Impact of COVID-19 pandemic in 2020 on the diagnosis and management of breast cancer in Korea: A multi-institutional study.

Abstract

10566 Background: Since the COVID-19 pandemic began in early 2020, there have been many reports that it has had a significant impact on screening, case identification and referral in cancer diagnosis. We investigated the diagnostic and therapeutic status of breast malignancy before and after the COVID-19 pandemic at the multi-institution level. Methods: We have reviewed the records of patients with breast cancer from February 2019 to July 2020 in six university hospitals in Korea. The patients were divided into two groups according to the initial date of cancer diagnosis: Period A, from February to April and Period B, from May to July in 2020. The two groups were compared for the same periods in 2019. The goals were to determine whether breast cancer screening and diagnosis have been delayed and thus resulted in stage migration. We also examined the difference in the number of surgeries in patients diagnosed with breast cancer during those periods. Results: The total of 1,669 breast malignancy diagnosis was made in the grouped periods of 2019, and 1,369 diagnoses in 2020. All patients were screened by PCR test for COVID-19 prior to hospitalization, and none of them tested positive. Overall, there was a 9.9% reduction in the number of diagnoses than in 2019 and the decrease was more significant in Period A (11.1% vs. 8.7%). According to the age, there was no difference until the 30s but decreased from those in their 40s and above. The decline was more pronounced in the elderly. The COVID-19 pandemic has affected breast cancer screening (decreased by 27.4%) and more diminished in Period A (41.0% vs. 19.0%). Invasive breast cancer stage was not statistically different in Period A compare with 2019 (p = 0.170). But the stage in Period B was different (p = 0.032), and more patients were observed in advanced stages in 2020. The decrease in surgery was noticeably observed in Period A (4.6%, from 480 to 438 surgeries) and not in Period B. The analysis of reconstruction surgery was similar. Conclusions: Patients with COVID-19 increased exponentially from late February in Korea. However, the number of patients per day decreased to less than 100 on March 15 and then flattened. The health care system for cancer was not overloaded and restrictions on visiting hospital were minimal. Analysis in the pandemic period of the 6-month showed that the number of breast cancer screening, diagnosis and surgeries decreased compared with the previous year. Those decreases were prominent in Period A when the COVID-19 patient surged. The upstage migration of breast cancer was generally insignificant but slightly occurred in Period B. The outbreak of infectious disease makes patients reluctant to come to the hospital, especially in the elderly. We need to discuss the potential long-lasting deleterious effect of the COVID-19 pandemic on cancer diagnosis and management. And we should prepare for how to deal with the backlog caused by the COVID-19 pandemic.

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.…”

“…All countries reported some form of lockdown during COVID-19 except for Chile, Hong Kong, South Korea and Taiwan. 19 , 23 , 31 , 48 Interestingly, Denmark was the only country under lockdown with normal operation of its breast cancer screening program. 40 …”

“…Reductions in screening mammography rates were reported in all studies and ranged from 53.8% to 22.2% among registry-based studies 20 , 35 , 44 and 80.0% to 9.8% among non-registry-based studies. 18 , 24 , 25 , 31 , 34 , 36 , 39 , 41 , 43 , 49 Figure 2 displays the results of the meta-analysis of mammographic screening rate ratios. Overall, we noted that mammogram rates declined between 2019 and 2020 by 41% (RR: 0.59, 95% CI: 0.46–0.75) and 53% (RR: 0.47, 95% CI: 0.38–0.58) according to data derived from 3 registry-based and 10 non-registry-based studies respectively.…”

“…Reductions in the diagnosis rate of breast cancer were observed in all but one study, by Vardhanabhuti et al, 48 with reported rates ranging from 36.0% reduction to a 0.5% increase among registry-based studies 26 , 27 , 40 , 48 , 50 and 64.7% to 3.0% reduction in non-registry-based studies. 19 , 21 – 23 , 28 – 34 , 37 – 39 , 42 , 43 , 45 – 47 Figure 3 displays the results of the meta-analysis of the diagnosis rate ratios. Similar to the changes in mammogram screening rates, we noted an estimated 18% (RR: 0.82, 95% CI: 0.63–1.06) and 29% (RR: 0.71, 95% CI: 0.63–0.80) reduction in diagnosis rates between 2019 and 2020 based on data derived from 4 registry-based and 18 non-registry-based studies respectively.…”

Treatment Patterns, Clinical Outcomes and Health Care Resource Utilisation in Patients with EGFR-mutated Metastatic Non-Small Cell Lung Cancer: A Real-World Study in South Korea

“…It is unclear if any treatments or HRU were provided or reported at a reduced rate than there would have been before the pandemic. However, the accessibility of hospitals and the severity of cancer diseases are thought to have limited any reduction in HRU due to COVID-19 in clinical practice in South Korea [32,33].…”