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Wilke LG, Nguyen TT, Yang Q, Hanlon BM, Wagner KA, Strickland P, Brown E, Dietz JR, Boughey JC. Analysis of the Impact of the COVID-19 Pandemic on the Multidisciplinary Management of Breast Cancer: Review from the American Society of Breast Surgeons COVID-19 and Mastery Registries. Ann Surg Oncol 2021; 28:5535-5543. [PMID: 34431019 PMCID: PMC8384097 DOI: 10.1245/s10434-021-10639-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/08/2021] [Indexed: 12/29/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in rapid and regionally different approaches to breast cancer care.
Methods In order to evaluate these changes, a COVID-19-specific registry was developed within the American Society of Breast Surgeons (ASBrS) Mastery that tracked whether decisions were usual or modified for COVID-19. Data on patient care entered into the COVID-19-specific registry and the ASBrS Mastery registry from 1 March 2020 to 15 March 2021 were reviewed.
Results Overall, 177 surgeons entered demographic and treatment data on 2791 patients. Mean patient age was 62.7 years and 9.0% (252) were of African American race. Initial consultation occurred via telehealth in 6.2% (173) of patients and 1.4% (40) developed COVID-19. Mean invasive tumor size was 2.1 cm and 17.8% (411) were node-positive. In estrogen receptor-positive/human epidermal growth factor receptor 2-negative (ER+/HER2−) disease, neoadjuvant endocrine therapy (NET) was used as the usual approach in 6.9% (119) of patients and due to COVID-19 in an additional 31% (542) of patients. Patients were more likely to receive NET due to COVID-19 with increasing age and if they lived in the Northeast or Southeast (odds ratio [OR] 1.1, 2.3, and 1.7, respectively; p < 0.05). Genomic testing was performed on 51.5% (781) of estrogen-positive patients, of whom 20.7% (162) had testing on the core due to COVID-19. Patients were less likely to have core biopsy genomic testing due to COVID-19 if they were older (OR 0.89; p = 0.01) and more likely if they were node-positive (OR 4.0; p < 0.05). A change in surgical approach due to COVID-19 was reported for 5.4% (151) of patients. Conclusion The ASBrS COVID-19 registry provided a platform for monitoring treatment changes due to the pandemic, highlighting the increased use of NET.
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Affiliation(s)
- Lee G Wilke
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | | | - Qiuyu Yang
- UW Department of Surgery, Madison, WI, USA
| | | | | | | | - Eric Brown
- Comprehensive Breast Care, Troy, MI, USA
| | - Jill R Dietz
- Allegheny Health Network Cancer Institute, Pittsburgh, PA, USA
| | - Judy C Boughey
- Division of Breast and Melanoma Surgical Oncology, Department of Surgery, Mayo Clinic, Rochester, MN, USA
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2
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Choi H, Noh H, Kim KM, Cho IJ, Lim S, Han A. Increasing Mortality in Korean Patients With Breast Cancer: High Mortality Rate in Elderly Breast Cancer Population Due to Suboptimal Treatment and Other Diseases. Cancer Control 2021; 28:10732748211037914. [PMID: 34406898 PMCID: PMC8718158 DOI: 10.1177/10732748211037914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The incidence of breast cancer in Asia, including Korea, has rapidly increased. Each country has shown different clinical features. This study presents a comprehensive understanding of breast cancer in different age groups in Korea and determines potential measures for improving patient survival. Methods Patients diagnosed with invasive breast cancer stages I to III with available clinicopathologic and follow-up data were included in the study. Kaplan–Meier survival graphs were generated for each group and compared using log-rank test. The hazard ratio for each risk factor was calculated using the Cox regression model and the 95% confidence interval. Results The final cohort included 833 patients with a mean age of 51.3±11.3 years (range, 22–89 years), and 191 (22.9%) of them were aged >60 years. Patients aged ≥60 years had worse overall survival (OS) and distant disease-free survival than those aged <60 years. Although no difference was observed in the tumor biology, elderly patients showed significant differences in practice patterns: they tended to undergo mastectomy (40.2% vs 62.8%, P<0.001), did not receive the standard chemotherapy (88.4% vs 69.3%, P < 0.001), and had a higher risk of developing second primary cancer or diseases other than breast cancer (1.2% vs 6.8%, P < 0.001), which significantly correlated with poor survival in elderly patients. Conclusion Less-than-the-standard treatment of care or development of a second primary disease resulted in poor prognosis in elderly patients in Korea. A multi-institutional and multinational study is warranted to elucidate the clinical features of breast cancer in Asian patients.
