The COVID-19 pandemic has impacted everyone across the globe. Confusion, fear, and safety protocols continue to make navigating breast cancer screenings and treatment more difficult than ever. Although data and recommendations are constantly evolving, we present some helpful information below to address the most common questions we see relating to breast cancer care during the pandemic.
Leading health organizations and medical professionals agree it is safe to resume breast cancer screening. The importance of resuming annual screenings and/or diagnostic imaging tests cannot be understated. With safety protocols in place at every medical facility, patients can more confidently go to these appointments as long as they adhere to the recommended guidelines, such as wearing a face mask/covering and physical distancing as much as possible.
Many patients today are reporting delays in their breast cancer surgery due to the limitations in place within hospital systems. These limitations help ease the burden on the healthcare system created by COVID-19. The impact of these delays has raised obvious concerns from patients and medical professionals alike.
Luckily, more hospitals and surgical centers are opening up and breast cancer surgery delays are becoming less frequent. Currently, treatment options like chemotherapy and radiation are continuing as normal and patients should follow their healthcare team’s recommendations.
As a helpful resource, the American Society of Breast Surgeons has published recommendations to help guide physicians and their patients through the common scenarios related to breast cancer treatment during the COVID-19 pandemic.
Vaccine distribution regulations vary by state, but in many areas breast cancer patients are eligible to receive the vaccine now. Before receiving the COVID-19 vaccine, patients should consult with their medical team.
There’s a lot of confusion among breast cancer patients as to whether the vaccine is a good idea or a bad idea for somebody undergoing treatment. Reports of lymph node swelling after a vaccine that mimicks breast cancer spread (metastasis) has obviously caused a lot of concern. However, this should not be mistaken for disease progression. It is also very understandable for some of you to feel uncomfortable receiving a vaccine that is so new and has been developed so quickly. However, please know that new vaccines cannot be released for public use without the appropriate safety protocols being followed.
For many, breast reconstruction has had to be rescheduled or postponed due to their local hospital infection rates and bed capacities. This can be extremely frustrating to say the least. However, please know that delayed reconstruction is still possible any time after a mastectomy (or lumpectomy).
For current scheduling availability and recommendations in your area, please keep in close touch with your plastic surgery team.
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The COVID-19 pandemic is impacting many breast cancer patients and their surgical treatment plans across the globe. Many patients today are reporting delays in their breast cancer surgery due to the limitations in place by local governments to help ease the burden on the healthcare system created by COVID-19. The impact of these delays has raised concerns from patients and medical professionals about the long-term impact on patient health. A new study published in the Journal of American College of Surgeons attempts to provide some better understanding.
To gain insight into the effects of surgical delays on early-staged breast cancer patients, the researchers used the National Cancer Database to analyze breast cancer patients treated between 2010 and 2016. About 379,000 patients in the database underwent breast cancer surgery following a diagnosis of DCIS or early-stage (cT1-2N0) ER+ disease. The study evaluated whether longer times between diagnosis and surgical treatment had an impact on 5-year survival rates and cancer staging.
The authors of the study concluded that for women with early-stage breast cancer who had to delay their surgical care due to COVID-19, there should be no impact on overall survival.
The published research also noted there was no negative impact to survival for patients with estrogen sensitive, early-stage breast cancer who were taking tamoxifen or aromatase inhibitors as part of their treatment plan. Interestingly, patients with invasive early-stage breast cancer who had to delay their surgical treatment did not have an increased rate of pathologic upstaging (or a higher cancer stage diagnosis after surgery). Women with ER+ DCIS have a slightly higher risk of upstaging with surgical treatment delays of over 60 days. Similarly, patients with ER- DCIS have a higher risk of upstaging if surgical cancer treatment is delayed more than 120 days. However, even with the elevated risk in upstaging for the DCIS patient populations, there was no impact on their overall survival.
Although these findings cannot accurately account for the delays experienced by patients being treated during the COVID-19 pandemic, this information provides some reassurance for surgeons and their patients dealing with delays in breast cancer surgery.
