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Background: Real-world evidence through secondary use of data (SUD) in oncology is gaining increasing interest, to better understand cancer epidemiology and provide insights into treatment patterns in daily practice. This study evaluates incidence of HR+/HER2- early BC (eBC) and its management in clinical practice through SUD and gauge the impact of the SARS-COV2 pandemic. Method(s): This observational retrospective analysis integrates administrative databases for healthcare resources consumption (pharmaceuticals, hospitalizations, diagnostic tests and specialist visits databases) from a sample of Italian Local Health Units, based on 15 million inhabitants across Italy. Patients with >=1 hospitalization discharge diagnosis for BC, with surgical intervention and HR+ status (determined by coding for HR+ status or by presence of endocrine therapy) between 01/2010-06/2021 were included. Patients with at least one prescription of anti- HER2 monoclonal antibodies were excluded. Patients were classified by menopausal state through prescription for the gonadotropin-releasing hormone analogues (GnRHa). Incidence was calculated during all study period. Result(s): Incidence rate has a slight upwards trend, as expected, ranging from 53.9 in 2013 to 62.7 in 2019 per 100,000 health-assisted subjects. Incidence in 2020 is 49.2 per 100,000 (table 1 for quarter split). As for adjuvant therapies, 31,836 patients were included in the analysis of which 5343 (16.8%) were classified as premenopausal. Mean age was 64.5 years. Most patients (78.8%) were treated with only adjuvant endocrine therapy (ET). 16.5% of the sample received adjuvant chemotherapy (CT). CT treatment was more prescribed in premenopausal patients. CT treatment was started within 12 weeks of surgery for 3.9% of the sample. Most patients (12.7%) started it between 12 weeks and 24 weeks. Conclusion(s): SUD can provide lots of information with the right queries. The analysis confirms the slight increase in incidence observed by national registries and provides an estimate of the impact of SARS-COV2 with a 22% reduction of breast surgery in 2020. Administrative data can be used to assess clinical variables (e.g. premenopause through GnRHa prescription), and could be further explored for disease stage through axillary dissection, and recurrence through prescription of therapies used in metastatic setting.
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Background: The outbreak of the COVID-19 pandemic led to a rapid reorganization of health care system in Italy. Therefore, CS slowed down during the two lockdown periods including for BC primary prevention such as mammography and breast ultrasound. Hence, the aim of our retrospective analysis was to evaluate the impact of the discontinuation of CS and subsequent delay in surgical treatment during COVID-19 on BC diagnosis. Patients and methods: All patients who underwent breast surgery after BC diagnosis from March 8, 2019 to March 8, 2021 were included in the study. Our population was then divided into two groups: group A, pre-Pandemic group, considered women who underwent surgical procedures from March 2019 to March 2020. Group B, Pandemic group, included patients who underwent breast surgery from March 9, 2020 to March 8, 2021. Results: A total of 524 newly diagnosed patients were evaluated;n=239 and n=285 in the pre-Pandemic and Pandemic, respectively. We observe an increase of patients with lymph-node involvement (35% vs 29% p= 0.14) and with a higher cancer stage (Stage III-IV 20% vs 15% p=0.13), but not statistically significative in the Pandemic Group compared to the pre-Pandemic group. Conclusions: In our analysis, the slowdown of CS for BC did not have a significant impact on BC diagnosis even though our data reveal a slight increase of advanced BC stage in pandemic group. Hence, a potential explanation could be identified in our efforts to keep diagnosis and treating oncological patients. Nevertheless, new data about post covid BC diagnosis are not still available. Reasonable, our findings are most likely going to be re-debeated in few years to clarify if this trend could be confirmed.
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INTRODUCTION: Squamous carcinoma is a very rare breast cancer resulting from a differentiated squamous metaplasia. Its diagnosis is late due to the absence of specific clinical and radiological features. PRESENTATION OF CASE: The authors present the case of a 39-year-old patient with the clinical onset of an inflammatory cyst diagnosed with mammography and cytological examination. After segmentectomy, on histological examination was defined as: "squamous keratinizing aspect". In light of this report she was subjected to quadrantectomy with lymphadenectomy. She did not undergo radiotherapy treatment, which was delayed due to the ongoing pandemic. After a few months developed a local recurrence and underwent a mastectomy with multidisciplinary treatment. DISCUSSION: Squamously-differentiated metaplastic carcinoma of the breast is one of the rarest forms of breast cancer. Its etiopathogenesis is still unclear but some authors suggest that it originates from a squamous metaplasia deriving from the epithelium of cysts. This is a very aggressive and fast-growing tumour especially in young women, in fact the patient had a recurrence after a few months. She came to our attention 6 months after the initial surgery with a relapse at a local-regional level for which she was subjected to radical treatment and with a metastatic spread for which she was given the first-line chemotherapy treatment. CONCLUSION: There are no well-defined guidelines for the treatment of this rare form of cancer. The case illustrates how the rapid aggressiveness of the disease requires adequate and immediate multidisciplinary treatment from the very beginning.
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Starting from the assumption that “health is the primary good” and although the humanitarian character of the epidemic remains the most urgent aspect to be treated, unfortunately it is not the only one. As acknowledged by the World Health Organization on 11 March, the COVID-19 epidemic has become a worldwide pandemic. The response to the emergency connected with the spread of the virus, to limit its negative impact on the economic system, must consist in a rapid and targeted intervention. The aim of this paper is to analyse the main aspects of Covid 19 from the point of view of health, constitutional and statistical, highlighting the evolution of the/phenomenon and its territorial diffusion, with reference to the spread of the virus in Italy. © Springer Nature Switzerland AG 2020.