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1.
CMAJ Open ; 9(4): E1205-E1212, 2021.
Article in English | MEDLINE | ID: covidwho-1592340

ABSTRACT

BACKGROUND: Breast cancer screening in Ontario, Canada, was deferred during the first wave of the COVID-19 pandemic, and a prioritization framework to resume services according to breast cancer risk was developed. The purpose of this study was to assess the impact of the pandemic within the Ontario Breast Screening Program (OBSP) by comparing total volumes of screening mammographic examinations and volumes of screening mammographic examinations with abnormal results before and during the pandemic, and to assess backlogs on the basis of adherence to the prioritization framework. METHODS: A descriptive study was conducted among women aged 50 to 74 years at average risk and women aged 30 to 69 years at high risk, who participated in the OBSP. Percentage change was calculated by comparing observed monthly volumes of mammographic examinations from March 2020 to March 2021 with 2019 volumes and proportions by risk group. We plotted estimates of backlog volumes of mammographic examinations by risk group, comparing pandemic with prepandemic screening practices. Volumes of mammographic examinations with abnormal results were plotted by risk group. RESULTS: Volumes of mammographic examinations in the OBSP showed the largest declines in April and May 2020 (> 99% decrease) and returned to prepandemic levels as of March 2021, with an accumulated backlog of 340 876 examinations. As of March 2021, prioritization had reduced the backlog volumes of screens for participants at high risk for breast cancer by 96.5% (186 v. 5469 expected) and annual rescreens for participants at average risk for breast cancer by 13.5% (62 432 v. 72 202 expected); there was a minimal decline for initial screens. Conversely, the backlog increased by 7.6% for biennial rescreens (221 674 v. 206 079 expected). More than half (59.4%) of mammographic examinations with abnormal results were for participants in the higher risk groups. INTERPRETATION: Prioritizing screening for those at higher risk for breast cancer may increase diagnostic yield and redirect resources to minimize potential long-term harms caused by the pandemic. This further supports the clinical utility of risk-stratified cancer screening.


Subject(s)
Breast Neoplasms/diagnosis , COVID-19/epidemiology , Early Detection of Cancer , Guideline Adherence/statistics & numerical data , Mammography , Aged , Early Detection of Cancer/methods , Early Detection of Cancer/standards , Early Detection of Cancer/statistics & numerical data , Female , Health Priorities/standards , Health Priorities/statistics & numerical data , Humans , Mammography/standards , Mammography/statistics & numerical data , Middle Aged , Ontario/epidemiology , Risk Factors
2.
Future Oncol ; 17(34): 4757-4767, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1484980

ABSTRACT

Introduction: Since breast imaging requires very close contact with patients, a protocol is needed to perform safe daily screening activities during the COVID-19 pandemic. Materials and methods: Patients were triaged and separated into three different clinical scenarios by performing a telephone questionnaire before each diagnostic exam or a nasopharyngeal swab before every recovery. Specific procedures for each scenario are described. Results: From July to October 2020, 994 exams were performed. A total of 16 cancers and 7 suspected COVID-19 patients were identified. No medical staff were infected. Conclusion: This protocol is an example of the practical use of guidelines applied to a breast unit to assist specialists in preventing COVID-19 infection and optimizing resources for breast cancer diagnosis.


Lay abstract On March 11th, 2020, the WHO officially declared the COVID-19 infection pandemic. Since breast cancer represents the most frequent cancer in women of all ages, and breast imaging examinations require very close contact with patients, a protocol was designed to optimize the management of patients and healthcare workers, performing strict COVID-19 screening and avoiding any impairment of survival of patients with breast cancer. Patients were separated into three different clinical scenarios (non-COVID-19 patients, suspected COVID-19 patients and confirmed COVID-19 patients) by performing a telephone questionnaire before each diagnostic exam or a nasopharyngeal swab before every recovery. Specific procedures for each scenario are described. Confirmed or suspected patients are rescheduled if not urgent. From July to October 2020, 994 exams were performed. A total of 16 cancers and 7 suspected COVID-19 patients were identified. No medical staff were infected. This study demonstrates efficacy in terms of continuity in the provision of an essential level of care in a breast cancer screening and ambulatory setting, providing an example of the practical use of guidelines applied to a breast unit, to assist specialists in preventing COVID-19 infection and optimizing resources for breast cancer diagnosis.


