New Research Reveals Effects of COVID-19 on Breast Cancer Detection, Treatment and Care

During the COVID-19 pandemic, many countries halted their breast cancer screening programs. A new study, presented at the 12th European Breast Cancer Conference, suggests that interruption of detection could result in an increase in the proportion of women dying from breast cancer.

However, the study also suggests that this risk can be reduced, for example, by ensuring that all women who would have been screened during the pandemic are not lost, even if they are now older than the upper age limit for the exam.

Two more studies, also presented at the conference, show how the COVID-19 pandemic affected the treatment and daily lives of women who have already been diagnosed with breast cancer.

The screening study was presented at the virtual conference by Lindy Kregting, a Ph.D. Erasmus MC student, University Medical Center Rotterdam, The Netherlands. She said: “Screening works by detecting cancers at an early stage when there is the best chance for successful treatment. Cancer screening programs have never been so severely disrupted before, so we don’t know what impact this will have.

“We wanted to investigate what the long-term impact on breast cancer deaths might be and see what strategies would be most effective in restarting breast screening programs.”

The researchers used an established modeling tool called MISCAN-Breast to simulate four different strategies to restart breast screening after six months of discontinuation:

• a simple restart after the delay in which all the screening tests continued in the expected order, meaning that one in four women would end up going to the test one less time in their life (delay),
• a delay in detection, except in the case of women due to their first detection (delay except the first),
• a delay in detection, but temporarily increasing the upper age limit to ensure that women do not miss the final test (delay with increasing age),
• and increased capacity to ensure a full upgrade where all delayed displays were recovered within six months after the outage (full upgrade).

Their model was based on the Dutch breast cancer screening program, in which women are invited to screen every two years between the ages of 50 and 75. Similar screening programs exist in many other European countries, although the age range and screening intervals vary.

Based on the four scenarios, the model showed how much capacity would be needed (the number of screening and follow-up tests) and the effects that each strategy would have on the incidence and death rates from breast cancer.

The researchers found that the first stage (delay) had the most damaging effect, with an estimated increase of 2.35 deaths from breast cancer per 100,000 women over the next ten years.

The increased ability to achieve full recovery was the best of times, with an increase of just 0.13 deaths from breast cancer per 100,000 women over the next ten years. However, the researchers say this capacity increase is probably not feasible for most health services in countries.

The other two scenarios, delay except the first assessment and delay with increasing age, fell in between the two with respective increases of 1.98 and 1.85 in breast cancer deaths per 100,000 over the next ten years. Based on these findings, they suggest that a delay in detection with a temporary increase in the upper age limit might be the best option for most screening programs.

Ms Kregting added: “Our study shows that a six-month delay is likely to lead to a modest but significant increase in breast cancer death rates, but different strategies for restarting screening have different results. The best way to prevent deaths from breast cancer is to catch up on all the screening tests that were missed during the COVID-19 pandemic. However, we know that most breast screening programs will not be staffed and the additional equipment needed to do this.

“We found that the next best option, and one that we believe is feasible, is to restart breast screening as normal after the delay, but making sure that no woman misses her last invitation to screening, even if it is already higher than the limit. of superior age “.

A second study that included 1,051 women diagnosed with breast cancer from Utrecht in the Netherlands looked at how the COVID-19 pandemic affected their daily lives. The study found that 48% of women felt lonely during the pandemic.

The research also found that 31% of women were less likely to seek help from their GP, 27% were concerned about the effects of the pandemic on their aftercare and 15% were less likely to seek help from their breast cancer doctor.

The study was presented by Dr. Claudia Bargon, physician and Ph.D. student at University Medical Center Utrecht (UMC Utrecht). She said: “We know that medical services, including those for patients with breast cancer, had to be reorganized during the crisis. We also know that social support can be of vital importance for many women who have been diagnosed with breast cancer and that support may be restricted by social distancing measures.

“Our study shows that women were less likely to seek medical help during the pandemic and that a large proportion of women suffered loneliness during confinement. This suggests that patients need to be reassured that they should seek medical help when they need it and that we must allow patients to access mental health support, even if it is necessary to provide it online rather than in person. “

A third study compared a group of 41 women treated for breast cancer in March and April 2020 at the University Hospital of Sassari, Italy, with 42 women treated in March and April of the previous year.

The researchers found no difference in the number of women who had breast cancer surgery, how long they waited for surgery, or whether they had a procedure called a sentinel node biopsy, which looks for signs that the cancer has started. spread to the lymph nodes under the arm. . However, they found that women operated on during the peak of the COVID-19 pandemic were less likely to receive immediate breast reconstruction after mastectomy (removal of the breast) or to receive an “ intraoperative regional nerve block, ” a procedure done during surgery to reduce the chance of breast pain after surgery.

The work was presented by Dr. Alessandro Fancellu, Associate Professor of Surgery at the University of Sassari. She said: “These two procedures do not have an effect on the risk of breast cancer coming back; however, they do have an effect on the quality of life for women after breast cancer surgery. We know there could be a second peak of COVID-19 and if that happens, we want to maintain the highest possible standards for our patients. “

Professor Giuseppe Viale is from the University of Milan and the European Institute of Oncology, Italy, and was not involved in the research. He said: “Around the world, our medical services have had to reorganize to meet the challenge of COVID-19. It is really important that we understand the impact this has had on the diagnosis, treatment and care of patients with breast cancer.

“These studies provide some reassurance because they suggest that the disruption in breast cancer screening, treatment and care has not been devastating. However, they do show where we can improve, for example by encouraging women to seek medical help or advice, you may need, and how we can get services like the breast exam back on track. ”

Provided by the European Organization for Research and Treatment of Cancer