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Affiliation(s)
- Hyangsuk Choi
- Department of Surgery, 37974Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Hany Noh
- Department of Surgery, 37974Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Kwang-Min Kim
- Department of Surgery, 37974Yonsei University Wonju College of Medicine, Wonju, Korea
| | - In-Jeong Cho
- Department of Surgery, 37974Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seungtaek Lim
- Department of Oncology, 37974Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Airi Han
- Department of Surgery, 37974Yonsei University Wonju College of Medicine, Wonju, Korea
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3
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Crivellaro P, Tafur M, George R, Muradali D. Diagnostic interval for non-screening patients undergoing mammography during the COVID-19 pandemic. Eur Radiol 2021; 32:613-620. [PMID: 34143286 PMCID: PMC8211559 DOI: 10.1007/s00330-021-08117-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/07/2021] [Accepted: 06/01/2021] [Indexed: 12/17/2022]
Abstract
Objective During the COVID-19 pandemic, there was a temporary cessation of mammography screening. However, in some facilities, diagnostic breast imaging services continued for patients with a high clinical suspicion of breast cancer. The objective of this study was to evaluate changes in the diagnostic interval (DI) of non-screening patients presenting for diagnostic mammography during the first wave of the COVID-19 pandemic. Methods Retrospective chart review was performed on patients presenting for non-screening diagnostic mammography from April 1 to June 30, 2020 (pandemic group) and April 1 to June 30, 2019 (pre-pandemic group). Age, reason for referral, number and type of imaging studies/biopsies necessary for a final diagnosis were recorded. Diagnostic interval (DI) was defined as the number of days from the date of the diagnostic mammogram to the date of the final diagnosis. Results Compared to the pre-pandemic group (n = 64), the pandemic group (n = 77) showed a reduction in DI of the entire cohort (pandemic: 1 day; pre-pandemic: 15 days, p < 0.0001) for patients not requiring tissue sampling (pandemic: 1 day; pre-pandemic: 11 days, .p < 0.0001) and those requiring tissue sampling with benign pathology (pandemic 9 days; pre-pandemic, 33 days, p = 0.0002). A higher percentage of patients in the pandemic group had their assessment completed during the initial visit (pandemic: 50.6%; pre-pandemic: 23.4%, p = 0.0009). Conclusion During the first wave of the COVID-19 pandemic, the DI for patients with non-screening-related diagnostic mammography was significantly shorter, with a higher percentage of patients completing their assessments on the initial visit, compared to one year prior. Key Points • Despite reductions in manpower and clinical services, during pandemic times, it is possible to maintain a diagnostic breast imaging service for women at high clinical suspicion for breast cancer. • During pandemic times, breast imaging departments should consider restructuring to a Rapid Diagnostic Unit model with a navigation team that follows patients through the assessment process to a final diagnosis. • Departmental restructuring and patient navigation during pandemic times could either maintain or shorten the diagnostic interval for patients presenting for diagnostic mammography.
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Affiliation(s)
- Priscila Crivellaro
- Department of Medical Imaging, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.,Department of Medical Imaging, University of Toronto, 263 McCaul Street, 4th Floor, Toronto, Ontario, M5T 1W7, Canada
| | - Monica Tafur
- Department of Medical Imaging, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.,Department of Medical Imaging, University of Toronto, 263 McCaul Street, 4th Floor, Toronto, Ontario, M5T 1W7, Canada
| | - Ralph George
- Department of Medical Imaging, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.,Department of Surgery, University of Toronto, 149 College Street, 5th floor, Toronto, Ontario, M5T 1P5, Canada
| | - Derek Muradali
- Department of Medical Imaging, St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada. .,Department of Medical Imaging, University of Toronto, 263 McCaul Street, 4th Floor, Toronto, Ontario, M5T 1W7, Canada.
