Impact of the COVID-19 Pandemic on Cancer Staging: An Analysis of Patients With Breast Cancer From a Community Practice in Brazil

Abstract

PURPOSE A nationwide lockdown was enforced in Brazil starting in March 2020 because of the COVID-19 pandemic when cancer screening activities were reduced. In this study, we evaluated the impact of the COVID-19 pandemic on breast cancer (BC) diagnosis. METHODS We extracted data from the medical records of patients age older than 18 years who were diagnosed with BC and started treatment or follow-up in private oncology institutions in Brazil between 2018 and 2021. The primary objective was to compare the stage distribution during the COVID-19 pandemic (2020-2021) with a historical prepandemic control cohort (2018-2019). Early BC was defined as stage I-II and advanced disease as stage IV. RESULTS We collected data for 11,753 patients with an initial diagnosis of BC, with 6,493 patients in the pandemic (2020-2021) and 5,260 patients in the prepandemic period (2018-2019). We observed a lower prevalence of early-stage BC (63.6% v 68.4%) and a higher prevalence of advanced-stage BC (16.9 v 12.7%), after the onset of the pandemic (both P < .01). This pattern was similar for both estrogen receptor–positive/human epidermal growth factor receptor 2–negative and human epidermal growth factor receptor 2–positive tumors: significantly decreased in the early stage from 69% to 67% and 68% to 58%, respectively, and a considerable increase in advanced-stage disease from 13% to 15% and 13% to 20%, respectively. For triple-negative BC, there was a significantly higher percentage of patients with advanced-stage disease during the pandemic (17% v 11%). Overall, age 50 years or older and postmenopausal status were associated with a greater risk of advanced stage at diagnosis during the pandemic period. CONCLUSION We observed a substantial increase in the number of cases of advanced-stage BC in Brazil during the COVID-19 pandemic.

Impact of the COVID‐19 pandemic on clinical presentation, treatments, and outcomes of new breast cancer patients: A retrospective multicenter cohort study

“…An English study on 439 patients showed more advanced BCs at initial presentation, with higher rates of node‐positive and metastatic stages in 2020 compared to 2019 45 . Other studies in the US, South America, Europe, the Middle East, and Asia, obtained similar results 12–14,30,43,46–49 . Studies showing no tumor shift, as displayed in the presented results, are scarce, 11,15 but may also have been underreported.…”

“…As a result of these disruptions, modelers have anticipated a worldwide increase in BC mortality by 2030 because of delays in diagnosis and treatment 9,10 . However, real‐world evaluations of the impact of the outbreak on care trajectories and outcomes of new BC cases remain scarce, include a low number of patients, and/or lack mid‐term follow‐up of patients' clinical outcomes 10–15 …”

Os impactos da pandemia COVID-19 no diagnóstico e tratamento do câncer de mama, uma revisão sistemática na literatura

“…Atraso este comentando por Duarte, que relembra uma portaria do Instituto Nacional do Câncer (INCA) José Alencar Gomes da Silva, que em março de 2020, recomendou aos profissionais médicos que orientassem a não procurara dos serviços de saúde para rastreamento do câncer, portaria revogada em junho do mesmo ano devido a heterogeneidade da pandemia entre os estados brasileiros. (Resende, 2022;Duarte, 2022).…”

Treatment Patterns and Outcomes of Patients with Grade 4 Glioma Treated with Radiation during the COVID-19 Pandemic

“…Similar trends were observed for patients with other cancers during the COVID pandemic. One study reported a substantial increase in breast cancer patients presenting at an advanced stage compared to a pre-pandemic cohort in Brazil [ 17 ], while another showed increased morbidity from larger tumor size in patients with head and neck cancers [ 15 ]. These trends are thought to represent a delay in presentation to hospitals during COVID, perhaps due to fear of contracting COVID or general recommendations to avoid hospital visits when possible [ 18 ].…”

“…For patients with other cancers, the long-term impact of delays and alterations in cancer care will not be fully appreciated for years to come, but several studies highly suggest that delays in diagnosis, resulting in a more advanced stage at the time of treatment, and delays to treatment will likely result in worsened overall survival [ 17 , 20 , 21 , 26 ]. However, for grade 4 gliomas, which have a relatively short prognosis, our follow-up period is sufficient to evaluate median overall survival and accurately analyze how differences between the pre-COVID and COVID eras influenced survival.…”