Fewer early stage breast cancer diagnoses after COVID-19 outbreak: Preliminary report from the Italian COVID-DELAY study

ABSTRACT

Background: The coronavirus disease (COVID-19) has imposed an unprecedented challenge on the Health Care System. With the reallocation of crucial health resources to effectively exit the crisis, the pandemic has profoundly affected cancer patients' (pts) management. Breast cancer (BC) diagnosis results, especially in the early stage, from screening programs temporarily paused during COVID-19 outbreak. The aim of our multicenter study is to investigate the impact of COVID-19 on the likelihood of receiving timely diagnosis, staging and treatment for BC pts compared to pre-pandemic period. Material (patients) and methods: Medical records of all consecutive newly diagnosed BC pts referred to 4 Italian Oncology Departments between March and December 2020 were assessed. Monthly access rate and temporal intervals between date of symptoms onset, radiological, cytohistological diagnosis and treatment start were analyzed and compared with those of the same period in 2019. Differences between the two years were analyzed using Fisher's exact or chi-square test for categorical variables and unpaired Student t test, or the Mann-Whitney U test for continuous variables. Results: A significant reduction (23%) in newly diagnosed BC pts was seen when compared with 2019 (552 vs 719). Newly BC pts in 2020 were less likely to be diagnosed with early stage (stage I-II) BC (77% vs 84%, p < 0.01), had a worsened ECOG PS (19% had PS > 0 in 2020 vs 16% in 2019, p = 0.15) and were more symptomatic at diagnosis (43% vs 23%, p < 0.01). Other clinical and tumor characteristics (such as histotype [p = 0.23] and molecular subtype [p = 0.71]) were similar regardless of the year. Looking at pts management, time intervals between symptom onset and radiological diagnosis (median 17 days in 2020 vs 21 in 2019, p = 0.04), symptom onset and cytohistological diagnosis (26 vs 35 days, p = 0.06), cytohistological diagnosis and treatment start (median 62 vs 76 days, p < 0.01) were maintained or even improved. However, less BC cases were discussed in multidisciplinary tumor meetings during the 2020 (52% vs 69%, p < 0.01). Conclusions: While the COVID-19 effects on cancer care will be likely felt for years to come, our data indicate a sharp decline in BC detection in 2020 with major impact on early stage diagnosis. Despite the upheaval generated by this global Health Care crisis, our study proves the effectiveness of the actions taken by Oncology Departments to guarantee diagnostic-therapeutic pathways.