Breast imaging and cancer diagnosis during the COVID-19 pandemic: recommendations from the Italian College of Breast Radiologists by SIRM

Abstract

The Italian College of Breast Radiologists by the Italian Society of Medical Radiology (SIRM) provides recommendations for breast care provision and procedural prioritization during COVID-19 pandemic, being aware that medical decisions must be currently taken balancing patient's individual and community safety: (1) patients having a scheduled or to-be-scheduled appointment for in-depth diagnostic breast imaging or needle biopsy should confirm the appointment or obtain a new one; (2) patients who have suspicious symptoms of breast cancer (in particular: new onset palpable nodule; skin or nipple retraction; orange peel skin; unilateral secretion from the nipple) should request non-deferrable tests at radiology services; (3) asymptomatic women performing annual mammographic follow-up after breast cancer treatment should preferably schedule the appointment within 1 year and 3 months from the previous check, compatibly with the local organizational conditions; (4) asymptomatic women who have not responded to the invitation for screening mammography after the onset of the pandemic or have been informed of the suspension of the screening activity should schedule the check preferably within 3 months from the date of the not performed check, compatibly with local organizational conditions. The Italian College of Breast Radiologists by SIRM recommends precautions to protect both patients and healthcare workers (radiologists, radiographers, nurses, and reception staff) from infection or disease spread on the occasion of breast imaging procedures, particularly mammography, breast ultrasound, breast magnetic resonance imaging, and breast intervention procedures.

The Impact of the COVID-19 Pandemic on Breast Imaging

“…The Society of Breast Imaging followed suit with a statement that was broader and less prescriptive, but also recommended delaying screening by “several weeks or a few months” 16 . Other international societies published similar statements 17 , 18 .…”

“…The European Society for Medical Oncology Guidelines include increasing telehealth appointments (noting in person visits are needed for new cancer patients or urgent infections / post-operative complications) and specific guidance for management and advised that the risk/benefit balance for most patients favored continued administration of systemic therapies and chemotherapies, with additional precautions when possible (e.g., choosing less immunosuppressive therapies, regimens requiring fewer appointments) 26 . Numerous other guidance documents have emerged fluidly including from ASCO and an online resource from ASCO, and others globally 18 , 28 , 29 , 30 , 31 , 32 , 33 .…”

Delay in Breast Cancer Treatments During the First COVID-19 Lockdown. A Multicentric Analysis of 432 Patients

“…Absolute number of surgical procedures during the COVID-19 outbreak are comparable with the same period of the previous year (2019). According to the restrictive measures and scientific recommendations, we observed a significant reduction in non-oncological surgical procedure (reconstructive surgery) (6,7,19,20). During the lockdown, most national and international guidelines recommended that reconstruction procedures should be deferred (21,22).…”

Two-month stop in mammographic screening significantly impacts on breast cancer stage at diagnosis and upfront treatment in the COVID era

“…This prospect results in improved survival and may avert BC deaths. 14 Although asymptomatic women who have skipped their screening mammogram because of COVID-19 are recommended to reschedule the check preferably within 3 months, 11 the real impact of temporary mammographic screening suspension on BC outcomes remains uncertain. Yong et al 15 have recently estimated the long-term clinical impact of BC screening interruptions in Canada using a validated mathematical model.…”

“…These were recommended to postpone the check preferably within 3 months of the date of the check as originally scheduled, as long as the operating conditions allowed for it. 11 Such recommendations were driven by the common goal to preserve hospital resources for COVID-19 patients, by deferring breast imaging procedures without compromising long-term outcomes for individual patients. Nevertheless, the real impact of a temporary mammographic screening suspension on BC outcomes remains uncertain.…”