Subject(s)
Breast Neoplasms/diagnostic imaging , Breast Neoplasms/diagnosis , Breast/diagnostic imaging , COVID-19/prevention & control , Adult , Aged , Aged, 80 and over , Breast Neoplasms/virology , Female , Humans , Male , Middle Aged , Pandemics/prevention & control , SARS-CoV-2/pathogenicity
3.
Technol Cancer Res Treat ; 20: 15330338211035037, 2021.
Article in English | MEDLINE | ID: covidwho-1484272

ABSTRACT

BACKGROUND: Oncotype Dx (ODx) is a genomic assay which estimates the risk of distant recurrence and predicts adjuvant chemotherapy benefit in early stage breast cancer patients. Most ODx data is derived from excisional specimens. AIM: We assess the utility of ODx on core needle biopsies (CNB) and measure its impact on neoadjuvant treatment decisions, particularly in patients with clinically complicated situations. METHODS: Consecutive ODx results on breast CNBs with invasive carcinoma from 2012-2020 at 3 tertiary care hospitals with dedicated Breast Health Centers were reviewed. Clinical indications to perform ODx on CNB were recorded through a review of patients' electronic medical records. Clinicopathologic features, surgical or oncologic modalities and follow-up data were recorded. RESULTS: Three distinct clinical indications for performing ODx on CNB in 85 ER+ invasive breast carcinomas were identified: 1) Excisions with insufficient tissue to perform ODx, 2) adjudicate neoadjuvant therapy versus primary surgical resection, and 3) select neoadjuvant chemotherapy (NAC) versus neoadjuvant endocrine therapy (NET). Primary surgery was selected in patients with low score RS (<18), and NET was preferred in patients with intermediate or high RS (>18). NET was preferred over NAC in patients with low RS (<18). CONCLUSION: This study shows that CNB ODx RS helps guide treatment decisions in a neoadjuvant setting along with other contributing factors such as the presence of pathogenic mutations, node positivity, patient age, and comorbidities. The use of ODx on CNB is furthermore valuable in the midst of the COVID-19 pandemic for early breast cancer patients to administer effective therapy in a timely manner.


Subject(s)
Breast Neoplasms, Male/diagnosis , Breast Neoplasms/diagnosis , Carcinoma, Ductal, Breast/diagnosis , Neoplasm Recurrence, Local , Adult , Aged , Aged, 80 and over , Biomarkers, Tumor/genetics , Biopsy, Large-Core Needle , Breast Neoplasms/pathology , Breast Neoplasms, Male/pathology , Carcinoma , Carcinoma, Ductal, Breast/pathology , Combined Modality Therapy , Electronic Health Records , Female , Gene Expression Profiling/methods , Genomics , Hormones/therapeutic use , Humans , Male , Medical Oncology , Middle Aged , Neoadjuvant Therapy , Neoplasm Invasiveness , Retrospective Studies , Treatment Outcome
4.
J Natl Cancer Inst ; 113(9): 1161-1167, 2021 09 04.
Article in English | MEDLINE | ID: covidwho-1402395

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic led to a near-total cessation of mammography services in the United States in mid-March 2020. It is unclear if screening and diagnostic mammography volumes have recovered to prepandemic levels and whether use has varied by women's characteristics. METHODS: We collected data on 461 083 screening mammograms and 112 207 diagnostic mammograms conducted during January 2019 through July 2020 at 62 radiology facilities in the Breast Cancer Surveillance Consortium. We compared monthly screening and diagnostic mammography volumes before and during the pandemic stratified by age, race and ethnicity, breast density, and family history of breast cancer. RESULTS: Screening and diagnostic mammography volumes in April 2020 were 1.1% (95% confidence interval [CI] = 0.5% to 2.4%) and 21.4% (95% CI = 18.7% to 24.4%) of the April 2019 prepandemic volumes, respectively, but by July 2020 had rebounded to 89.7% (95% CI = 79.6% to 101.1%) and 101.6% (95% CI = 93.8% to 110.1%) of the July 2019 prepandemic volumes, respectively. The year-to-date cumulative volume of screening and diagnostic mammograms performed through July 2020 was 66.2% (95% CI = 60.3% to 72.6%) and 79.9% (95% CI = 75.4% to 84.6%), respectively, of year-to-date volume through July 2019. Screening mammography rebound was similar across age groups and by family history of breast cancer. Monthly screening mammography volume in July 2020 for Black, White, Hispanic, and Asian women reached 96.7% (95% CI = 88.1% to 106.1%), 92.9% (95% CI = 82.9% to 104.0%), 72.7% (95% CI = 56.5% to 93.6%), and 51.3% (95% CI = 39.7% to 66.2%) of the July 2019 prepandemic volume, respectively. CONCLUSIONS: Despite a strong overall rebound in mammography volume by July 2020, the rebound lagged among Asian and Hispanic women, and a substantial cumulative deficit in missed mammograms accumulated, which may have important health consequences.