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4
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Potter DA, Thomas A, Rugo HS. A Neoadjuvant Chemotherapy Trial for Early Breast Cancer is Impacted by COVID-19: Addressing Vaccination and Cancer Trials Through Education, Equity, and Outcomes. Clin Cancer Res 2021; 27:4486-4490. [PMID: 34108186 DOI: 10.1158/1078-0432.ccr-21-1133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/14/2021] [Accepted: 06/03/2021] [Indexed: 11/16/2022]
Abstract
While COVID-19 vaccine distribution has addressed vulnerabilities related to age and comorbidities, there is a need to ensure vaccination of patients with cancer receiving experimental and routine treatment, where interruption of treatment by infection is likely to result in inferior outcomes. Among patients with cancer, those undergoing neoadjuvant chemotherapy (NAC) or adjuvant chemotherapy (Adj chemo) for early breast cancer (EBC) are at particularly high risk for inferior outcomes, in part, because optimal timing of chemotherapy is essential for promoting distant disease-free survival. COVID-19 data from the ongoing multicenter I-SPY 2 trial of NAC for EBC provides a window into the magnitude of the problem of treatment interruption, not only for the trial itself but also for routine Adj chemo. In the I-SPY 2 trial, 4.5% of patients had disruption of therapy by COVID-19, prior to wide vaccine availability, suggesting that nationally up to 5,700 patients with EBC were at risk for adverse outcomes from COVID-19 infection in 2020. To address this problem, vaccine education and public engagement are essential to overcome hesitancy, while equity of distribution is needed to address access. To accomplish these goals, healthcare organizations (HCO) need to not only call out disinformation but also engage the public with vaccine education and find common ground for vaccine acceptance, while partnering with state/local governments to improve efficiency of vaccine distribution. These approaches are important to improve trial access and to reduce susceptibility to COVID-19, as the pandemic could continue to impact access to clinical trials and routine cancer treatment.
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Affiliation(s)
- David A Potter
- University of Minnesota Division of Hematology, Oncology and Transplantation, Masonic Cancer Center, Minneapolis, Minnesota.
| | - Alexandra Thomas
- Wake Forest Baptist Health Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Hope S Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, California
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5
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Korde LA, Somerfield MR, Carey LA, Crews JR, Denduluri N, Hwang ES, Khan SA, Loibl S, Morris EA, Perez A, Regan MM, Spears PA, Sudheendra PK, Symmans WF, Yung RL, Harvey BE, Hershman DL. Neoadjuvant Chemotherapy, Endocrine Therapy, and Targeted Therapy for Breast Cancer: ASCO Guideline. J Clin Oncol 2021; 39:1485-1505. [PMID: 33507815 PMCID: PMC8274745 DOI: 10.1200/jco.20.03399] [Citation(s) in RCA: 402] [Impact Index Per Article: 134.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/04/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To develop guideline recommendations concerning optimal neoadjuvant therapy for breast cancer. METHODS ASCO convened an Expert Panel to conduct a systematic review of the literature on neoadjuvant therapy for breast cancer and provide recommended care options. RESULTS A total of 41 articles met eligibility criteria and form the evidentiary basis for the guideline recommendations. RECOMMENDATIONS Patients undergoing neoadjuvant therapy should be managed by a multidisciplinary care team. Appropriate candidates for neoadjuvant therapy include patients with inflammatory breast cancer and those in whom residual disease may prompt a change in therapy. Neoadjuvant therapy can also be used to reduce the extent of local therapy or reduce delays in initiating therapy. Although tumor histology, grade, stage, and estrogen, progesterone, and human epidermal growth factor receptor 2 (HER2) expression should routinely be used to guide clinical decisions, there is insufficient evidence to support the use of other markers or genomic profiles. Patients with triple-negative breast cancer (TNBC) who have clinically node-positive and/or at least T1c disease should be offered an anthracycline- and taxane-containing regimen; those with cT1a or cT1bN0 TNBC should not routinely be offered neoadjuvant therapy. Carboplatin may be offered to patients with TNBC to increase pathologic complete response. There is currently insufficient evidence to support adding immune checkpoint inhibitors to standard chemotherapy. In patients with hormone receptor (HR)-positive (HR-positive), HER2-negative tumors, neoadjuvant chemotherapy can be used when a treatment decision can be made without surgical information. Among postmenopausal patients with HR-positive, HER2-negative disease, hormone therapy can be used to downstage disease. Patients with node-positive or high-risk node-negative, HER2-positive disease should be offered neoadjuvant therapy in combination with anti-HER2-positive therapy. Patients with T1aN0 and T1bN0, HER2-positive disease should not be routinely offered neoadjuvant therapy.Additional information is available at www.asco.org/breast-cancer-guidelines.
