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1.
In Vivo ; 35(5): 2763-2770, 2021.
Article in English | MEDLINE | ID: covidwho-1441422

ABSTRACT

BACKGROUND/AIM: Being scheduled for radiotherapy can cause emotional distress. This study aimed to identify risk factors in 338 patients assigned to radiotherapy for breast cancer. PATIENTS AND METHODS: Nineteen potential risk factors including the COVID-19 pandemic were investigated for associations with the six emotional problems included in the National Comprehensive Cancer Network Distress Thermometer. RESULTS: Worry and fears were significantly associated with age ≤60 years; sadness with age and Karnofsky performance score (KPS) <90; depression with KPS and Charlson Comorbidity Index ≥3; loss of interest with KPS. Trends were found for associations between sadness and additional breast cancer/DCIS, Charlson Index and chemotherapy; between depression and additional breast cancer/DCIS, treatment volume and nodal stage N1-3; between nervousness and additional breast cancer/DCIS, mastectomy and triple-negativity; between loss of interest and Charlson Index, family history of breast cancer/DCIS, invasive cancer, chemotherapy, and treatment volume. The COVID-19 pandemic did not increase emotional problems. CONCLUSION: Several risk factors for emotional problems were identified. Patients with such factors should receive psychological support well before radiotherapy.


Subject(s)
Breast Neoplasms , COVID-19 , Carcinoma, Intraductal, Noninfiltrating , Breast Neoplasms/epidemiology , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Carcinoma, Intraductal, Noninfiltrating/surgery , Female , Humans , Mastectomy , Mastectomy, Segmental , Middle Aged , Pandemics , Radiotherapy, Adjuvant/adverse effects , SARS-CoV-2
2.
Clin Imaging ; 80: 19-25, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1293658

ABSTRACT

Partial breast irradiation (PBI) and ultra-hypofractionated whole breast irradiation (uWBI) are contemporary alternatives to conventional and standard hypofractionated whole breast irradiation (WBI), which shorten treatment from 3 to 6 weeks to 1-2 weeks for select patients. PBI and accelerated PBI (APBI) can be delivered with external beam radiation (3D conformal radiation therapy (3D-CRT) or intensity modulated radiation therapy (IMRT)), intraoperative radiation (IORT), or brachytherapy. These new radiation techniques offer the advantage of convenience and lower cost, which ultimately improves access to care. Globally, the COVID 19 pandemic has accelerated APBI/PBI and ultra-hypofractionated regimens into routine practice for carefully selected patients. Recent long-term data from randomized controlled trials (RCTs) have demonstrated these techniques are safe and effective in suitable patients demonstrating equivalent or improved local recurrence, acute/late toxicity, and cosmesis. PBI and APBI should be limited to low risk unifocal invasive ductal carcinoma and ductal carcinoma in situ with tumor size < 2 cm, clear margins (≥2 mm), ER+, and negative nodes. Based on the results from UK Fast-Forward and UK FAST ultra-hypofractionated breast radiation can be safely employed for early stage node negative patients, but is not yet considered an international standard of care. In this review, authors will appraise recent data for these shorter course radiation treatment regimens, as well as, considerations for breast radiologists including surveillance imaging and radiographic findings.


Subject(s)
Breast Neoplasms , COVID-19 , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Female , Humans , Mastectomy, Segmental , Neoplasm Recurrence, Local , Radiologists , SARS-CoV-2
3.
J Geriatr Oncol ; 12(7): 1130-1135, 2021 09.
Article in English | MEDLINE | ID: covidwho-1233491

ABSTRACT

This review is aimed at evaluating whether radiation therapy (RT) can be omitted in older adult early-stage low-risk breast cancer (BC) patients. The published data are particularly relevant at present, during the COVID-19 pandemic emergency, to define a treatment strategy and to prioritize essential therapy. Cochrane Database of Systematic Reviews and PubMED were systematically researched from outset through April 2020 using Mesh terms. Only randomized controlled trials (RCT), with one arm without adjuvant whole-breast irradiation (WBI), were included in the analysis. Recent literature regarding the COVID pandemic and BC RT was assessed. The reported RCTs identified a group of BC patients (pT1-2N0M0 R0, grade 1-2, estrogen receptor (ER) positive, human epidermal growth factor receptor 2 (HER2) negative tumours) in which the absolute risk of local recurrence (LR) was considered low enough to omit RT. The most common risk factors were tumor diameter, nodal and receptor status. Adjuvant RT had a significant impact on LR but not on distant metastasis (DM) or death. During the COVID 19 pandemic, results from RTCs were re-considered to define treatment recommendations for BC patients. International scientific societies and radiation oncology experts suggested RT omission, whenever possible, in older adult early-stage BC patients. Adjuvant RT might be omitted in a highly selected group of older adult early-stage BC patients with favourable prognostic factors. Hypofractionated regimens should be the standard. RT omission, partial breast irradiation (PBI), and ultra- hypofractionated regimens could be considered in selected cases due to the pandemic.