Subject(s)
Breast Neoplasms/diagnosis , COVID-19/epidemiology , Early Detection of Cancer/statistics & numerical data , Mammography/statistics & numerical data , Registries/statistics & numerical data , SARS-CoV-2/isolation & purification , Adult , Aged , Breast Neoplasms/psychology , COVID-19/virology , Female , Humans , Middle Aged , United States/epidemiology
5.
Cancer Res Treat ; 53(3): 650-656, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1403959

ABSTRACT

PURPOSE: Coronavirus disease 2019 (COVID-19) pandemic has spread worldwide rapidly and patients with cancer have been considered as a vulnerable group for this infection. This study aimed to examine the expressions of angiotensin-converting enzyme 2 (ACE2) and transmembrane serine protease 2 (TMPRSS2) in tumor tissues of six common cancer types. MATERIALS AND METHODS: The expression levels of ACE2 and TMPRSS2 in tumors and control samples were obtained from online databases. Survival prognosis and biological functions of these genes were investigated for each tumor type. RESULTS: There was the overexpression of ACE2 in colon and stomach adenocarcinomas compared to controls, meanwhile colon and prostate adenocarcinomas showed a significantly higher expression of TMPRSS2. Additionally, survival prognosis analysis has demonstrated that upregulation of ACE2 in liver hepatocellular carcinoma was associated with higher overall survival (hazard ratio, 0.65; p=0.016) and disease-free survival (hazard ratio, 0.66; p=0.007), while overexpression of TMPRSS2 was associated with a 26% reduced risk of death in lung adenocarcinoma (p=0.047) but 50% increased risk of death in breast invasive carcinoma (p=0.015). CONCLUSION: There is a need to take extra precautions for COVID-19 in patients with colorectal cancer, stomach cancer, and lung cancer. Further information on other types of cancer at different stages should be investigated.


Subject(s)
Angiotensin-Converting Enzyme 2/genetics , COVID-19/diagnosis , Neoplasms/diagnosis , Neoplasms/genetics , Serine Endopeptidases/genetics , Adenocarcinoma/complications , Adenocarcinoma/diagnosis , Adenocarcinoma/epidemiology , Adenocarcinoma/genetics , Breast Neoplasms/complications , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , Breast Neoplasms/genetics , COVID-19/complications , COVID-19/epidemiology , COVID-19/genetics , Case-Control Studies , Databases as Topic , Female , Gastrointestinal Neoplasms/complications , Gastrointestinal Neoplasms/diagnosis , Gastrointestinal Neoplasms/epidemiology , Gastrointestinal Neoplasms/genetics , Gene Expression Regulation, Neoplastic , Genetic Predisposition to Disease , Humans , Liver Neoplasms/complications , Liver Neoplasms/diagnosis , Liver Neoplasms/epidemiology , Liver Neoplasms/genetics , Lung Neoplasms/complications , Lung Neoplasms/diagnosis , Lung Neoplasms/epidemiology , Lung Neoplasms/genetics , Male , Mutation , Neoplasms/complications , Neoplasms/epidemiology , Pandemics , Prognosis , Prostatic Neoplasms/complications , Prostatic Neoplasms/diagnosis , Prostatic Neoplasms/epidemiology , Prostatic Neoplasms/genetics , Retrospective Studies , SARS-CoV-2/physiology , Survival Analysis
6.
Zhonghua Zhong Liu Za Zhi ; 42(4): 288-291, 2020 Apr 23.
Article in Chinese | MEDLINE | ID: covidwho-1379995

ABSTRACT

The outbreak of 2019 novel coronavirus disease (COVID-19) is spreading rapidly. In order to prevent cluster outbreaks, the government strengthened the management and control of personnel mobility, which had a great impact on the examination and treatment of breast cancer patients. This paper discusses how to realize scientific health management of breast cancer patients outside the hospital based on the existing epidemic situation, characteristics of breast cancer patients and public health safety factors. The breast cancer patients should synthetically consider the epidemic prevention situation of inhabitance, the disease stage and previous therapeutic schedule to decide the next therapeutic schedule. If necessary, after professional discussion and communication between doctors and patients online or offline, the hospital visiting time should be delayed through seeking alternative treatment schemes, and psychological counseling for patients should be paid attention to at the same time.


