Background/Aim: Coronavirus-19 (COVID-19) pandemic outbreak is currently having a huge impact on medical resource allocation. Breast Cancer (BC) patients are concerned both with BC treatment and COVID-19. This study aimed to estimate the impact of anxiety among patients, caused by the spreading of COVID-19. Patients and Methods: Between the 16th of January and the 20th of March 2020, we retrospectively enrolled 160 patients. Eighty-two patients with a suspected breast lesion (SBL) were divided into two groups: PRE-COVID-19-SBL and POST-COVID-19-SBL. Seventy-eight BC patients were divided into PRE-COVID-19-BC and POST-COVID-19-BC. Patient characteristics including age, marital status, SBL/BC diameter, personal and family history of BC, clinical stage and molecular subtype were recorded. Procedure Refusal (PR) and Surgical Refusal (SR) were also recorded with their reason. Results: BC and SBL analysis showed no difference in pre-treatment characteristics (p>0.05). Both POST-COVID-19-SBL and POST-COVID-19-BC groups showed higher rates of PR and SR (p=0.0208, p=0.0065 respectively). Infection risk represented primary reason for refusal among POST-COVID-19 patients. Conclusion: COVID-19-related anxiety could affect patients' decisionmaking process. Since December 2019, the novel coronavirus (SARS-COV-2) has emerged as a highly contagious human pathogen. On March 20, 2020 more than 234000 cases were confirmed worldwide , with more than 9800 registered deaths (1). Following the initial outbreak in the Chinese Hubei Province on March 11, WHO has labelled the latest coronavirus disease COVID-19 (caused by SARS-COV-2) as a pandemic. The reported fatality rate is 4.2% globally (1, 2). Human to human transmission occurs through direct contact or air droplets (2) placing health care providers at a high risk due to the close proximity to potentially infected patients (3). Preliminary data of nationwide analysis in China demonstrated cancer as a risk factor for developing severe complications/disease course among COVID-19 patients (4, 5). Although further studies are required in order to accurately estimate the risk (6, 7) among patients who underwent chemotherapy or surgery in the months prior to the outbreak, the risk of developing severe conditions seems considerably higher compared to the general population (6). Breast Cancer (BC) is the most common neoplasm worldwide representing the primary cause of death due to neoplasms in Italy (5). A report published in 2017 stated that more than 50% of BC patients were older than 60 years (8). Therefore, due to the higher risk of adverse events in older patients, underlined in the preliminary data (9), it is essential to evaluate the risk of COVID-19 infection among these frail BC patients (10). Furthermore, during the COVID-19 outbreak, hospital resources are reallocated from elective and semi-elective procedures to meet the needs of COVID-19 patients in critical conditions (11). The subsequent scarcity of resources could potentially delay diagnostic evaluations and treatment of BC ...

Despite advances in treatment, up to 30% of patients with early breast cancer (BC) experience distant disease relapse. However, a comprehensive understanding of tumor spread and site-specific recurrence patterns remains lacking. This retrospective case-control study included 103 consecutive patients with metastatic BC admitted to our institution (2000–2013). Cases were matched according to age, tumor biology, and clinicopathological features to 221 patients with non-metastatic BC (control group). The median follow-up period among the 324 eligible patients was 7.3 years. While relatively low values for sensitivity (71%) and specificity (56%) were found for axillary lymph node (ALN) involvement as an indicator of risk and pattern of distant relapse, nodal status remained the most powerful predictor of metastases (OR: 3.294; CL: 1.9–5.5). Rates of dissemination and metastatic efficiency differed according to molecular subtype. HER2-positive subtypes showed a stronger association with systemic spread (OR: 2.127; CL: 1.2–3.8) than other subgroups. Classification as Luminal or Non-Luminal showed an increased risk of lung and distant nodal recurrence, and a decreased risk in bone metastases in the Non-Luminal group (OR: 2.9, 3.345, and 0.2, respectively). Tumors with HER2 overexpression had a significantly high risk for distant relapse (OR: 2.127) compared with HER2-negative tumors and also showed higher central nervous system (CNS) and lung metastatic potential (OR: 5.6 and 2.65, respectively) and low risk of bone disease progression (OR: 0.294). Furthermore, we found significant associations between biological profiles and sites of recurrence. A new process of clinical/diagnostic staging, including molecular subtypes, could better predict the likelihood of distant relapses and their anatomical location. Recognition and appreciation of clinically distinct molecular subtypes may assist in evaluation of the probability of distant relapses and their sites. Our analysis provides new insights into management of metastatic disease behavior, to lead to an optimal disease-tailored approach and appropriate follow-up.

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Background. Surgical stress and general anesthesia can have detrimental effects on postoperative immune function. We sought to comparatively evaluate postoperative lymphocytes response in patients undergoing videoassisted thoracoscopic surgery (VATS) under thoracic epidural or general anesthesia.Methods. Between October 2008 and June 2009, 50 patients with nonmalignant pulmonary conditions were randomized to undergo VATS through either sole epidural anesthesia and spontaneous ventilation (awake group, n ‫؍‬ 25) or general anesthesia with one-lung ventilation (control group, n ‫؍‬ 25). In both groups, assessment of total lymphocytes count and changes in proportion of lymphocyte subsets including CD19؉, CD3؉, CD4؉, CD8؉, CD4؉:CD8؉ ratio, and CD16؉CD56؉ (natural-killer cell) were evaluated by two-way analysis of variance test for repeated measures at baseline and postoperative days 1, 2, and 3. The Mann-Whitney test was performed at each time point only for significant parameters at between-group analysis of variance.

