The effect of COVID-19 on breast cancer care and treatment in North America: A scoping review.

BACKGROUND: Breast Cancer (BC) is the most common cancer in women in the United States. The COVID-19 pandemic affected healthcare delivery throughout North America. Breast cancer diagnosis and management was similarly affected. METHODS: We conducted a scoping review to determine the impact of COVID-19 on BC care and the impact on patients' well-being. RESULTS: Our review found that the pandemic led to changes in screenings, biopsies, medical therapy, and surgery. Constraints of the pandemic left patients without resources to navigate the emotional toll from social distancing. There was a disparity in patients' perceptions of the impact of the pandemic on BC care. CONCLUSION: Although the pandemic altered medical care in general, we found that the impact on breast cancer care was counterintuitively not as significant as predicted. However, the pandemic did impact breast cancer patients' mental well-being. This highlights the importance of properly communicating, in real-time, guidelines on breast cancer management to allay the fears of the general public.

Delays in operative management of early-stage, estrogen receptor-positive breast cancer during the COVID-19 pandemic: A multi-institutional matched historical cohort study.

BACKGROUND: During the COVID-19 pandemic, guidelines recommended that breast cancer centers delay estrogen receptor-positive breast cancer surgeries with neoadjuvant endocrine therapy. We aimed to evaluate pathologic upstaging of breast cancer patients affected by these guidelines. METHODS: Female patients with stage I/II breast cancer receiving neoadjuvant endocrine therapy were prospectively identified and were matched to a historical cohort of stage I/II estrogen receptor-positive breast cancer patients treated with upfront surgery ≤35 days. Primary outcomes were pathologic T and N upstaging versus clinical staging. RESULTS: After matching, 28 neoadjuvant endocrine therapy and 48 control patients remained. Median age in each group was 65 (P = .68). Most patients (78.6% and 79.2%) had invasive ductal carcinoma with a clinical tumor size of 0.9 cm vs 1.7 cm (P = .056). Time to surgery was 68 days in the neoadjuvant endocrine therapy group and 26.5 days in the control (P < .001). A total of 23 neoadjuvant endocrine therapy patients (82.1%) had the same or lower pT-stage compared with 31 (64.5%) control patients (P = .115). Only 3 (10.7%) neoadjuvant endocrine therapy patients had increased pN-stage vs 14 (29.2%) control patients (P = .063). CONCLUSION: Despite 2.5-times longer delays, patients with early-stage estrogen receptor-positive breast cancer receiving neoadjuvant endocrine therapy did not experience pathologic upstaging during the COVID-19 pandemic. These findings may support the use of neoadjuvant endocrine therapy in similar patients if delays to surgery are projected.