COVID-19 Pandemic Effects on Breast Cancer Diagnosis in Croatia: A Population- and Registry-Based Study

Abstract

Background. Our objective was to assess the effects of COVID-19 antiepidemic measures and subsequent changes in the function of the health care system on the number of newly diagnosed breast cancers in the Republic of Croatia. Subjects, Materials, and Methods. We performed a retrospective, population-and registry-based study during 2020. The comparator was the number of patients newly diagnosed with breast cancer during 2017, 2018, and 2019. The outcome was the change in number of newly diagnosed breast cancer cases. Results. The average monthly percent change after the initial lockdown measures were introduced was −11.0% (95% confidence interval − 22.0% to 1.5%), resulting in a 24% reduction of the newly diagnosed breast cancer cases in Croatia during April, May, and June compared with the same period of 2019. However, during 2020, only 1% fewer new cases were detected than in 2019, or 6% fewer than what would be expected based on the linear trend during 2017-2019. Conclusion. It seems that national health care system measures for controlling the spread of COVID-19 had a detrimental effect on the number of newly diagnosed breast cancer cases in Croatia during the first lockdown. As it is not plausible to expect an epidemiological change to occur at the same time, this may result in later diagnosis, later initiation of treatment, and less favorable outcomes in the future. However, the effect weakened after the first lockdown and COVID-19 control measures were relaxed, and it has not reoccurred during the second COVID-19 wave. Although the COVID-19 lockdown affected the number of newly diagnosed breast cancers, the oncology health care system has shown resilience and compensated for these effects by the end of 2020. The Oncologist 2021;26:1-5 Implications for Practice: It is possible to compensate for the adverse effects of COVID-19 pandemic control measures on breast cancer diagnosis relatively promptly, and it is of crucial importance to do it as soon as possible. Moreover, as shown by this study's results on the number of newly diagnosed breast cancer cases during the second wave of the pandemic, these adverse effects are preventable to a non-negligible extent.

Assessing the impact of the COVID-19 pandemic on breast cancer screening and diagnosis rates: A rapid review and meta-analysis

“…Therefore, 33 reports consisting of 31 studies formed the basis of this review. 18 – 50 A PRISMA flow diagram outlining the screening process is presented in Figure 1 . The list of excluded studies with reasons of exclusion is reported in Supplementary Table S2.…”

What Has Changed During the COVID-19 Pandemic? - The Effect on an Academic Breast Department in Portugal

“…Nonetheless, after multivariate analysis, the significantly longer waiting time on list during the lockdown, was the only predictive factor for lymph node involvement progression (21). In a population-and registry-based study from Croatia, the average monthly percent change in referrals after the initial lockdown measures were introduced was −11.0%, resulting in a 24% reduction in newly diagnosed BC cases during April, May, and June compared with the same period of 2019 (22). Moreover, from the point of view of the patient, in a US national survey of BC survivors, nearly half of respondents reported delays in cancer care in the early weeks of the COVID-19 pandemic (23).…”

Prompt Resumption of Screening Programme Reduced the Impact of COVID-19 on New Breast Cancer Diagnoses in Northern Italy

“…A decline in cancer diagnoses was observed in most countries where it has been investigated and for almost all tumour sites [ 10 , 11 , 14 , 24 , 25 , 26 ], in particular for those subject to screening [ 12 , 27 , 28 , 29 , 30 , 31 ]. The recovery of post-lockdown diagnosis almost never compensates for the previously observed decline [ 15 , 29 , 30 , 32 ].…”