0.9 for 2021 vs 2019 (95% CI, 0.52-1.55).

The study's cross-sectional design limits its generalizability, as it may not accurately represent the broader population despite capturing all newly diagnosed breast cancer patients in the unit's area.

Authors concluded, “Validation on a larger, population-based cohort of patients is warranted to robustly assess the impact of the COVID-19 pandemic on treatment practices and outcomes for patients with EBC.”

Reference

Girardi F, Marini S, Porra F, et al. The impact of COVID-19 on treatment practices for patients with early breast cancer: A cross-sectional study from a large cancer center in Italy. Oncologist. 2023;28(12):e1179-e1184. doi:10.1093/oncolo/oyad255