Background/Aim: Coronavirus disease is spreading worldwide. Due to fast transmission and high fatality rate drastic emergency restrictions were issued. During the lockdown, only urgent medical services are guaranteed. All non-urgent services, as breast cancer (BC) screening, are temporarily suspended. The potential of breast cancer screening programs in increasing the survival rate and decreasing the mortality rate has been widely confirmed. Suspension could lead to worse outcomes for breast cancer patients. Our study aimed to analyse the data and provide estimates regarding the temporary BC screening suspension. Patients and Methods: Data regarding breast cancer and respective screening programs were achieved through literature research and analysis. Results: Considering three different scenarios with respect to the lockdown's impact on breast cancer screening, we estimate that approximately 10,000 patients could have a missed diagnosis during these 3 months. Considering a 6-month period, as suggested by the Imperial college model, the number of patients who will not receive a diagnosis will rise to 16,000. Conclusion: Breast cancer screening should be resumed as soon as possible in order to avoid further breast cancer missed diagnosis and reduce the impact of delayed diagnosis. The Coronavirus disease 2019 (Covid-19) pandemic is becoming incessant, having infected almost four million people worldwide (1). Based on the latest data, in Italy, more than 200,000 people are positive for SARS-COV-2 with a case fatality rate of up to 14% (2). Due to the fast human-to-human transmission and the high fatality rate, on 10 March 2020, the Italian Government, as did other countries, introduced drastic emergency restrictions. These extraordinary measures to limit viral transmission, include: cessation of most activities, quarantine and strict self-isolation (2). Accordingly, this emergency implies a total reorganization of the Health System, including temporary resource reallocation toward COVID-19 (3). Many hospitals are turning into COVID-19 specialized medical centers. During this transition phase, only urgent medical services are guaranteed while oncological procedures are suffering a significant slowdown (3). In this regard, the Breast Unit has been strongly affected by these restrictions as well, with a potential impact on women's health and quality of life (4). Every year, 3 million patients receive a cancer diagnosis worldwide. Breast cancer (BC) corresponds to 14% of cancer diagnoses and to 30% of cancers in women. In Italy, approximately 53,500 women receive a BC diagnosis every year (5). During the last years, there has been an improvement 3047 This article is freely accessible online.

Objective To assess the magnitude of COVID-19 spread and the associated risk factors among health care workers (HCWs), we conducted an in-hospital survey in a central Italian COVID Hospital. Methods Participants underwent nasopharyngeal swab and/or serum collection for SARS-CoV-2 IgG examination. We divided participants according to working status, into rotating-night shift workers (r-NSW) and day-workers. Results We found 30 cases of COVID-19 infection in a total of 1180 HCWs (2.5%). Most COVID-19-positive hospital employees were r-NSWs with significantly higher BMI than that of individuals who tested negative. After adjustment for covariates, night work and BMI > 30 were associated with a markedly greater risk of COVID-19 diagnosis (OR 3.049 [95%CI 1.260-7.380] and OR 7.15 [95%CI 2.91-17.51], respectively). Conclusions Our results describe a low prevalence of COVID-19 infection among HCWs at a central Italian COVID Hospital. COVID-19 infection risk appears to be associated with obesity and night shift work, thus supporting the need for careful health surveillance among frontline HCWs exposed to COVID-19.

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Background/Aim: Despite the large amount of clinical data available of Coronavirus-19 (COVID-19), not many studies have been conducted about the psychological toll on Health Care Workers (HCWs). Patients and Methods: In this multicentric descriptive study, surveys were distributed among 4 different Breast Cancer Centers (BCC). BCCs were distinguished according to COVID-19 tertiary care hospital (COVID/No-COVID) and district prevalence (DP) (High vs. Low). DASS-21 score, PSS score and demographic data (age, sex, work) were evaluated. Results: A total of 51 HCWs were analyzed in the study. Age, work and sex did not demonstrate statistically significant values. Statistically significant distribution was found between DASS-21-stress score and COVID/No-COVID (p=0.043). No difference was found in the remaining DASS-21 and PSS scores, dividing the HCWs according to COVID-19-hospital and DP. Conclusion: Working in a COVID-19-hospital represents a factor that negatively affects psychosocial wellbeing. However, DP seems not to affect the psychosocial well-being of BCC HCWs. During the outbreak, psychological support for low risk HCWs should be provided regardless DP. The first case of atypical pneumonia previously named as Severe Acute Respiratory Syndrome Corona Virus 2 (COVID-19) was recorded in December 2019 in China. Italy has been the first European country to be involved in this outbreak. The national health care system (NHS) is currently reallocating resources from elective and semi-elective patients toward severe COVID-19 patients (1, 2). Italy has exceeded the cases recorded in China and unfortunately, up to now (May, 17th), 225,435 cases and 31908 deaths have been registered with still over 700 admitted to intensive care units (3). The Italian outbreak is mainly located in clusters along the north of Italy (Lombardia, Veneto and Emilia Romagna) and a low incidence in central and southern regions (1, 3, 4). In order to control COVID-19, resource reallocation eventually led to the creation of hospitals partially or totally dedicated to COVID-19 patients (COVID-hospital), therefore 1685 This article is freely accessible online.