Subject(s)
Breast Neoplasms , Coronavirus Infections , Coronavirus , Disease Outbreaks/prevention & control , Pandemics/prevention & control , Pneumonia, Viral , Telemedicine , Ambulatory Care , Betacoronavirus , Breast Neoplasms/diagnosis , Breast Neoplasms/psychology , Breast Neoplasms/therapy , COVID-19 , China , Coronavirus Infections/epidemiology , Humans , Pneumonia, Viral/epidemiology , SARS-CoV-2
7.
Int J Environ Res Public Health ; 18(8)2021 04 10.
Article in English | MEDLINE | ID: covidwho-1378354

ABSTRACT

Considering the constant increase in breast cancer patients, identifying factors that influence the moment of diagnosis is essential for optimizing therapeutic management and associated cost. The purpose of the study is to evaluate the impact of the economic crisis on the moment of a breast cancer diagnosis. This retrospective observational study analyzed a cohort of 4929 patients diagnosed with breast cancer over the course of 19 years in the Western region of Romania. The time interval was divided based on the onset of the economic crisis into 3 periods: pre-crisis (2001-2006), crisis (2007-2012), and post-crisis (2013-2019). The disease stage at the moment of diagnosis was considered either early (stages 0, I, II) or advanced (stages III, IV). Although recording a similar mean number of patients diagnosed per year during the pre- and crisis periods, a significantly higher percentage of patients were diagnosed with late-stage breast cancer during the economic crisis period compared to the previous interval (46.9% vs. 56.3%, p < 0.01). This difference was further accentuated when accounting for environmental setting, with 65.2% of patients from a rural setting being diagnosed with advanced disease during the crisis interval. An overall improvement of 12% in early-stage breast cancer diagnosis was recorded in the post-crisis period (55.7%, p < 0.001). The findings of this study support periods of economic instability as potential factors for a delay in breast cancer diagnosis and highlight the need for the development of specific strategies aimed at reducing cancer healthcare and associated financial burden in times of economic crisis.


Subject(s)
Breast Neoplasms , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , Delayed Diagnosis , Economic Recession , Humans , Retrospective Studies , Romania
8.
J Mammary Gland Biol Neoplasia ; 26(3): 221-226, 2021 09.
Article in English | MEDLINE | ID: covidwho-1375665

ABSTRACT

The twelfth annual workshop of the European Network for Breast Development and Cancer focused on methods in mammary gland biology and breast cancer, was scheduled to take place on March 26-28, 2020, in Weggis, Switzerland. Due to the COVID-19 pandemic, the meeting was rescheduled twice and eventually happened as a virtual meeting on April 22 and 23, 2021. The main topics of the meeting were branching and development of the mammary gland, tumor microenvironment, circulating tumor cells, tumor dormancy and breast cancer metastasis. Novel and unpublished findings related to these topics were presented, with a particular focus on the methods used to obtain them. Virtual poster sessions were a success, with many constructive and fruitful interactions between researchers and covered many areas of mammary gland biology and breast cancer.


Subject(s)
Biomedical Research/methods , Breast Neoplasms/pathology , Mammary Glands, Human/pathology , Biomarkers, Tumor/metabolism , Breast Neoplasms/diagnosis , Breast Neoplasms/metabolism , Breast Neoplasms/therapy , Combined Modality Therapy , Europe , Female , Humans , Mammary Glands, Human/growth & development , Mammary Glands, Human/metabolism , Neoplasm Metastasis , Neoplasm Staging , Neoplastic Cells, Circulating , Prognosis , Tumor Microenvironment
9.
Cancer ; 127(23): 4512-4515, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1372707

ABSTRACT

BACKGROUND: Breast cancer screening utilization steeply dropped at the start of the coronavirus disease 2019 (COVID-19) pandemic. However, the effects on breast cancer screening in lower income populations are unknown. This study examined changes in breast cancer screening rates (BCSRs) during the pandemic among 32 community health centers (CHCs) that provided health care to lower income populations. METHODS: Secondary data from 32 CHCs participating in an American Cancer Society grant program to increase breast cancer screening services were used. BCSRs were defined as the percentage of women aged 50 to 74 years who had a medical visit in the past 12 months (142,207 in 2018, 142,003 in 2019, and 150,630 in 2020) and received a screening mammogram within the last 27 months. BCSRs in July 2020, July 2019, and June 2018 were compared with screening rate ratios (SRRs) and corresponding 95% confidence intervals (CIs). RESULTS: BCSRs significantly rose by 18% between 2018 and 2019 (from 45.8% to 53.9%; SRR, 1.18; 95% CI, 1.17-1.18) and then declined by 8% between 2019 and 2020 (from 53.9% to 49.6%; SRR, 0.92; 95% CI, 0.92-0.93). If the 2018-2019 BCSR trends had continued through 2020, 63.3% of women would have been screened in 2020 in contrast to the 49.6% who were; this potentially translated into 47,517 fewer mammograms and 242 missed breast cancer diagnoses in this population. CONCLUSIONS: In this study of 32 CHCs, BCSRs declined by 8% from July 2019 to 2020, and this reversed an 18% improvement between July 2018 and 2019. Declining BCSRs among CHCs during the COVID-19 pandemic call for policies to support and resources to identify women in need of screening.