Subject(s)
Breast Neoplasms , COVID-19 , Radiation Oncology , Aged , Breast Neoplasms/radiotherapy , Breast Neoplasms/surgery , Female , Humans , Italy , Mastectomy, Segmental , Neoplasm Recurrence, Local , Radiotherapy, Adjuvant , SARS-CoV-2 , Systematic Reviews as Topic
4.
Ann R Coll Surg Engl ; 103(5): e141-e143, 2021 May.
Article in English | MEDLINE | ID: covidwho-1121494

ABSTRACT

At the onset of the COVID-19 crisis, a 63-year-old woman with multiple life-limiting comorbidities was referred with a necrotic infected left breast mass on a background of breast cancer treated with conservation surgery and radiotherapy 22 years previously. The clinical diagnosis was locally advanced breast cancer, but four separate biopsies were non-diagnostic. Deteriorating renal function and incipient sepsis and endocarditis resulted in urgent salvage mastectomy during the peak of the COVID19 pandemic. The final diagnosis was infected ischaemic/infarcted breast (wet gangrene) secondary to vascular insufficiency related to diabetes, cardiac revascularisation surgery and breast radiotherapy.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Breast/surgery , Diabetic Angiopathies/therapy , Enterobacteriaceae Infections/therapy , Gangrene/therapy , Mastectomy/methods , Mastitis/therapy , Negative-Pressure Wound Therapy/methods , Breast/blood supply , Breast Neoplasms/diagnosis , COVID-19 , Carcinoma, Ductal, Breast/diagnosis , Coronary Artery Bypass , Debridement/methods , Diabetes Mellitus, Type 2/complications , Diabetic Angiopathies/diagnosis , Diabetic Angiopathies/etiology , Diagnosis, Differential , Enterobacteriaceae Infections/diagnosis , Female , Gangrene/diagnosis , Humans , Infarction , Mammary Arteries/surgery , Mastectomy, Segmental , Mastitis/diagnosis , Middle Aged , Morganella morganii , Neoplasm Recurrence, Local/diagnosis , Radiotherapy , SARS-CoV-2 , Salvage Therapy
5.
6.
Breast ; 55: 1-6, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-969026

ABSTRACT

INTRODUCTION: In order to minimise the risk of breast cancer patients for COVID-19 infection related morbidity and mortality prioritisation of care has utmost importance since the onset of the pandemic. However, COVID-19 related risk in patients undergoing breast cancer surgery has not been studied yet. We evaluated the safety of breast cancer surgery during COVID-19 pandemic in the West of Scotland region. METHODS: A prospective cohort study of patients having breast cancer surgery was carried out in a geographical region during the first eight weeks of the hospital lockdown and outcomes were compared to the regional cancer registry data of pre-COVID-19 patients of the same units (n = 1415). RESULTS: 188 operations were carried out in 179 patients. Tumour size was significantly larger in patients undergoing surgery during hospital lockdown than before (cT3-4: 16.8% vs. 7.4%; p < 0.001; pT2 - pT4: 45.5% vs. 35.6%; p = 0.002). ER negative and HER-2 positive rate was significantly higher during lockdown (ER negative: 41.3% vs. 17%, p < 0.001; HER-2 positive: 23.4% vs. 14.8%; p = 0.004). While breast conservation rate was lower during lockdown (58.6% vs. 65%; p < 0.001), level II oncoplastic conservation was significantly higher in order to reduce mastectomy rate (22.8% vs. 5.6%; p < 0.001). No immediate reconstruction was offered during lockdown. 51.2% had co-morbidity, and 7.8% developed postoperative complications in lockdown. There was no peri-operative COVID-19 infection related morbidity or mortality. CONCLUSION: breast cancer can be safely provided during COVID-19 pandemic in selected patients.


