Impact of COVID-19 on the Diagnosis and Surgical Care of Patients with Breast Cancer—a Retrospective Observational Cohort Study from Kerala, South India

Abstract

The COVID-19 pandemic has strained the healthcare system worldwide. Our study aimed to evaluate the impact of the COVID-19 pandemic on the diagnosis and surgical care of patients with breast cancer in Amrita Institute of Medical Sciences, Kochi. This is a single-centre retrospective observational cohort study conducted in a tertiary care institution intended to analyse the management of patients with breast cancer before and after the pandemic outbreak. The number of mammograms dropped from 3689 in the pre-pandemic phase to 1901 in the post-pandemic phase, whilst the number of core biopsies remained almost the same (391 before the pandemic and 367 after the pandemic). The number of new patients decreased by 57.7% (from 614 to 354). However, the number of breast cancer surgeries has remained almost the same (318 before the pandemic and 287 after the pandemic). The number of breast conservation surgeries dropped from 127 in 2019 to 93 in 2020 ( p -value = 0.01). Conversely, 24 patients underwent neoadjuvant chemotherapy in 2019, and this number increased to 37 in 2020, representing a statistically significant increase ( p = 0.04). Even during a pandemic, cancer care is possible with proper resource allocation and by adopting a multidisciplinary approach.

Impact of coronavirus disease 2019 pandemic on breast cancer surgery using the National Database of Japan

“…A single-center study in India and a multicenter study with five hospitals in the Netherlands reported that the number of BCS decreased during the pandemic. In contrast, the total number of breast surgeries or mastectomies did not change 9,26 . A study using the Kaiser Permanente Northern California Breast Cancer Tracking System database in the United States reported that the percentage of partial mastectomy decreased in 2020 compared with 2019 among patients who underwent surgery as the first treatment 18 .…”

“…Various countries have reported a decrease in the number of breast cancer surgeries during the COVID-19 pandemic 8,9,11,19,[23][24][25][26][27] . Additionally, several studies have examined changes in the number according to the type of surgery; however, the results remain inconsistent.…”

“…Under these situations, breast cancer diagnosis had decreased worldwide 7 , 17 – 22 . Given these facts, a decrease in the number of surgeries for breast cancer during the pandemic was expected, and this has already been confirmed in various countries, including the United States 8 , 23 – 25 , the Netherlands 26 , Turkey 27 , Lithuania 11 , South India 9 , and South Korea 19 .…”