Effect of SARS-CoV-2 pandemic on breast cancer stage at diagnosis

Abstract

Objective: We aimed to research the effects of the COVID-19 pandemic on breast cancer stages at the time of diagnosis. Material and Method: The data of female patients over 18 who underwent breast surgery and sentinel lymph node sampling for malignancy between 01.06.2019 and 31.11.2019 with between 01.06.2020 and 31.11.2020 were analyzed. Patients were divided into two groups as before and during the pandemic. Results: Data of 55 patients in total were reached, of which 31 were diagnosed before the pandemic and 24 after the pandemic. There is no significant difference between the two groups in terms of age. Average tumor size is 3.42±2.00 cm, and 18 patient (32.7%) has positive sentinel lymph node biopsy (SLNB). In before pandemic group (Group 1) SLNB positivity rate is only 25.8% (n=8) but in during pandemic group (Group 2) this rate reaches 41.7% (n=10), but this is not statistically significant(p=0.214). While the tumor size of the patients in Group 1 was 3.35±2.25 cm, it was 3.51±1.67 cm in Group 2. Still, no statistically significant difference was observed (p=0.141). Conclusion: As a result of our study, although statistically insignificant, an increase in tumor sizes and positive lymph node numbers was detected. We predict that statistically significant results will be obtained in studies with a larger number of cases.

Keywords

• covid-19
• breast cancer
• sentinel lymp node
• prognosis

References

1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. Jama 2020; 323: 1239-42.
2. Organization WH. Novel Coronavirus (2019-nCoV). Situation Report–22, Data as reported by 11 February 2020. 2020.
3. Buonomo OC, Materazzo M, Pellicciaro M, Caspi J, Piccione E, Vanni G. Tor Vergata University-Hospital in the beginning of COVID-19-Era: Experience and recommendation for breast cancer patients. in vivo 2020; 34: 1661-5.
4. Lai AG, Pasea L, Banerjee A, et al. Estimating excess mortality in people with cancer and multimorbidity in the COVID-19 emergency. MedRxiv 2020.
5. Maringe C, Spicer J, Morris M, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. Lancet Oncol 2020; 21: 1023-34.
6. İnanç İH, Bursa N, Gültepe A, Şabanoğlu C. The impact of COVID-19 on rural population: A retrospective study. J Health Sci Med 2021; 4: 722-7.
7. Ekiz İşcanlı İG, Şaylan B. Evaluation of factors which determining survival of SARS COV-2 infected patients in intensive care unit. Anatolian Curr Med J 2021; 3: 36-43.
8. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians 2021;71: 209-49.

9. Marmot MG, Altman D, Cameron D, Dewar J, Thompson S, Wilcox M. The benefits and harms of breast cancer screening: an independent review. Br J Cancer 2013; 108: 2205-40.
10. Figueroa JD, Gray E, Pashayan N, et al. The impact of the COVID-19 pandemic on breast cancer early detection and screening. Prevent Med 2021; 151: 106585.
11. Peng SM, Yang KC, Chan WP, et al. Impact of the COVID‐19 pandemic on a population‐based breast cancer screening program. Cancer 2020; 126: 5202-5.
12. Shimazu K, Tamaki Y, Taguchi T, Takamura Y, Noguchi S. Comparison between periareolar and peritumoral injection of radiotracer for sentinel lymph node biopsy in patients with breast cancer. Surgery 2002; 131: 277-86.
13. Pijpers R, Meijer S, Hoekstra OS, et al. Impact of lymphoscintigraphy on sentinel node identification with technetium-99m-colloidal albumin in breast cancer. J Nuclear Med 1997; 38: 366-8.
14. Curigliano G, Cardoso MJ, Poortmans P, et al. Recommendations for triage, prioritization and treatment of breast cancer patients during the COVID-19 pandemic. The Breast 2020;52: 8-16.
15. Buonomo O, Granai A, Felici A, et al. Day-surgical management of ductal carcinoma in situ (DCIS) of the breast using wide local excision with sentinel node biopsy. Tumori J 2002; 88: S48-S9.
16. Dorling L, Carvalho S, Allen J, et al. Breast cancer risk genes-association analysis in more than 113,000 women. N Engl J Med 2021: 428-39.
17. Cardoso F, Kyriakides S, Ohno S, et al. Early breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2019; 30: 1194-220.
18. Kupstas AR, Hoskin TL, Day CN, Habermann EB, Boughey JC. Effect of surgery type on time to adjuvant chemotherapy and impact of delay on breast cancer survival: a national cancer database analysis. Ann Surg Oncol 2019; 26: 3240-9.
19. Karanlık H, Özmen V, Asoğlu O, et al. Meme kanseri cerrahi tedavisinin uzun dönem sonuçlari. Meme Sağlığı Derg 2006; 2: 2.
20. Arvold ND, Taghian AG, Niemierko A, et al. Age, breast cancer subtype approximation, and local recurrence after breast-conserving therapy. J Clin Oncol 2011; 29: 3885.
21. Veronesi U, Viale G, Rotmensz N, Goldhirsch A. Rethinking TNM: breast cancer TNM classification for treatment decision-making and research. The Breast 2006; 15: 3-8.
22. Carter CL, Allen C, Henson DE. Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer 1989; 63: 181-7.
23. Foulkes WD, Reis-Filho JS, Narod SA. Tumor size and survival in breast cancer—a reappraisal. Nat Rev Clin Oncol 2010; 7: 348-53.
24. Fisher B, Slack NH, Bross ID, Investigators C. Cancer of the breast: size of neoplasm and prognosis. Cancer 1969; 24: 1071-80.
25. Olivotto IA, Jackson JS, Mates D, et al. Prediction of axillary lymph node involvement of women with invasive breast carcinoma: a multivariate analysis. Cancer: Interdisciplinary Int J Am Cancer Soc 1998; 83: 948-55.
26. Mook S, Schmidt MK, Rutgers EJ, et al. Calibration and discriminatory accuracy of prognosis calculation for breast cancer with the online Adjuvant! program: a hospital-based retrospective cohort study. Lancet Oncol 2009; 10: 1070-6.
27. Krag DN, Anderson SJ, Julian TB, et al. Sentinel-lymph-node resection compared with conventional axillary-lymph-node dissection in clinically node-negative patients with breast cancer: overall survival findings from the NSABP B-32 randomised phase 3 trial. Lancet Oncol 2010; 11: 927-33.