Impact of COVID-19 On Breast Cancer Management: A Radiological Prespective from A Tertiary Centre

Abstract

Objective: The coronavirus-2019 (COVID-19) pandemic caused delaying breast cancer management, increasing time interval in chemotherapy cycles and surgery. This has implications on radiological manifestation of cancer. Further, we evaluated changes observed in mammography. Materials and Methods:This case control study was conducted from March 25 th , 2020 to August 15 th , 2020 at the Integrated Breast Care Centre, All India Institute of Medical Science Rishikesh (AIIMS), Rishikesh. Sonomammography was performed on follow-up patients who were on chemotherapy and were scheduled for surgery. Moreover, duration of delay from the last neoadjuvant chemotherapy (NACT) cycle was recorded. Similar data in the pre-COVID-19 period from November 4 th , 2019 to March 24 th , 2020 was compared with post-COVID-19 data and was analyzed by SPSS Version 23. Results:The study included 54 patients who presented between March 25 th , 2020 and August 15 th , 2020. Furthermore, the delay in NACT cycles has been shown to be associated with disease progression (p = 0.045). Subgroup analysis of treatment duration with various parameters revealed significant correlation between size, appearance of ulceration, and response evaluation (p<0.05). However, no significant association was found between duration of delay and the histological subtype of lesion (p>0.05). A substantial difference was seen in the evaluation of NACT response in pre-and post-COVID-19 time, with partial response (n = 39, 58.24%) seen as the most common response in pre-COVID-19 time and progressive disease (n = 28, 51.9%) as the most common response in post-COVID-19 time (p<0.001). Conclusion:The coronavirus pandemic has severe impact on breast cancer management. A delay in NACT causes progression in cancer. This can be seen in ultrasound and mammogram.

Breast cancer care amidst a pandemic: a scoping review to understand the impact of coronavirus disease 2019 on health services and health outcomes

“…Specifically, one study found an increase in neoadjuvant endocrine therapy [ 49 ], and another study found that women treated during COVID-19 were more likely to receive neoadjuvant endocrine therapy [ 50 ]. While one study found no difference in the time interval from diagnosis to treatment [ 51 ], another study found the time from treatment to surgery increased [ 74 ]. Clinicians do not believe that treatment changes should be continued moving forwards from COVID-19 [ 55 ].…”

Interruption of breast cancer care and importance of inter‐hospital cooperation during the COVID‐19 pandemic: A case report of advanced breast cancer in Fukushima, Japan

“…In Japan, one of the first cases of COVID‐19 was detected in March 2020 in Tokyo, and from April to May 2020, the Japanese government declared a state of emergency in Tokyo and some other prefectures as the daily number of COVID‐19 cases increased exponentially. Consequently, the majority of the hospitals restricted out‐patient visits as an infection control measure against COVID‐19 1 . In addition, some patients refrained from visiting hospitals to avoid contracting the virus 2 .…”

“…the majority of the hospitals restricted out-patient visits as an infection control measure against COVID-19. 1 In addition, some patients refrained from visiting hospitals to avoid contracting the virus. 2 Indeed, COVID-19 pandemic has been noted as a cause for interruption of such as radiation therapy during treatment for breast cancer.…”

Interruption of breast cancer care and importance of inter-hospital cooperation during the COVID-19 pandemic: A case report of advanced breast cancer in Fukushima, Japan

“…Consequently, the majority of the hospitals restricted out-patient visits as an infection control measure against COVID-19. 1 In addition, some patients refrained from visiting hospitals to avoid contracting the virus. 2 However, there is not enough information regarding breast cancer patients who are disproportionately affected by the COVID-19 pandemic in terms of continuation of care.…”