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Affiliation(s)
- Larissa A Korde
- Clinical Investigations Branch, CTEP, DCTD, National Cancer Institute, Bethesda, MD
| | | | - Lisa A Carey
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | | | | | | | | | - Alejandra Perez
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Plantation, FL
| | | | - Patricia A Spears
- University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | | | | | | | | | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center at Columbia University, New York, NY
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6
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Johal KS, Vinnicombe Z, Khan U, Mohanna PN. COVID-19 and plastic surgery: lessons from a national speciality review in the United Kingdom. J Plast Reconstr Aesthet Surg 2021; 74:3073-3079. [PMID: 34130913 PMCID: PMC8053401 DOI: 10.1016/j.bjps.2021.03.109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/07/2021] [Accepted: 03/18/2021] [Indexed: 01/08/2023]
Abstract
Background Ramifications of coronavirus disease 2019 (COVID-19) on the re-structuring of healthcare are widespread, including delivery of surgical services across all specialties, including plastic surgery. Re-deployment of personnel and cessation of elective services are commonplace. However, there is a continued need for both emergency and oncological surgery. A national review of practice was conducted during the COVID-19 pandemic, to assess impact on services, staffing and training. Methods Key aspects of current plastic surgery practice in the United Kingdom were examined in this cross-sectional study; operating capacity, location of theatre lists (national health service or outsourced private institutions (PIs)), differences across sub-specialties, change in anaesthesia practices, staffing, re-deployment, on-call provision and impact on training. Results Three-hundred and forty-four plastic surgeons in the United Kingdom provided practice data across 51 units. Theatre capacity and outpatient services were markedly reduced. Outsourcing of operating lists to PIs was widely utilised. Increased use of local anaesthetic hand procedures, the prioritisation of shorter operations with reduced microsurgery in both head and neck/lower limb and almost complete cessation of breast reconstruction were noted, together with marked regional variations. Re-deployment occurred at all staffing levels, whilst telemedicine played a critical role in both patient management and training. Conclusions COVID-19 has enforced unprecedented changes to surgical care delivery and training, as identified by examination of plastic surgery nationally in the United Kingdom. Novel means to support continued elective and emergency services, including oncology have been identified. Lessons learned will allow phased return of services and improved preparation for the future.
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Affiliation(s)
- Kavan S Johal
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom.
| | - Zak Vinnicombe
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom
| | - Umraz Khan
- Department of Plastic Surgery, Southmead Hospital, North Bristol NHS Trust, United Kingdom
| | - Pari-Naz Mohanna
- Department of Plastic Surgery, St Thomas' Hospital, London, United Kingdom
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7
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Hawrot K, Shulman LN, Bleiweiss IJ, Wilkie EJ, Frosch ZAK, Jankowitz RC, Laughlin AI. Time to Treatment Initiation for Breast Cancer During the 2020 COVID-19 Pandemic. JCO Oncol Pract 2021; 17:534-540. [PMID: 33710914 PMCID: PMC8457793 DOI: 10.1200/op.20.00807] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The COVID-19 pandemic has posed significant pressures on healthcare systems, raising concern that related care delays will result in excess cancer-related deaths. Because data regarding the impact on patients with breast cancer are urgently needed, we aimed to provide a preliminary estimate of the impact of COVID-19 on time to treatment initiation (TTI) for patients newly diagnosed with breast cancer cared for at a large academic center. METHODS We conducted a retrospective study of patients with newly diagnosed early-stage breast cancer between January 1, 2020, and May 15, 2020, a time period during which care was affected by COVID-19, and an unaffected cohort diagnosed between January 1, 2018 and May 15, 2018. Outcomes included patient volume, TTI, and initial treatment modality. Adjusted TTI was compared using multivariable linear regression. RESULTS Three hundred sixty-six patients were included. There was an 18.8% decrease in patient volume in 2020 (n = 164) versus 2018 (n = 202). There was no association between time of diagnosis (pre-COVID-19 or during COVID-19) and adjusted TTI (P = .926). There were fewer in situ diagnoses in the 2020 cohort (P = .040). There was increased use of preoperative systemic therapy in 2020 (43.9% overall, 20.7% chemotherapy, and 23.2% hormonal therapy) versus 2018 (16.4% overall, 12.4% chemotherapy, and 4.0% hormonal therapy) (P < .001). CONCLUSION TTI was maintained among patients diagnosed and treated for breast cancer during the COVID-19 pandemic at a single large academic center. There was a decrease in patient volume, specifically in patients with in situ disease and a shift in initial therapy toward the use of preoperative hormonal therapy.