Subject(s)
Breast Neoplasms , COVID-19 , Early Detection of Cancer/statistics & numerical data , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , Community Health Centers , Female , Humans , Mammography , Mass Screening/statistics & numerical data , Pandemics , United States/epidemiology
11.
Future Oncol ; 17(25): 3373-3381, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1320568

ABSTRACT

Aim: To assess the anxiety levels of breast cancer patients during the COVID-19 pandemic. Materials & methods: A total of 298 patients completed the State-Trait Anxiety Inventory (STAI-S and STAI-T) and the Visual Analogue Scale for Anxiety (VAS) and VAS for Anxiety in COVID-19 (VAS-CoV). Results: 144 patients were in the high anxiety category for STAI-S, and 202 patients were in the high anxiety category for STAI-T. STAI-T score was significantly high in the metastatic group (p = 0.017). VAS-CoV score in the hormonotherapy group was significantly higher than in the no-treatment group (p = 0.023). There was a positive correlation between VAS-CoV and VAS levels (r = 0.708, p < 0.001), VAS-CoV and STAI-S and STAI-T scores (r = 0.402, p < 0.001; r = 0.185, p = 0.001, respectively), and a negative correlation between education years and STAI-T scores (r = -0.172, p = 0.003). Conclusion: The COVID-19 pandemic is related to high anxiety levels in breast cancer patients.


Lay abstract COVID-19 pandemic is related to rapidly rising anxiety levels worldwide. Because of the high mortality of COVID-19 in cancer patients, changing treatment routines and disruptions of the healthcare system, cancer patients are the most affected population in this situation. Anxiety among females and breast cancer patients tend to be high, although anxiety levels in cancer patients during the pandemic period varies according to the cancer type, treatment status and sociodemographic factors. This study assessed the effect of the COVID-19 pandemic on breast cancer patients' anxiety levels according to treatment status and stage of the disease. A total of 298 breast cancer patients completed the universally validated anxiety questionnaires. Results demonstrated high trait anxiety in breast cancer patients, particularly in the metastatic group. The current findings highlighted the importance of intensive assessment and close monitoring of breast cancer patients' psychological situations. It is crucial to provide psychological support to breast cancer patients to contribute to both treatment and follow-up processes during the pandemic.


Subject(s)
Anxiety/epidemiology , Breast Neoplasms/epidemiology , Breast Neoplasms/psychology , COVID-19/epidemiology , Aged , Aged, 80 and over , Anxiety/diagnosis , Anxiety/therapy , Breast Neoplasms/diagnosis , Breast Neoplasms/therapy , COVID-19/virology , Comorbidity , Cross-Sectional Studies , Disease Management , Female , Humans , Middle Aged , Public Health Surveillance , SARS-CoV-2 , Socioeconomic Factors , Turkey/epidemiology
13.
BMJ Health Care Inform ; 28(1)2021 Jul.
Article in English | MEDLINE | ID: covidwho-1318027

ABSTRACT

OBJECTIVES: Argentina is a low and middle-income country (LMIC) with a highly fragmented healthcare system that conflicts with access to healthcare stated by the country's Universal Health Coverage plan. A tele-mammography network could improve access to breast cancer screening decreasing its mortality. This research aims to conduct an economic evaluation of the implementation of a tele-mammography program to improve access to healthcare. METHODS: A cost-utility analysis was performed to explore the incremental benefit of annual tele-mammography screening for at-risk Argentinian women over 40 years old. A Markov model was developed to simulate annual mammography or tele-mammography screening in two hypothetical population-based cohorts of asymptomatic women. Parameter uncertainty was evaluated through deterministic and probabilistic sensitivity analysis. Model structure uncertainty was also explored to test the robustness of the results. RESULTS: It was estimated that 31 out of 100 new cases of breast cancer would be detected by mammography and 39/100 by tele-mammography. The model returned an incremental cost-effectiveness ratio (ICER) of £26 051/quality-adjusted life-year (QALY) which is lower than the WHO-recommended threshold of £26 288/QALY for Argentina. Deterministic sensitivity analysis showed the ICER is most sensitive to the uptake and sensitivity of the screening tests. Probabilistic sensitivity analysis showed tele-mammography is cost-effective in 59% of simulations. DISCUSSION: Tele-mammography should be considered for adoption as it could improve access to expertise in underserved areas where adherence to screening protocols is poor. Disaggregated data by province is needed for a better- informed policy decision. Telemedicine could also be beneficial in ensuring the continuity of care when health systems are under stress like in the current COVID-19 pandemic. CONCLUSION: There is a 59% chance that tele-mammography is cost-effective compared to mammography for at-risk Argentinian women over 40- years old, and should be adopted to improve access to healthcare in underserved areas of the country.


