In the first 3 months of the COVID-19 pandemic, breast cancer surgery rates fell by 20 percent, but there were wide differences in demographic and other patient characteristics, according to data presented at the 2020 San Antonio Breast Cancer Symposium (Abstract SS2-01).
Researchers at the University of Wisconsin School of Medicine and Public Health, Madison, conducted a 3-month review of surgical procedures documented in the Mastery of Breast Surgery Program, a COVID-19 specific registry developed by the American Society of Breast Surgeons. The registry is HIPAA-compliant, and surgeons enter patient demographic data, as well as their surgical and medical care (neoadjuvant endocrine [NET] vs. neoadjuvant chemotherapy [NCT]). Data fields track whether decisions were usual for that practice or modified due to COVID-19.
Study Details
The review covered data entered between March 1 and June 17 and included data from 1,781 patients entered by 154 surgeons. Of 472 patients treated with primary surgery for which the impact of COVID-19 was assessed, surgery was delayed in 20 percent, reported Lee G. Wilke, MD, Professor of Surgical Oncology and Director of the Health Breast Center, at the UW-Madison School of Medicine and Public Health.
"To save protective equipment and minimize exposures, many hospitals stopped some or all cancer surgery, leading oncologic providers to quickly adjust patient management," she noted. "The goal of our study was to describe the breast cancer patient level changes which occurred during the initial months of COVID-19 in the United States.
The mean age of women for whom surgery was delayed was 63 years. Procedures involving Caucasian women accounted for 78 percent of the total delays, followed by 10 percent in African-American women and 6 percent in Hispanic patients. Geographic distribution ranged from 10.8 percent in the Northwest to 29.5 percent in the Northeast. In 94.8 percent of the cases, initial consultation took place in person, while 5.2 percent were conducted by video/telephone. Just over 1 percent of patients tested positive for COVID-19.
Mean invasive tumor size was 21.2 mm and 15.7 percent were node-positive. Among 1,445 invasive breast cancers, 75 percent (1,081) were ER+/HER2-, 13.5 percent (195) were HER2+, and 11.1 percent (160) were triple-negative cases (TNBC). Ductal carcinoma in situ (DCIS) comprised 18.2 percent (325) of the women, and of 267 cases of ER+ DCIS, 49 percent (131) had primary surgery and 49 percent (130) received NET. The majority of NET use (95%) was due to COVID-19 (124).
According to Wilke, almost all ER- DCIS patients underwent primary surgery. Increasing age was not a statistically significant factor in the use of NET. Compared to patients from the Northwest, patients from the Southwest and Northeast had the greatest use of NET (COVID-19) versus NET (usual) (ORs 14.4 and 4.6).
Genomic testing was performed on the core biopsy in 216 patients, with 65 percent (141) due to COVID-19. Among the patients who had genomic testing due to COVID-19, 116 (82%) had NET, 18 (13%) had NCT, while the remainder underwent primary surgery. Patients from the Northeast had 2.1 times greater odds of having surgery delayed compared to those from the Midwest.
Patients also experienced changes to their surgical plan, with the most common being 6 percent who converted from mastectomy to breast conservation, and 7 percent from mastectomy with reconstruction to mastectomy without reconstruction.
Effects on Treatment
"COVID-19 led to significant modifications in breast cancer treatment, including high rates of NET, genomic assay testing on core biopsies, as well as delays in surgery; each of which were consistent with the prioritization and treatment recommendations from the COVID-19 Pandemic Breast Cancer Consortium," Wilke and her colleagues determined.
"The majority of patients with TNBC and HER2+ disease received guideline-concordant NCT. The ASBrS Mastery COVID-19 registry provides a snapshot into the rapid care changes caused by the pandemic, has ongoing data entry and analysis, and will enable understanding of the impact on long-term breast cancer outcomes."
Kurt Samson is a contributing writer.