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Increase in Diagnosis of Node-Positive and Stage III Breast Cancer After Screening Interruption Due to the COVID-19 Pandemic


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A new report from Italy published by Toss et al in ESMO Open noted an increase in diagnoses of node-positive and stage III breast cancer after a 2-month interruption in breast cancer screening due to the COVID-19 pandemic. These findings support recommendations for a quick restoration of breast cancer screening at full capacity, with adequate prioritization strategies to mitigate harm and meet infection prevention requirements. 

Reallocation of Resources

The analysis aimed to evaluate the consequences of interruption of mammographic screening of breast cancer for 2 months in a region of Northern Italy that was highly affected by COVID-19. Response to the pandemic included a rapid reorganization and allocation of health-care resources, staff, and infrastructure to minimize exposure risks. Prioritization further aimed to avoid a negative impact on patient outcomes, especially in oncology. 

A majority of organizations and oncology institutions published their recommendations, driven by a common goal to save hospital resources for patients infected with COVID-19 and to reorganize cancer management strategies. The majority of these recommendations stated that population mammographic screening and screening of mutation carriers should be suspended until the pandemic subsides. 

The study authors noted that the Italian College of Breast Radiologists provided recommendations for procedural prioritization of breast imaging and cancer diagnosis during the COVID-19 pandemic. These recommendations were mainly aimed at asymptomatic women who did not respond to the invitation for screening mammography after the onset of the pandemic and those who were informed of the suspension of the screening activity. It was recommended to postpone the check preferably within 3 months of the originally scheduled date, as long as the operating conditions allow for it. However, the real impact of a temporary mammographic screening suspension on breast cancer outcomes was uncertain. 

KEY POINTS

  • The authors found that a 2-month stop in mammographic screening produced a significant decrease of 10.4% for in situ breast cancer diagnosis, but increases of 11.2% for node-positive and of 10.3% for stage III breast cancer diagnosis.
  • The screening interruption had a major impact on the subgroup of patients with breast cancer at high proliferation rates; among these patients, the rate of node-positive breast cancer increased by 18.5%, and stage III disease increased by 11.4%.

Analysis Findings

This retrospective, single-institution analysis compared the clinical and pathologic characteristics of breast cancer diagnosed between May 2020 and July 2020, after a 2-month screening interruption, with breast cancer diagnosed in the same trimester of 2019 when mammographic screening was regularly performed. 

The authors found that a 2-month stop in mammographic screening produced a significant decrease of 10.4% for in situ breast cancer diagnosis but increases of 11.2% for node-positive breast cancer and of 10.3% for stage III disease diagnosis. 

The screening interruption had a major impact on the subgroup of patients with breast cancer at high proliferation rates. Among these patients, the rate of node-positive breast cancer increased by 18.5%, and stage III disease increased by 11.4%. In the subgroup of patients with low proliferation rates, a 9.3% increase in stage III tumors was observed, although node-positive tumors remained stable. 

The authors reported that despite the screening interruption, procedures to establish a definitive diagnosis and start treatment were subsequently carried out without delay. 

They commented that postponing screening procedures as a result of the COVID-19 pandemic was prudent at one time, at the beginning of the pandemic. However, the spread, duration, and future peaks of COVID-19 are unpredictable. They underlined that overlooking other life-threatening conditions such as breast cancer for too long may turn one public health crisis into another. 

Disclosure: For full disclosures of the study authors, visit esmoopen.com.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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