By Minas Chrysopoulo, MD FACS
Published March 31, 2020. Updated April 10, 2020
Breast cancer does not take a break…even amid a global crisis like the Coronavirus pandemic. For most people, it’s already overwhelming to hear the words “you have breast cancer”. In the midst of the current COVID-19 outbreak, increased uncertainty and changes in treatment recommendations are elevating everyone’s anxiety further. Many people are now being told that their treatment plan is changing. If you’re one of them, please know that your breast cancer team is adjusting your treatment plan to keep you safe and limit your exposure to coronavirus. Breast cancer patients are at increased risk of severe symptoms if they get coronavirus. People with severe symptoms need admission to a hospital for supportive care and are more likely to need intensive care, ventilator support for severe breathing problems, and are also at increased risk of death.
A recent study published in the Lancet, a highly respected medical journal, evaluated 34 patients who were infected with Coronavirus but didn’t have any symptoms, and underwent elective surgery. All developed pneumonia and 20% died.
All the medical and surgical societies are prioritizing your safety during this pandemic. At the same time as maximizing your safety, your team won’t do anything that negatively impacts your long-term prognosis.
Individuals Needing Chemo and/or Radiation
Most facilities providing chemo and radiation therapy treatment for breast cancer patients remain open and necessary treatment is not being delayed. Vigilant cleaning, health screenings of all patients before they enter the facility, and the advisement of patients to wear masks are just a few of the many steps healthcare workers are implementing to ensure patient safety. In many places, patients are no longer allowed to bring someone with them during their chemo treatments.
Individuals Requiring Breast Cancer Surgery
COVID-19 is impacting the surgical plans of many patients. At this time, the White House and numerous surgical societies are issuing guidelines recommending all surgeries that are not immediately life-saving be postponed. The American College of Surgeons and the American Society of Breast Surgeons are recommending delaying any surgery where a 6-8 week delay would not impact clinical outcomes. This includes surgery for DCIS, stage one ER/PR+ invasive cancers, re-excisions, surgery for high-risk lesions, and prophylactic (risk-reducing) mastectomies. Wherever possible, patients are being treated with hormonal therapy (eg Tamoxifen), aromatase inhibitors, or neo-adjuvant chemotherapy to enable surgery to be delayed. Recommendations are also calling for scheduled mastectomies to be converted to lumpectomies when clinically acceptable. Patients still wanting a mastectomy (with or without reconstruction) will be able to return for their definitive surgery once the crisis has passed.
Individuals Choosing Breast Reconstruction
For patients wanting breast reconstruction, there will unfortunately be a delay between the lumpectomy/mastectomy and the reconstruction procedure in most situations. In the US, some institutions are still allowing tissue-expander reconstruction, but the American Society of Plastic Surgeons (ASPS) strongly advises all autologous (flap) reconstructions be delayed. Although breast reconstruction is considered medically necessary, it is not immediately life-saving. For many, delaying reconstruction is understandably devastating, but it is important to remember there is no deadline for reconstruction and your health and safety are the top priorities of your surgical team.
Although reconstructive surgeries around the globe are being postponed, patients can still use this waiting period to research all their reconstructive options to determine which procedure is best for them. The Breast Advocate app provides personalized evidence-based information and recommendations for breast cancer surgery and reconstruction, after taking your situation and personal preferences into account.
Individuals at High Risk
At this time, individuals interested in prophylactic (risk-reducing) surgery because they are at high risk for developing breast cancer (eg BRCA+), should continue to self-monitor for breast changes at home. All society guidelines are strongly urging all prophylactic surgeries be postponed. Screening mammograms and MRIs may be delayed in your location during this pandemic. If any concerning breast changes occur, call you healthcare provider for further diagnostic instructions. Please also talk to your physician about the option of taking tamoxifen to decrease your risk while you wait for surgery.
It is important to remember that we must all do our part to protect ourselves, our loved ones, and our healthcare providers during this overwhelming time. By taking these measures, your risk of contracting COVID-19 will be minimized, hospital admissions will be reduced, necessary PPE will be conserved for our healthcare providers on the front lines, and lives will be saved.