Subject(s)
Breast Neoplasms/surgery , COVID-19/epidemiology , Cross Infection/epidemiology , Mastectomy/methods , Postoperative Complications/epidemiology , Adult , Aged , Aged, 80 and over , Breast Carcinoma In Situ/pathology , Breast Carcinoma In Situ/surgery , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/pathology , Carcinoma, Ductal, Breast/surgery , Carcinoma, Intraductal, Noninfiltrating/pathology , Carcinoma, Intraductal, Noninfiltrating/surgery , Carcinoma, Lobular/pathology , Carcinoma, Lobular/surgery , Cohort Studies , Female , Humans , Male , Mastectomy/statistics & numerical data , Mastectomy, Segmental/methods , Mastectomy, Segmental/statistics & numerical data , Middle Aged , Neoplasm Staging , Prospective Studies , SARS-CoV-2 , Scotland/epidemiology , State Medicine , Tumor Burden
7.
BMJ Case Rep ; 13(11)2020 Nov 30.
Article in English | MEDLINE | ID: covidwho-949262

ABSTRACT

Primary leiomyosarcoma of the breast is an extremely rare neoplasm accounting for less than 0.0006% of all breast malignancies, with fewer than 80 cases reported in the literature to date. Here, we present a case of leiomyosarcoma of the breast in a 61-year-old woman without traditional risk factors. This case was treated with lumpectomy requiring wide margins due to the high rate of local recurrence. A planned breast reduction surgery was deemed adequate postlumpectomy therapy to prevent cancer recurrence, negating the need for chemotherapy or radiation therapy. To our knowledge, this is the first case in which cosmetic breast reduction surgery will be used as postlumpectomy cancer recurrence risk mitigation for primary leiomyosarcoma of the breast. Patients with this malignancy have a relatively poor prognosis compared with other breast cancer types, with a 5-year disease-free survival of 33%-52%. As such, frequent follow-up and monitoring for postresection recurrence is essential.


Subject(s)
Breast Neoplasms/surgery , Breast/surgery , Leiomyosarcoma/surgery , Mammaplasty , Mastectomy, Segmental , Breast Neoplasms/diagnostic imaging , Female , Humans , Leiomyosarcoma/diagnostic imaging , Margins of Excision , Middle Aged , Ultrasonography
8.
JCO Glob Oncol ; 6: 1696-1703, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-914174

ABSTRACT

PURPOSE: There is a shortage of radiation therapy service centers in low- to middle-income countries. TARGIT-intraoperative radiation therapy (IORT) may offer a viable alternative to improve radiation treatment efficiency and alleviate hospital patient loads. The Breast Care Unit in Johannesburg became the first facility in Africa to offer TARGIT-IORT, and the purpose of this study was to present a retrospective review of patients receiving IORT at this center between November 2017 and May 2020. PATIENTS AND METHODS: Patient selection criteria were based mainly on the latest American Society of Radiation Oncology guidelines. Selection criteria included early-stage breast carcinoma (luminal A) and luminal B with negative upfront sentinel lymph node biopsy that negated external-beam radiation therapy (EBRT). Patient characteristics, reasons for choosing IORT, histology, and use of oncoplastic surgery that resulted in complications were recorded. RESULTS: One hundred seven patients successfully received IORT/TARGIT-IORT. Mean age was 60.8 years (standard deviation, 9.3 years). A total of 73.8% of patients presented with luminal A, 15.0% with luminal B, and 5.6% with triple-negative cancer. One patient who presented with locally advanced breast cancer (T4N2) opted for IORT as a boost in addition to planned EBRT. Eighty-seven patients underwent wide local excision (WLE) with mastopexy, and 12 underwent WLE with parenchymal. Primary reasons for selecting IORT/TARGIT-IORT were distance from the hospital (43.9%), choice (40.2%), and age (10.3%). CONCLUSION: This retrospective study of IORT/TARGIT-IORT performed in Africa confirms its viability, with low complication rates and no detrimental effects with breast conservation, resulting in positive acceptance and the potential to reduce Oncology Center patient loads. Limitations of the study include the fact that only short-term data on local recurrence were available. Health and socioeconomic value models must still be addressed in the African setting.