Subject(s)
Breast Neoplasms , Cost-Benefit Analysis/economics , Early Detection of Cancer/economics , Mammography/economics , Medical Informatics , Telemedicine , Adult , Argentina , Breast Neoplasms/diagnosis , Breast Neoplasms/economics , COVID-19 , Female , Health Services Accessibility , Humans , Middle Aged , Quality-Adjusted Life Years , Vulnerable Populations
14.
J Natl Cancer Inst ; 113(11): 1484-1494, 2021 11 02.
Article in English | MEDLINE | ID: covidwho-1309611

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has disrupted breast cancer control through short-term declines in screening and delays in diagnosis and treatments. We projected the impact of COVID-19 on future breast cancer mortality between 2020 and 2030. METHODS: Three established Cancer Intervention and Surveillance Modeling Network breast cancer models modeled reductions in mammography screening use, delays in symptomatic cancer diagnosis, and reduced use of chemotherapy for women with early-stage disease for the first 6 months of the pandemic with return to prepandemic patterns after that time. Sensitivity analyses were performed to determine the effect of key model parameters, including the duration of the pandemic impact. RESULTS: By 2030, the models project 950 (model range = 860-1297) cumulative excess breast cancer deaths related to reduced screening, 1314 (model range = 266-1325) associated with delayed diagnosis of symptomatic cases, and 151 (model range = 146-207) associated with reduced chemotherapy use in women with hormone positive, early-stage cancer. Jointly, 2487 (model range = 1713-2575) excess breast cancer deaths were estimated, representing a 0.52% (model range = 0.36%-0.56%) cumulative increase over breast cancer deaths expected by 2030 in the absence of the pandemic's disruptions. Sensitivity analyses indicated that the breast cancer mortality impact would be approximately double if the modeled pandemic effects on screening, symptomatic diagnosis, and chemotherapy extended for 12 months. CONCLUSIONS: Initial pandemic-related disruptions in breast cancer care will have a small long-term cumulative impact on breast cancer mortality. Continued efforts to ensure prompt return to screening and minimize delays in evaluation of symptomatic women can largely mitigate the effects of the initial pandemic-associated disruptions.


Subject(s)
Breast Neoplasms/mortality , COVID-19/complications , Computer Simulation , Early Detection of Cancer/statistics & numerical data , Mammography/statistics & numerical data , SARS-CoV-2/isolation & purification , Time-to-Treatment/statistics & numerical data , Aged , Breast Neoplasms/diagnosis , Breast Neoplasms/therapy , Breast Neoplasms/virology , COVID-19/transmission , COVID-19/virology , Female , Humans , Middle Aged , Prognosis , Survival Rate
15.
Ann Oncol ; 32(10): 1216-1235, 2021 10.
Article in English | MEDLINE | ID: covidwho-1303426

ABSTRACT

The 17th St Gallen International Breast Cancer Consensus Conference in 2021 was held virtually, owing to the global COVID-19 pandemic. More than 3300 participants took part in this important bi-annual critical review of the 'state of the art' in the multidisciplinary care of early-stage breast cancer. Seventy-four expert panelists (see Appendix 1) from all continents discussed and commented on the previously elaborated consensus questions, as well as many key questions on early breast cancer diagnosis and treatment asked by the audience. The theme of this year's conference was 'Customizing local and systemic therapies.' A well-organized program of pre-recorded symposia, live panel discussions and real-time panel voting results drew a worldwide audience of thousands, reflecting the far-reaching impact of breast cancer on every continent. The interactive technology platform allowed, for the first time, audience members to ask direct questions to panelists, and to weigh in with their own vote on several key panel questions. A hallmark of this meeting was to focus on customized recommendations for treatment of early-stage breast cancer. There is increasing recognition that the care of a breast cancer patient depends on highly individualized clinical features, including the stage at presentation, the biological subset of breast cancer, the genetic factors that may underlie breast cancer risk, the genomic signatures that inform treatment recommendations, the extent of response before surgery in patients who receive neoadjuvant therapy, and patient preferences. This customized approach to treatment requires integration of clinical care between patients and radiology, pathology, genetics, and surgical, medical and radiation oncology providers. It also requires a dynamic response from clinicians as they encounter accumulating clinical information at the time of diagnosis and then serially with each step in the treatment plan and follow-up, reflecting patient experiences and treatment response.


