Impact of the COVID-19 Pandemic on Breast Cancer Screening and Operative Treatment.

INTRODUCTION: The COVID-19 pandemic has impacted many areas of health care and had a significant impact on care delivery, including breast cancer. METHODS: To better understand the changes to detection and treatment of breast cancer at our institution, we analyzed mammogram rates (screening and diagnostic) and breast cancer operations in 2019-2020. Mammography rates were calculated using county level census data for eligible women (Z-test). For breast cancer staging, a stage severity score was analyzed with a Mann-Whitney U-test (two-tail, P < .05) with proportions derived from WFBH operative volume quarterly reports. Results: Data revealed a relative decline from 2019 to 2020 in breast cancer screening. Screening mammograms decreased by 44% or 1558 fewer screening mammograms (Z = 4.75, P < .00001) and by 21% or 771 fewer for diagnostic mammograms (Z = 2.16, P = .03). With regards to breast cancer operations, we did not identify a statistically significant difference in number of new breast cancer operations at WFBH with 340 cases in 2020 as compared to 384 cases in 2019 (P = .9905). We compared a breast cancer severity score (weighted by stage at time of operation), which did not reveal statistically significant difference in clinical stage of breast cancer at time of operation (P = .71, U = 28). CONCLUSION: Mammography was impacted more than breast surgery cases by the COVID-19 pandemic. More data needs to be collected to evaluate future morbidity and mortality related to breast cancer operations and persistent disparities related to delay in breast cancer care due to COVID-19.

Is Excisional Biopsy and Chemoprevention Warranted in Patients With Atypical Lobular Hyperplasia on Core Biopsy?

The management of atypical lobular hyperplasia (ALH) on core biopsy remains controversial. The upstaging rates after surgical excision vary. We reviewed our upgrade rates and use of chemoprevention for ALH. Patients were identified through our pathology database for ALH from 2006 to 2013. Patients were included in the study that had a diagnosis only of ALH on core needle biopsy. Tumor and patient characteristics and final pathology were analyzed. ALH was identified in 56 patients since 2006. Sixteen patients met the inclusion criteria. All the patients underwent surgical excision. Final pathology of the excised specimens confirmed ALH in 62 per cent (n = 11). Two cases contained lobular carcinoma in situ. The upgrade rate on excisional biopsy was 18.75 per cent (n = 3) to invasive cancer. Chemopreventative treatment was taken by 44 per cent of the patients. After a mean follow-up of three years, none of the patients who received chemoprevention developed breast cancer. One patient who refused tamoxifen developed breast cancer. This is one of the few studies to examine the current treatment of ALH. We noted a significant upstaging rate after excision. We recommend women to undergo surgical excision. Patients should also consider chemoprevention to reduce their risk for developing breast cancer.