Subject(s)
Breast Neoplasms/radiotherapy , COVID-19/radiotherapy , Neoplasm Recurrence, Local/radiotherapy , Pandemics , Adult , Breast Neoplasms/complications , Breast Neoplasms/surgery , Breast Neoplasms/virology , COVID-19/complications , COVID-19/surgery , COVID-19/virology , Female , Humans , Intraoperative Care , Mastectomy, Segmental , Middle Aged , Neoplasm Recurrence, Local/surgery , Neoplasm Recurrence, Local/virology , Patient Selection , Radiotherapy Dosage , Radiotherapy, Adjuvant/adverse effects , SARS-CoV-2/pathogenicity , South Africa/epidemiology
9.
Breast Cancer ; 27(6): 1045-1047, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-778098

ABSTRACT

The COVID-19 pandemic poses current and future challenges in the maintenance of surgical operating capacity. In the United Kingdom surgery has continued-in a reduced capacity-through the establishment of regional 'cancer hubs' using independent sector facilities to treat public healthcare patients. It is essential that these scarce operating facilities available are optimally utilized and that logistical challenges that result from remote operating away from the surgeon's primary hospital site are considered. These issues are best addressed through the application of currently available medical technology and enhanced training in advanced oncoplastic techniques, which extend the limits of breast conservation.


Subject(s)
Breast Neoplasms/surgery , Coronavirus Infections , Mammaplasty , Mastectomy , Pandemics , Pneumonia, Viral , Sentinel Lymph Node Biopsy , Betacoronavirus , COVID-19 , Diagnostic Imaging , Health Services Accessibility , Humans , Mastectomy, Segmental , SARS-CoV-2 , Surgery, Computer-Assisted , Surgical Oncology/education , Surgical Oncology/methods
10.
Breast Cancer Res Treat ; 184(2): 637-647, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-716322

ABSTRACT

PURPOSE: The COVID-19 pandemic has impacted early breast cancer (EBC) treatment worldwide. This study analyzed how Brazilian breast specialists are managing EBC. METHODS: An electronic survey was conducted with members of the Brazilian Society of Breast Cancer Specialists (SBM) between April 30 and May 11, 2020. Bivariate analysis was used to describe changes in how specialists managed EBC at the beginning and during the pandemic, according to breast cancer subtype and oncoplastic surgery. RESULTS: The response rate was 34.4% (503/1462 specialists). Most of the respondents (324; 64.4%) lived in a state capital city, were board-certified as breast specialists (395; 78.5%) and either worked in an academic institute or one associated with breast cancer treatment (390; 77.5%). The best response rate was from the southeast of the country (240; 47.7%) followed by the northeast (128; 25.4%). At the beginning of the pandemic, 43% changed their management approach. As the outbreak progressed, this proportion increased to 69.8% (p < 0.001). The southeast of the country (p = 0.005) and the state capital cities (p < 0.001) were associated with changes at the beginning of the pandemic, while being female (p = 0.001) was associated with changes during the pandemic. For hormone receptor-positive tumors with the best prognosis (Ki-67 < 20%), 47.9% and 17.7% of specialists would recommend neoadjuvant endocrine therapy for postmenopausal and premenopausal women, respectively. For tumors with poorer prognosis (Ki-67 > 30%), 34% and 10.9% would recommend it for postmenopausal and premenopausal women, respectively. Menopausal status significantly affected whether the specialists changed their approach (p < 0.00001). For tumors ≥ 1.0 cm, 42.9% of respondents would recommend neoadjuvant systemic therapy for triple-negative tumors and 39.6% for HER2 + tumors. Overall, 63.4% would recommend immediate total breast reconstruction, while only 3.4% would recommend autologous reconstruction. In breast-conserving surgery, 75% would recommend partial breast reconstruction; however, 54.1% would contraindicate mammoplasty. Furthermore, 84.9% of respondents would not recommend prophylactic mastectomy in cases of BRCA mutation. CONCLUSIONS: Important changes occurred in EBC treatment, particularly for hormone receptor-positive tumors, as the outbreak progressed in each region. Systematic monitoring could assure appropriate breast cancer treatment, mitigating the impact of the pandemic.