Subject(s)
Breast Neoplasms , COVID-19 , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , Breast Neoplasms/therapy , Female , Humans , Neoadjuvant Therapy , Pandemics , SARS-CoV-2
16.
Breast Cancer ; 28(6): 1340-1345, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1303376

ABSTRACT

BACKGROUND: In response to the Coronavirus-19 (COVID-19) pandemic, the Japanese government declared a state of emergency in Saitama, Chiba, Tokyo, Kanagawa, Osaka, Hyogo and Fukuoka prefectures on April 7, 2020; this was extended to the remaining prefectures on April 16, 2020. The state of emergency was lifted on May 25, 2020. Although it was known that breast cancer screening was postponed or canceled during this period, the actual extent of postponement or cancellation has not been clarified. METHODS: We investigated postponement or cancellation of breast cancer screening between April and May 2020 using a cross-sectional, web-based, self-reported questionnaire survey. In addition, we examined the association between socioeconomic and health-related factors and postponement or cancellation by multivariable log-binominal regression. RESULTS: Among 1874 women aged 30-79 years who had scheduled breast cancer screening during the study period, 493 women (26.3%) postponed or canceled screening. While women aged 30-39 years and 70-79 years postponed or canceled less frequently than women aged 40-49 years (prevalence ratio = 0.62 and 0.56, respectively), there was no significant difference between age groups in the women aged 40-69 years. Postponement or cancellation was more frequent in five prefectures, where the state of emergency was declared early (prevalence ratio = 1.25). Employment status, annual household income, family structure, academic background, smoking status, and fear of COVID-19 were not associated with postponement or cancellation. CONCLUSION: Although care should be taken with the interpretation of these findings due to possible biases, they suggest that the postponement or cancellation of breast cancer screening might be due more to facility suspension than to individual factors. It is necessary to explore the ideal way of encouraging breast cancer screening uptake, in an environment of coexistence with COVID-19.


Subject(s)
Breast Neoplasms/diagnosis , COVID-19/prevention & control , Communicable Disease Control/standards , Early Detection of Cancer/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Adult , Age Factors , Aged , Breast Neoplasms/prevention & control , COVID-19/epidemiology , COVID-19/transmission , COVID-19/virology , Cross-Sectional Studies , Early Detection of Cancer/psychology , Early Detection of Cancer/standards , Fear , Female , Humans , Japan/epidemiology , Middle Aged , Pandemics/prevention & control , Patient Acceptance of Health Care/psychology , SARS-CoV-2/pathogenicity , Self Report/statistics & numerical data
17.
Aging (Albany NY) ; 13(13): 16904-16921, 2021 07 06.
Article in English | MEDLINE | ID: covidwho-1298261

ABSTRACT

Abnormal ATPase H+ Transporting Accessory Protein 1 (ATP6AP1) expression may promote carcinogenesis. We investigated the association of ATP6AP1 with breast cancer (BC) and COVID-19. The Oncomine, Gene Expression Profiling Interactive Analysis, Human Protein Atlas and Kaplan-Meier plotter databases were used to evaluate the expression and prognostic value of ATP6AP1 in BC. ATP6AP1 was upregulated in BC tissues, and higher ATP6AP1 expression was associated with poorer outcomes. Data from the Tumor Immune Estimation Resource, Tumor-Immune System Interaction Database and Kaplan-Meier plotter indicated that ATP6AP1 expression correlated with immune infiltration, and that its prognostic effects in BC depended on tumor-infiltrating immune cell subtype levels. Multiple databases were used to evaluate the association of ATP6AP1 with clinicopathological factors, assess the mutation and methylation of ATP6AP1, and analyze gene co-expression and enrichment. The ATP6AP1 promoter was hypomethylated in BC tissues and differentially methylated between different disease stages and subtypes. Data from the Gene Expression Omnibus indicated that ATP6AP1 levels in certain cell types were reduced after SARS-CoV-2 infections. Ultimately, higher ATP6AP1 expression was associated with a poorer prognosis and with higher or lower infiltration of particular immune cells in BC. BC patients may be particularly susceptible to SARS-CoV-2 infections, which may alter their prognoses.


Subject(s)
Biomarkers, Tumor/analysis , Breast Neoplasms/genetics , COVID-19/genetics , Vacuolar Proton-Translocating ATPases/genetics , Breast Neoplasms/diagnosis , Breast Neoplasms/immunology , COVID-19/diagnostic imaging , COVID-19/immunology , DNA Methylation , Female , Gene Expression Regulation, Enzymologic , Gene Expression Regulation, Neoplastic , Humans , Kaplan-Meier Estimate , Male , Mutation/genetics , Predictive Value of Tests , Prognosis , Survival Analysis , Treatment Outcome , Vacuolar Proton-Translocating ATPases/analysis , Vacuolar Proton-Translocating ATPases/immunology
18.
Prev Med ; 151: 106602, 2021 10.
Article in English | MEDLINE | ID: covidwho-1294327

