Effects of lower screening activity during the COVID-19 pandemic on breast cancer patient pathways: Evidence from the age cut-off of organized screening.

We examined the effects of the COVID-19 pandemic on the screening, diagnosis and treatment of breast cancer in Hungary based on administrative data until June 2021, covering three pandemic waves. After correcting for trend and seasonality, the number of mammography examinations decreased by 68% in 2020q2, was around its usual level in 2020q3 and was reduced by 20-35% throughout 2020q4-2021q2. The reduction was caused by a combination of supply-side (temporary suspensions of screening) and demand-side (lower screening participation during the pandemic waves) factors. The number of new breast cancer diagnoses and mastectomy surgeries responded with a lag, and were below their usual level by 15-30% in all quarters between 2020q2 and 2021q2, apart from 2020q4, when there was no significant difference. Using a regression discontinuity framework, we found that the partial mastectomy rate (indicative of early diagnosis) dropped more substantially in 2020q2 in the 61-65 years old age group that was just below the age cut-off of organized screening than in the 66-70 years old age group, and this difference was partially offset in 2021q1. We suggest that policymakers need to motivate the target population (by providing both information and incentives) to catch up on missed screenings.

Neoadjuvant chemotherapy in breast cancer. experience of the molise breast unit

Background: In 2020, in Italy, an estimated 54,976 new diagnoses of breast cancer were made. The State-Regions Agreement has issued the “Guidelines on the organizational and welfare methods of the network on breast unit”, for diagnostic-therapeutic paths in senology. Methods: In the 2018 the Molise Region established a Breast Unit (B.U.);the personalized approach, especially in breast cancer, is more effective by integrating the progress of breast surgery, with staging methods such as MRI, treatment methods, such as neoadjuvant therapy (NACT), able to improve survival and quality of life especially in positive HER2 tumors and typically more aggressive “triple negative” diseases. Every week, in the COVID era on an online platform, the GOM meets to discuss cases;preoperative cases are discussed for which the methods of diagnosis and staging are proposed and the therapeutic hypothesis is discussed. All patients eligible for conservative treatments are stadiated with imaging techniques, in particular MRI, the most accurate tool for the basic evaluation of disease extent, and a biopsy for the evaluation of biological variables. Patological complete response (pCR), defined as the absence of invasive disease in the breast and lymphnodes, should be use to measure response to guide decision making. Results: There were 125 patients diagnosed in 2019, in 2020 there were 157, in 2021 there were 50 (until 18 May). In the year 2019, the B.U. gradually structured. In 2020 the median age was 52 a. (32-72 BC). Of the 157 patients evaluated, 8 or 5.1%, performed neoadjuvant chemotherapy (7 T2 cases, 1 T1c case;5 G3 cases, 3 G2 cases;7 cases with positive RE of which 1 HER-2 score 3+, 1 triple negative). All have undergone quadrantectomy. In 2021 the median age of the 50 patients was 64.5 a. (35-81 BC) and 14 cases, or 28%, performed neoadjuvant chemotherapy (9 T2 cases, 5 T4 cases;13 G3 cases, 1 Case G2;6 HER-2 score 3+ cases;3 triple negative cases and 11 cases with positive RE (all patients are still being treated). Conclusions: In Italy NACT is proposeed to about 20% of women with breast cancer, the European average is about 30% with peaks of 50-60% in Germany and the United Kingdom. The activity data of the B.U. Molise and the systemic treatment with NACT indicate an approach in line with Italian data and with the tendency to improve them since closer to European standards denoting a more modern method and perhaps a real cultural change.

The PROCEM study protocol: Added value of preoperative contrast-enhanced mammography in staging of malignant breast lesions - a prospective randomized multicenter study.

BACKGROUND: Correct preoperative estimation of the malignant extent is crucial for optimal planning of breast cancer surgery. The sensitivity of mammography is lower in dense breasts, and additional imaging techniques are sometimes warranted. Contrast-enhanced mammography (CEM) has shown similar sensitivity and in some cases better specificity, than magnetic resonance imaging (MRI) in small, observational studies. CEM may be more cost-effective than MRI, and may provide better identification of the tumor extent, however, no randomized trials have been performed to date to investigate the added value of CEM. In a feasibility study, we found that the treatment was changed in 10/47 (21%) cases after additional CEM. The purpose of the present study is to evaluate the added value of CEM in preoperative staging of breast cancer in a randomized study. METHOD: This prospective randomized study will include 440 patients with strongly suspected or established diagnosis of breast malignancy, based on assessment with mammography, ultrasound and core biopsy/cytology, and for whom primary surgery is planned. Patients will be randomized 1:1 using a web-based randomization tool to additional investigation with CEM or no further imaging. The CEM findings will be taken into consideration, which may lead to changes in primary treatment, which is the primary endpoint of this study. Secondary endpoints include rate of reoperation and number of avoidable mastectomies, as well as a cost-benefit analysis of additional CEM. Patient-reported health-related quality of life will be investigated at 1 year with the validated Breast-Q™ questionnaire. The rate of local recurrence or new cancer ipsi- or contralaterally within 5 years will be assessed from medical records and pathology reports. DISCUSSION: The aim of this trial is to explore the added value of CEM in preoperative staging of breast cancer. The results obtained from this study will contribute to our knowledge on CEM as an additional imaging method to standard investigation with digital mammography and ultrasound. The findings may also provide additional information on which patient groups would benefit from CEM, and on the economic aspects of CEM in standard preoperative practice. TRIAL REGISTRATION: This trial is registered at clinicaltrials.gov , registration no: NCT04437602 , date of registration: June 18, 2020.

Monomicrobial Necrotizing Fasciitis of the Breast: A Case Managed by Partial Mastectomy and Hydrogel Dressing.

Necrotizing fasciitis (NF) is a rare life-threatening bacterial infection, which can be monomicrobial or polymicrobial, involving the fascia and eventually leading to necrosis. The course of the disease is rapidly progressive and can be misdiagnosed as an abscess or cellulitis. The disease requires more attention with respect to early diagnosis and treatment as it has a high mortality rate. In this report, we present the case of a 60-year-old female, who was a known case of hypertension and type 2 diabetes mellitus (T2DM). The patient presented to the emergency department on the 21st of October 2020, complaining of left breast pain for 10 days, which was associated with fever and nausea. On physical examination, the left breast was swollen and tender to palpation. There was a single patch of inflamed skin measuring 1 x 1 cm with greenish discoloration in the inframammary fold. Ultrasound of the breast showed a patch of focal mastitis with edema seen at 4-8 o'clock with no underlying fluid collection. She was admitted as a case of left breast abscess and was started on antibiotics. Despite the antibiotic therapy, the patient was still febrile and developed two more inflammatory and necrotic patches with no discharge. The patient underwent urgent surgical debridement of the necrotic tissues, leaving the wound packed for postoperative dressing. The patient stayed in isolation for a total of 25 days as she was found to be positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The surgical wound was closed, and the patient was discharged. Early diagnosis and management of NF is the key to saving the patient's life and improving outcomes.