Subject(s)
Antineoplastic Agents, Hormonal/therapeutic use , Antineoplastic Agents/therapeutic use , Breast Neoplasms/therapy , Coronavirus Infections , Mammaplasty , Mastectomy , Neoadjuvant Therapy , Pandemics , Pneumonia, Viral , Adult , Betacoronavirus , Brazil , Breast Neoplasms/genetics , Breast Neoplasms/metabolism , Breast Neoplasms/pathology , COVID-19 , Delivery of Health Care , Disease Management , Female , Genes, BRCA1 , Genes, BRCA2 , Humans , Male , Mastectomy, Segmental , Middle Aged , Patient Selection , Postmenopause , Premenopause , Prophylactic Mastectomy , Receptor, ErbB-2/metabolism , Receptors, Estrogen/metabolism , Receptors, Progesterone/metabolism , SARS-CoV-2 , Societies, Medical , Surveys and Questionnaires , Tumor Burden
12.
Breast Cancer ; 28(1): 137-144, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-691217

ABSTRACT

INTRODUCTION: COVID-19 is a declared worldwide pandemic. In our country, due to shortage of hospitals and beds in intensive care unit, oncological and breast cancer (BC) resources are temporarily shifted to COVID-19 patients. In addition, risk of cross-infections should be considered in these frail patients. To accomplish more surgical procedures and to reduce the length of hospital stay (LOS), fast track awake BC surgery should be implemented. The aim of the study is to estimate the effects of surgical shift in our facility during the early COVID-19 outbreak. MATERIALS AND METHODS: From 30th January 2020 to 30th of March 2020, 86 consecutive patients were retrospectively enrolled and divided into pre-COVID-19-BC and COVID-19-BC. Clinical parameters and anamnestic data were collected and analyzed. Surgical procedures, relative complications and type of anaesthesia were reported. The effect on surgical time (ST), operative room time (ORT) and length of stay (LOS) were described and examined. RESULTS: No statistical difference was found in complications rate, clinical data and surgical procedures (p > 0.05). Awake breast conservative surgery (BCS) was the most frequent procedure in COVID-19-BC (p = 0.006). A statistically significant decrease in ORT and LOS was reported in COVID-19-BC (p = 0.040 and p = 0.0015 respectively), while comparable time resulted for ST (p = 0.976). Mean ORT and LOS reduction were 20.79 min and 0.57 hospital bed days. CONCLUSION: In the "COVID-19 era", fast track awake breast surgery provides a reduction of ORT, LOS and potentially surgical treatment for a wider number of oncological patients.


Subject(s)
Breast Neoplasms/surgery , COVID-19 , Mastectomy/methods , Aged , Anesthesia/methods , Breast Neoplasms/pathology , COVID-19/prevention & control , Female , Humans , Italy , Length of Stay , Lymph Node Excision , Mastectomy/adverse effects , Mastectomy, Segmental/adverse effects , Mastectomy, Segmental/methods , Middle Aged , Operative Time , Postoperative Complications/etiology , Retrospective Studies , Wakefulness
13.
Breast Cancer Res Treat ; 182(3): 527-530, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-601125

ABSTRACT

PURPOSE: The Coronavirus pandemic has exposed substantial racial and ethnic health and healthcare disparities. Black breast cancer patients face significant disparities in stage of presentation, surgical management, and mortality. The objective of this editorial is to examine the possible implications of the surgical delay imposed by the pandemic on black breast cancer patients. METHODS: The American College of Surgeons, the Society of Surgical Oncology, and the American Society of Breast Surgeons recommendations for surgical delay during the Coronavirus Disease 2019 (COVID-19) were evaluated and discussed. RESULTS: Guidelines by major surgical organizations on surgical delay for breast cancer patients may inadvertently exacerbate disparities in time to surgery for black breast cancer patients. Our recommendations to better characterize the impact of these guidelines on surgical delay among vulnerable populations include the following: (1) track time from biopsy-proven diagnosis to surgery by race and ethnicity, (2) document patient and institution-related reasons for surgical delay, (3) record patient and disease-related variables/reasons for the selection of breast conservation surgery, mastectomy, and reconstruction by race and ethnicity, and (4) collect data on impactful social determinants of health such as financial reserve, housing conditions, stress, and transportation. CONCLUSIONS: The COVID-19 pandemic may exacerbate delays in time to surgery among black breast cancer patients. Surgeons should incorporate collection of social determinants of health into their clinical practice to better understand the impact of COVID-19 on racial and ethnic disparities in surgical management.