ABSTRACT

The COVID-19 pandemic forced the Dutch national breast screening program to a halt in week 12, 2020. In week 26, the breast program was resumed at 40% capacity, which increased to 60% in week 34. We examined the impact of the suspension and restart of the screening program on the incidence of screen-detected and non-screen-detected breast cancer. We selected women aged 50-74, diagnosed during weeks 2-35 of 2018 (n = 7250), 2019 (n = 7302), or 2020 (n = 5306), from the Netherlands Cancer Registry. Weeks 2-35 were divided in seven periods, based on events occurring at the start of the COVID-19 pandemic. Incidence of screen-detected and non-screen-detected tumors was calculated overall and by age group, cT-stage, and cTNM-stage for each period in 2020, and compared to the incidence in the same period of 2018/2019 (averaged). The incidence of screen-detected tumors decreased during weeks 12-13, reached almost zero during weeks 14-25, and increased during weeks 26-35. Incidence of non-screen-detected tumors decreased to a lesser extent during weeks 12-16. The decrease in incidence was seen in all age groups and mainly occurred for cTis, cT1, DCIS, and stage I tumors. Due to the suspension of the breast cancer screening program, and the restart at reduced capacity, the incidence of screen-detected breast tumors decreased by 67% during weeks 9-35 2020, which equates to about 2000 potentially delayed breast cancer diagnoses. Up to August 2020 there was no indication of a shift towards higher stage breast cancers after restart of the screening.


Subject(s)
Breast Neoplasms , COVID-19 , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , Early Detection of Cancer , Female , Humans , Incidence , Mammography , Mass Screening , Netherlands/epidemiology , Pandemics , SARS-CoV-2
19.
Prev Med ; 151: 106585, 2021 10.
Article in English | MEDLINE | ID: covidwho-1294322

ABSTRACT

The COVID-19 pandemic affects mortality and morbidity, with disruptions expected to continue for some time, with access to timely cancer-related services a concern. For breast cancer, early detection and treatment is key to improved survival and longer-term quality of life. Health services generally have been strained and in many settings with population breast mammography screening, efforts to diagnose and treat breast cancers earlier have been paused or have had reduced capacity. The resulting delays to diagnosis and treatment may lead to more intensive treatment requirements and, potentially, increased mortality. Modelled evaluations can support responses to the pandemic by estimating short- and long-term outcomes for various scenarios. Multiple calibrated and validated models exist for breast cancer screening, and some have been applied in 2020 to estimate the impact of breast screening disruptions and compare options for recovery, in a range of international settings. On behalf of the Covid and Cancer Modelling Consortium (CCGMC) Working Group 2 (Breast Cancer), we summarize and provide examples of such in a range of settings internationally, and propose priorities for future modelling exercises. International expert collaborations from the CCGMC Working Group 2 (Breast Cancer) will conduct analyses and modelling studies needed to inform key stakeholders recovery efforts in order to mitigate the impact of the pandemic on early diagnosis and treatment of breast cancer.


Subject(s)
Breast Neoplasms , COVID-19 , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , Early Detection of Cancer , Female , Humans , Mass Screening , Pandemics , Quality of Life , SARS-CoV-2
20.
Prev Med ; 151: 106559, 2021 10.
Article in English | MEDLINE | ID: covidwho-1294320

ABSTRACT

Women from racial and ethnic minority groups face a disproportionate burden of cervical and breast cancers in the United States. The Coronavirus Disease 2019 (COVID-19) pandemic might exacerbate these disparities as supply and demand for screening services are reduced. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides cancer screening services to women with low income and inadequate health insurance. We examined COVID-19's impact on NBCCEDP screening services during January-June 2020. We found the total number of NBCCEDP-funded breast and cervical cancer screening tests declined by 87% and 84%, respectively, during April 2020 compared with the previous 5-year averages for that month. The extent of declines varied by geography, race/ethnicity, and rurality. In April 2020, screening test volume declined most severely in Health and Human Services Region 2 - New York (96% for breast, 95% for cervical cancer screening) compared to the previous 5-year averages. The greatest declines were among American Indian/Alaskan Native women for breast cancer screening (98%) and Asian Pacific Islander women for cervical cancer screening (92%). Test volume began to recover in May and, by June 2020, NBCCEDP breast and cervical cancer screening test volume was 39% and 40% below the 5-year average for that month, respectively. However, breast cancer screening remained over 50% below the 5-year average among women in rural areas. NBCCEDP programs reported assisting health care providers resume screening.


Subject(s)
Breast Neoplasms , COVID-19 , Uterine Cervical Neoplasms , Breast Neoplasms/diagnosis , Early Detection of Cancer , Female , Humans , Mass Screening , Medically Uninsured , Minority Groups , New York , SARS-CoV-2 , United States , Uterine Cervical Neoplasms/diagnosis
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