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Management of early breast cancer during the COVID-19 pandemic in Brazil.
Cavalcante, Francisco Pimentel; Novita, Guilherme Garcia; Millen, Eduardo Camargo; Zerwes, Felipe Pereira; de Oliveira, Vilmar Marques; Sousa, Ana Luiza Lima; Freitas Junior, Ruffo.
  • Cavalcante FP; Fortaleza General Hospital (HGF), Rua Ávila Goularte, 900, Fortaleza, Ceará, 60150-160, Brazil. fpimentelcavalcante@gmail.com.
  • Novita GG; Grupo Américas, São Paulo, SP, Brazil.
  • Millen EC; São Vicente Clinic, Rio de Janeiro, RJ, Brazil.
  • Zerwes FP; Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
  • de Oliveira VM; Santa Casa de São Paulo, School of Medical Sciences, São Paulo, SP, Brazil.
  • Sousa ALL; Federal University of Goiás, Goiânia, Goiás, Brazil.
  • Freitas Junior R; Advanced Center for Diagnosis and Treatment for Breast Cancer (CORA), Federal University of Goiás, Goiânia, Goiás, Brazil.
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Breast Neoplasms / Mammaplasty / Coronavirus Infections / Antineoplastic Agents, Hormonal / Neoadjuvant Therapy / Pandemics / Mastectomy / Antineoplastic Agents Type of study: Observational study / Prognostic study / Randomized controlled trials / Systematic review/Meta Analysis Limits: Adult / Female / Humans / Male / Middle aged Country/Region as subject: South America / Brazil Language: English Journal: Breast Cancer Res Treat Year: 2020 Document Type: Article Affiliation country: S10549-020-05877-y

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Breast Neoplasms / Mammaplasty / Coronavirus Infections / Antineoplastic Agents, Hormonal / Neoadjuvant Therapy / Pandemics / Mastectomy / Antineoplastic Agents Type of study: Observational study / Prognostic study / Randomized controlled trials / Systematic review/Meta Analysis Limits: Adult / Female / Humans / Male / Middle aged Country/Region as subject: South America / Brazil Language: English Journal: Breast Cancer Res Treat Year: 2020 Document Type: Article Affiliation country: S10549-020-05877-y