Background/Aim: Coronavirus disease is spreading worldwide. Due to fast transmission and high fatality rate drastic emergency restrictions were issued. During the lockdown, only urgent medical services are guaranteed. All non-urgent services, as breast cancer (BC) screening, are temporarily suspended. The potential of breast cancer screening programs in increasing the survival rate and decreasing the mortality rate has been widely confirmed. Suspension could lead to worse outcomes for breast cancer patients. Our study aimed to analyse the data and provide estimates regarding the temporary BC screening suspension. Patients and Methods: Data regarding breast cancer and respective screening programs were achieved through literature research and analysis. Results: Considering three different scenarios with respect to the lockdown's impact on breast cancer screening, we estimate that approximately 10,000 patients could have a missed diagnosis during these 3 months. Considering a 6-month period, as suggested by the Imperial college model, the number of patients who will not receive a diagnosis will rise to 16,000. Conclusion: Breast cancer screening should be resumed as soon as possible in order to avoid further breast cancer missed diagnosis and reduce the impact of delayed diagnosis. The Coronavirus disease 2019 (Covid-19) pandemic is becoming incessant, having infected almost four million people worldwide (1). Based on the latest data, in Italy, more than 200,000 people are positive for SARS-COV-2 with a case fatality rate of up to 14% (2). Due to the fast human-to-human transmission and the high fatality rate, on 10 March 2020, the Italian Government, as did other countries, introduced drastic emergency restrictions. These extraordinary measures to limit viral transmission, include: cessation of most activities, quarantine and strict self-isolation (2). Accordingly, this emergency implies a total reorganization of the Health System, including temporary resource reallocation toward COVID-19 (3). Many hospitals are turning into COVID-19 specialized medical centers. During this transition phase, only urgent medical services are guaranteed while oncological procedures are suffering a significant slowdown (3). In this regard, the Breast Unit has been strongly affected by these restrictions as well, with a potential impact on women's health and quality of life (4). Every year, 3 million patients receive a cancer diagnosis worldwide. Breast cancer (BC) corresponds to 14% of cancer diagnoses and to 30% of cancers in women. In Italy, approximately 53,500 women receive a BC diagnosis every year (5). During the last years, there has been an improvement 3047 This article is freely accessible online.

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Background/Aim: The COVID-19 lockdown includes restrictive measures and temporary health system reorganization. Resources were shifted to COVID-19 patients, screening programs were temporary suspended, and oncological care suffered slow-down. The aim of the study was to evaluate the impact of these measures on breast cancer patients. Patients and Methods: All breast cancer patients referred to our unit from February 21, 2019 to February 21, 2021 were enrolled. Type of treatments and surgery, TNM, tumor diameter, and predictive and prognostic factors were analyzed. Results: Out of 445 patients with a breast cancer diagnosis, 182 (40.9%) were enrolled in the COVID-19 group (from February 21, 2010 to February 21, 2021). These patients were compared with 263 (59.1%) patients pre-COVID-19. Tumor diameters were bigger in the COVID-19 group. Type of surgery and N staging were statistically significantly different. Extreme advanced disease incidence was significantly different between the groups (2.7% COVID-19 group vs. 0 pre-COVID-19 group, p=0.011). Incidence of post-surgical radiation-therapy was higher in the COVID-19 group. Other variables analyzed were comparable without a statistically significant difference. Conclusion: COVID-19 led to increased tumor dimensions, advanced N-staging, and increased need for adjuvant treatments in breast cancer.

Background: Surgical stress and anesthesia affect the patient's immune system. Analysis of the lymphocyte response after breast-conserving surgery was conducted to investigate the differences between effects after general and local anesthesia. Materials and Methods: Fifty-six patients with breast cancer were enrolled for BCS through local or general anesthesia. Total leukocytes, total lymphocytes, lymphocyte-subsets including CD3 + , CD19 + , CD4 + , CD8 + , CD16 + CD56 + and CD4 + /CD8 + ratio was examined at baseline and on postoperative days 1, 2 and 3. Results: Baseline data showed no statistical difference between the two groups. Within-group ANOVA test showed significant differences for total leukocyte count (p<0.001), total lymphocyte count (p=0.009) and proportion of natural-killer cells (p=0.01) in the control group. Between-group analysis showed lower median values of total lymphocytes in the awake surgery group on postoperative days 1, 2 and 3 (p=0.001, p=0.02 and p=0.01, respectively) when compared to the control group. Patients who underwent surgery under general anesthesia had higher total lymphocyte counts on postoperative day 2 (p=0.04). Conclusion: In this randomized study, breast-conserving surgery plus local anesthesia had a lower impact on postoperative lymphocyte response when compared to the same procedure performed under general anesthesia. Lymphocytes are fundamental types of white blood cells. Cells of the lymphatic system play a crucial role in the immune system due to their regulatory function through regulatory cytokines and due to cytotoxic activity against tumors and infections (1, 2). As underlined in the literature, surgical stress and general anesthesia may reduce the numbers of circulating lymphocytes (1-6). It is a widely held view that impairment of immune function can predispose to infectious complications such as surgical site infections (SSI) (5-8). Moreover, reduced cytotoxic activity of peripheralblood lymphocytes can increase the probability of tumor progression and metastasis (4, 5, 9-13). According to several studies, use of a minimally invasive approach in thoracic surgery (1, 14, 15) and abdominal surgery (16-18) demonstrated that immune function may be better preserved. However, there is lack of high-level evidence about the protective role of minimally invasive techniques in early lymphocyte response and it is conceivable that, regardless of the surgical approach, any 1879 This article is freely accessible online.

Introduction COVID-19 is a declared worldwide pandemic. In our country, due to shortage of hospitals and beds in intensive care unit, oncological and breast cancer (BC) resources are temporarily shifted to COVID-19 patients. In addition, risk of cross-infections should be considered in these frail patients. To accomplish more surgical procedures and to reduce the length of hospital stay (LOS), fast track awake BC surgery should be implemented. The aim of the study is to estimate the effects of surgical shift in our facility during the early COVID-19 outbreak. Materials and methods From 30th January 2020 to 30th of March 2020, 86 consecutive patients were retrospectively enrolled and divided into pre-COVID-19-BC and COVID-19-BC. Clinical parameters and anamnestic data were collected and analyzed. Surgical procedures, relative complications and type of anaesthesia were reported. The effect on surgical time (ST), operative room time (ORT) and length of stay (LOS) were described and examined. Results No statistical difference was found in complications rate, clinical data and surgical procedures ( p > 0.05). Awake breast conservative surgery (BCS) was the most frequent procedure in COVID-19-BC ( p = 0.006). A statistically significant decrease in ORT and LOS was reported in COVID-19-BC ( p = 0.040 and p = 0.0015 respectively), while comparable time resulted for ST ( p = 0.976). Mean ORT and LOS reduction were 20.79 min and 0.57 hospital bed days. Conclusion In the “COVID-19 era”, fast track awake breast surgery provides a reduction of ORT, LOS and potentially surgical treatment for a wider number of oncological patients.