The coronavirus disease (COVID-19) has profoundly impacted on cancer care since March 2020. With our country in the eye of the pandemic storm, cancer patients (pts) faced an unprecedented challenge in accessing crucial services. Cancer screening programs were postponed to preserve health care system capacity. Breast cancer (BC) mainly benefits from early detection. Our multicenter study aimed to assess impact of COVID-19 outbreak on access to cancer diagnosis and treatment for BC pts compared to pre-pandemic period.
All consecutive medical records of new diagnosed BC pts pertained to 3 Italian Oncology Departments between March and December 2020 were evaluated. Monthly access rate and temporal intervals between date of symptoms onset, radiological, cytohistological diagnosis and treatment start were computed and compared with those of the same period in 2019. Differences between the two years were analyzed using Fisher’s exact test or chi-square test for categorical variables and unpaired Student t test, or the Mann-Whitney U test for continuous variables.
A significant reduction (27%) in newly diagnosed BC cases was seen when compared with 2019 (430 vs 595). Newly BC pts in 2020 were less likely to be diagnosed with early stage (stage I-II) BC (75% vs 84%, p < 0.01), had a worsened ECOG PS (20% had PS > 0 in 2020 vs 15% in 2019) and were more symptomatic at diagnosis (37% vs 17%, p < 0.01). Other clinical and tumor characteristics such as histotype and molecular subtype were similar regardless of the year. Looking at pts management, time intervals between symptom onset and radiological diagnosis (median 13 days in 2020 vs 21 days in 2019, p = 0.04), symptom onset and cytohistological diagnosis (23.5 vs 27.5 days, p = 0.11), cytohistological diagnosis and treatment start (median 62 vs 76 days, p < 0.01) were maintained or even improved. However, less BC were discussed in multidisciplinary meetings during 2020 (66% vs 78%, p < 0.01).
As COVID-19 continues to rage, our data shed light on the concerning decrease in BC early detection with potential lasting effects on cancer outcomes. Despite the pandemic context, Oncology Departments were able to guarantee the tightness of diagnostic-therapeutic pathways.
Clinical trial identification
Legal entity responsible for the study
Has not received any funding.
All authors have declared no conflicts of interest.