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Affiliation(s)
- Kathryn Hawrot
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lawrence N Shulman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ira J Bleiweiss
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Zachary A K Frosch
- Division of Hematology and Oncology, Perelman School of Medicine, Philadelphia, PA.,Penn Center for Cancer Care Innovation, Abramson Cancer Center, Philadelphia, PA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Rachel C Jankowitz
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.,Rena Rowan Breast Center, Abramson Cancer Center, Philadelphia, PA
| | - Amy I Laughlin
- Division of Hematology and Oncology, Perelman School of Medicine, Philadelphia, PA.,Penn Center for Cancer Care Innovation, Abramson Cancer Center, Philadelphia, PA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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8
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Codacci-Pisanelli G, Giuliani J, Bonetti A. The effect of COVID-19 pandemic on daily oncology clinical practice. Crit Rev Oncol Hematol 2021; 167:103272. [PMID: 33647444 PMCID: PMC7908834 DOI: 10.1016/j.critrevonc.2021.103272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Jacopo Giuliani
- Department of Oncology, Mater Salutis Hospital - Az, ULSS 9 Scaligera, Italy
| | - Andrea Bonetti
- Department of Oncology, Mater Salutis Hospital - Az, ULSS 9 Scaligera, Italy
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9
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Potter DA, Herrera-Ponzanelli CA, Hinojosa D, Castillo R, Hernandez-Cruz I, Arrieta VA, Franklin MJ, Yee D. Recent advances in neoadjuvant therapy for breast cancer. Fac Rev 2021; 10:2. [PMID: 33659921 PMCID: PMC7894264 DOI: 10.12703/r/10-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Neoadjuvant trials for early breast cancer have accelerated the identification of novel active agents, enabling streamlined conduct of registration trials with fewer subjects. Measurement of neoadjuvant drug effects has also enabled the identification of patients with high risk of distant recurrence and has justified development of additional adjuvant approaches to improve outcomes. Neoadjuvant evaluation of new drugs was significantly improved by the introduction of pathologic complete response (pCR) rate as a quantitative surrogate endpoint for distant disease-free survival (DDFS) and event free survival (EFS). The neoadjuvant phase 2 platform trial I-SPY 2 simultaneously tests multiple drugs across multiple breast cancer subtypes using Bayesian methods of adaptive randomization for assessment of drug efficacy. In addition to the pCR endpoint, the I-SPY 2 trial has demonstrated that the residual cancer burden (RCB) score measures gradations of tumor response that correlate with DDFS and EFS across treatments and subtypes. For HER2-positive and triple-negative breast cancers that have failed to attain pCR with neoadjuvant chemotherapy (NAC), effective modifications of adjuvant treatment have improved outcomes and changed the standard of care for these subtypes. Neoadjuvant therapy is therefore preferred for stage II and III, as well as some stage I, HER2-positive and triple-negative tumors. Neoadjuvant endocrine therapy (NET) strategies have also emerged from innovative trials for stage II and III estrogen receptor (ER)-positive/HER2-negative tumors, as in the ALTERNATE trial. From neoadjuvant trials, opportunities have emerged to de-escalate therapy on the basis of metrics of response to chemotherapy or hormonal therapy. Neoadjuvant therapy for early breast cancer is therefore emerging as a promising approach to accelerate new drug development, optimize treatment strategies, and (where appropriate) de-escalate neoadjuvant therapy.
