Purposes To delineate operational changes in Kaiser Permanente Northern California breast care and evaluate the impact of these changes during the initial COVID-19 Shelter-in-Place period (SiP, 3/17/20–5/17/20). Methods By extracting data from institutional databases and reviewing electronic medical charts, we compared clinical and treatment characteristics of breast cancer patients diagnosed 3/17/20–5/17/20 to those diagnosed 3/17/19–5/17/2019. Outcomes included time from biopsy to consultation and treatment. Comparisons were made using Chi-square or Wilcoxon rank-sum tests. Results Fewer new breast cancers were diagnosed in 2020 during the SiP period than during a similar period in 2019 ( n = 247 vs n = 703). A higher percentage presented with symptomatic disease in 2020 than 2019 (78% vs 37%, p < 0.001). Higher percentages of 2020 patients presented with grade 3 (37% vs 25%, p = 0.004) and triple-negative tumors (16% vs 10%, p = 0.04). A smaller percentage underwent surgery first in 2020 (71% vs 83%, p < 0.001) and a larger percentage had neoadjuvant chemotherapy (16% vs 11%, p < 0.001). Telehealth utilization increased from 0.8% in 2019 to 70.0% in 2020. Times to surgery and neoadjuvant chemotherapy were shorter in 2020 than 2019 (19 vs 26 days, p < 0.001, and 23 vs 28 days, p = 0.03, respectively). Conclusions During SiP, fewer breast cancers were diagnosed than during a similar period in 2019, and a higher proportion presented with symptomatic disease. Early-stage breast cancer diagnoses decreased, while metastatic cancer diagnoses remained similar. Telehealth increased significantly, and times to treatment were shorter in 2020 than 2019. Our system continued to provide timely breast cancer treatment despite significant pandemic-driven disruption.

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OBJECTIVE -Reduced iron stores after blood donation are associated with improved vascular function and decreased cardiovascular risk. We sought to determine whether irondependent changes in glucose metabolism may contribute to improved vascular function in blood donors.RESEARCH DESIGN AND METHODS -We conducted a prospective cross-sectional study in 21 high-frequency blood donors (more than eight donations in the last 2 years) and 21 low-frequency blood donors (one to two donations in the last 2 years) aged 50 -75 years. Serum markers of iron stores, whole-body insulin sensitivity index (WBISI) during oral glucose tolerance testing, and flow-mediated dilation in the brachial artery were determined in all subjects.RESULTS -Serum ferritin was decreased (median values 23 vs. 36 ng/ml, P Ͻ 0.05) and flow-mediated dilation in the brachial artery was increased (median values 5.9 vs. 5.3%, P Ͻ 0.05) in high-frequency donors compared with low-frequency donors, respectively, but WBISI (median values 4.8 vs. 4.7) and related measures of glucose tolerance did not differ between groups. Flow-mediated dilation significantly decreased at 1 h after oral glucose loading in both groups, but the decrease in flow-mediated dilation at 1 h did not differ between high-and low-frequency donors.CONCLUSIONS -High-frequency blood donation reduced serum ferritin and increased flow-mediated dilation compared with low-frequency donation but did not improve insulin sensitivity or protect the vascular endothelium from the adverse effects of acute hyperglycemia after oral glucose loading. These findings suggest that the mechanisms linking blood donation to improved vascular function are not likely related to changes in glucose metabolism. Diabetes Care 30:2685-2689, 2007I ron is a prooxidant cofactor that has been proposed to be associated with increased risk of cardiovascular events in humans (1,2). Chronic reduction in iron stores in response to frequent blood donation is associated with improved vascular function in the brachial artery and biochemical evidence of decreased oxidative stress (3). In a randomized trial of patients with peripheral vascular disease, reduction of iron stores with serial phlebotomy decreased mortality compared with conventional therapy in the subjects in the youngest age quartile (aged 43-61 years) (4).A potential mechanistic link between iron stores, vascular function, and cardiovascular risk may be related to irondependent effects on glucose metabolism (5,6). Diabetes is a well-recognized modifiable cardiovascular risk factor associated with increased serum ferritin levels and evidence of vascular endothelial dysfunction (7,8). Iron overload is associated with decreased insulin production, increased insulin resistance, and increased risk of diabetes (5,6). We hypothesized that improved vascular function associated with reduction in iron stores after blood donation might be partly attributable to improved insulin sensitivity. To test this hypothesis, we assessed insulin sensitivity during an oral glucose tolerance...

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