Subject(s)
African Americans , Breast Neoplasms/surgery , Coronavirus Infections/epidemiology , Healthcare Disparities/ethnology , Mastectomy , Pneumonia, Viral/epidemiology , Social Determinants of Health/ethnology , Time-to-Treatment , Betacoronavirus , Breast Neoplasms/pathology , COVID-19 , Female , Humans , Mammaplasty , Mastectomy, Segmental , Mortality , Neoplasm Staging , Pandemics , SARS-CoV-2 , United States/epidemiology
14.
Breast Cancer Res Treat ; 182(3): 515-521, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-593582

ABSTRACT

PURPOSE: Cryoablation is a minimally-invasive percutaneous procedure that is capable of reducing the psychosocial burden of surgical delay while also decreasing the morbidity of breast cancer therapy. The purpose of this editorial is to discuss the potential role of cryoablation for reducing the psychosocial burden of surgical delay during the COVID-19 pandemic by expediting the management of breast cancer while also lessening demand on limited healthcare resources. METHODS: This editorial critiques current expert opinion recommendations that aim to reduce viral transmission and preserve healthcare resources during the COVID-19 pandemic by advocating delay of elective breast cancer surgery. RESULTS: The editorial summarizes the current state of the evidence that supports the selective use of cryoablation as a definite or stopgap measure in the management of breast cancer during the COVID-19 pandemic or when healthcare resources are limited. CONCLUSIONS: As an office-based procedure performed under local anesthesia, cryoablation eliminates the need for operating room personnel and equipment while also reducing the psychosocial impact of delayed breast cancer surgery. By reducing the number of patient and healthcare provider interactions, cryoablation not only decreases the risk of viral transmission but also the need for personal protective devices during resource-limited times.


Subject(s)
Antineoplastic Agents, Hormonal/therapeutic use , Anxiety/psychology , Breast Neoplasms/therapy , Coronavirus Infections/epidemiology , Cryosurgery/methods , Mastectomy , Neoadjuvant Therapy , Pneumonia, Viral/epidemiology , Time-to-Treatment , Ambulatory Surgical Procedures , Betacoronavirus , Breast Neoplasms/metabolism , Breast Neoplasms/pathology , Breast Neoplasms/psychology , COVID-19 , Coronavirus Infections/prevention & control , Female , Humans , Mastectomy, Segmental , Neoplasm Staging , Pandemics/prevention & control , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/prevention & control , Risk Assessment , SARS-CoV-2
15.
In Vivo ; 34(3 Suppl): 1667-1673, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-527842

ABSTRACT

BACKGROUND: COVID-19 pandemic required a marked re-allocation of healthcare resources, including at Breast Units. A patient-tailored program was developed to assess its efficacy regarding prevention of COVID-19 infection among patients with breast cancer undergoing surgery and healthcare workers (HCWs). PATIENTS AND METHODS: From March 9th to April 9th 2020, 91 patients were selected for elective surgery by means of: i) Pre-hospital screening aimed at avoiding hospitalization of symptomatic or suspicious COVID-19 patients, and ii) prioritisation of surgical procedure according to specific disease features. RESULTS: Eighty-five patients (93.4%) were fit for surgery, while five patients (5.5%) were temporarily excluded through 'telephone triage'; another two patients were excluded at in-hospital triage. A total of 71 out of 85 patients (83.5%) were diagnosed with invasive cancer, most of whom were undergoing breast-conserving surgery (61 out of 85 patients, 71.8%). The mean in-hospital stay was 2.2 days (SD=0.7 days). After hospital discharge, no patient needed re-admission due to post-operative complications; moreover, no COVID-19 infection among patients or HCWs was detected. CONCLUSION: Safe breast cancer surgery was accomplished for both patients and HCWs by means of a careful preoperative selection of patients and in-hospital preventative measures. This screening program can be transferred to high-volume Breast Units and it may be useful in implementing European Community recommendations for prevention of COVID-19 infection.


Subject(s)
Breast Neoplasms/surgery , Carcinoma/surgery , Coronavirus Infections/prevention & control , Elective Surgical Procedures/statistics & numerical data , Infection Control/methods , Mastectomy/statistics & numerical data , Pandemics/prevention & control , Patient Selection , Pneumonia, Viral/prevention & control , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Breast Neoplasms/epidemiology , Breast Neoplasms/nursing , COVID-19 , COVID-19 Testing , Carcinoma/drug therapy , Carcinoma/epidemiology , Carcinoma/nursing , Clinical Laboratory Techniques , Combined Modality Therapy , Coronavirus Infections/diagnosis , Female , Hospital Units/organization & administration , Humans , Italy/epidemiology , Length of Stay/statistics & numerical data , Lymphatic Metastasis/diagnostic imaging , Lymphoscintigraphy , Mastectomy, Segmental/statistics & numerical data , Neoadjuvant Therapy , Patient Discharge , Protective Devices , Sentinel Lymph Node Biopsy , Symptom Assessment , Telemedicine , Triage
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