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Affiliation(s)
| | - César A Herrera-Ponzanelli
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, México
| | - Diego Hinojosa
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, México
| | - Rafael Castillo
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, México
| | - Irwin Hernandez-Cruz
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, México
| | - Victor A Arrieta
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, UNAM, México
- Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- PECEM, Facultad de Medicina, Universidad Nacional Autónoma de México, México City, México
| | | | - Douglas Yee
- University of Minnesota, Minneapolis, MN, USA
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10
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Abstract
"Starting in Wuhan, China, followed quickly in the United States in January 2020, an outbreak of a novel coronavirus, or COVID-19, escalated to a global pandemic by March. Significant disruptions occurred to breast imaging, including deferred screening mammography, triaging diagnostic breast imaging, and changes in breast cancer care algorithms. This article summarizes the effect of the global pandemic-and efforts to curtail its spread-on both breast cancer care and on breast imaging practices including effects on patients, clinical workflow, education, and research."
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Affiliation(s)
- Phoebe E Freer
- Breast Imaging, Department of Radiology and Imaging Sciences, University of Utah Health / Huntsman Cancer Institute, 30 North 1900 East #1A071, Salt Lake City, UT 84132, USA.
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11
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Pellicciaro M, Granai AV, Marchese G, Materazzo M, Cotesta M, Santori F, Giacobbi E, Servadei F, Grelli S, Perretta T, Meucci R, Pistolese CA, Vanni G. Breast cancer patients with hormone neoadjuvant bridging therapy due to asymptomatic Corona virus infection. Case report, clinical and histopathologic findings. Int J Surg Case Rep 2020; 76:377-380. [PMID: 33052300 PMCID: PMC7543888 DOI: 10.1016/j.ijscr.2020.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 11/25/2022] Open
Abstract
Oncological treatments experienced a significant slowdown due to COVID-19 pandemic. Breast cancer management has changed according to scientific recommendations. Breast cancer patients with simultaneous COVID-19 could receive delayed treatments. Treatments delay could impact breast cancer staging.
Introduction Breast cancer management during COVID-19 pandemic has changed and in case of COVID-19 patients with simultaneous neoplasia, it has been strongly recommended to treat Sars-CoV-2 infection firstly. Presentation of case We reported a case of a 53-years-old women with early breast cancer and simultaneous asymptomatic SARS-CoV-2 infection. According to COVID-19 breast cancer recommendations she underwent hormone neoadjuvant treatment as a bridging therapy for surgery. Six months from the diagnosis, after virus eradication, patient underwent breast surgery. No SARS-CoV-2 RNA was found both in the surgical specimen and sentinel lymph node but micrometastasis were reported. During the last follow-up, the patient was in good clinical condition and started the adjuvant chemotherapy. Discussion COVID-19 outbreak determined the publication of temporary recommendation leading to an extensive use of neoadjuvant chemotherapy in breast cancer patients. Although endocrine therapy is a mainstay in the adjuvant treatment, its role in the neoadjuvant schedule is unclear. Conclusion Upfront awake surgery should be preferred especially in asymptomatic COVID-19 patient with early breast cancer when monitoring of tumor response is not feasible.
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Affiliation(s)
- Marco Pellicciaro
- Breast Unit, Department of Surgical Science, PTV: Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Alessandra Vittoria Granai
- Breast Unit, Department of Surgical Science, PTV: Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | | | - Marco Materazzo
- Breast Unit, Department of Surgical Science, PTV: Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy.
| | - Maria Cotesta
- Breast Unit, Department of Surgical Science, PTV: Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Francesca Santori
- Breast Unit, Department of Surgical Science, PTV: Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Erica Giacobbi
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Francesca Servadei
- Anatomic Pathology, Department of Experimental Medicine, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Sandro Grelli
- Department of Experimental Medicine, University of Tor Vergata, 00133, Rome, Italy
| | - Tommaso Perretta
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Rosaria Meucci
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy, Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
| | - Gianluca Vanni
- Breast Unit, Department of Surgical Science, PTV: Policlinico Tor Vergata University, Viale Oxford 81, 00133, Rome, RM, Italy
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