Management of early breast cancer during the COVID-19 pandemic in Brazil

Abstract

Purpose: The COVID-19 pandemic has impacted early breast cancer (EBC) treatment worldwide. This study analyzed how Brazilian breast specialists are managing EBC. Methods: An electronic survey was conducted with members of the Brazilian Society of Breast Specialists between April 30 and May 11, 2020. Bivariate analysis was used to describe changes in how specialists managed EBC at the beginning and during the pandemic, according to molecular subtype and oncoplastic surgery. Results: The response rate was 34.4% (503/1,462 specialists). At the beginning of the pandemic, 43% changed their management approach. As the outbreak progressed, this proportion increased to 69.8% (p<0.001). For hormone receptor-positive tumors with the best prognosis (Ki67<20%), 47.9% and 17.7% of specialists would recommend neoadjuvant endocrine therapy for postmenopausal and premenopausal women, respectively. For tumors with poorer prognosis (Ki67>30%), 34% and 10.9% would recommend it for postmenopausal and premenopausal women, respectively. Menopausal status significantly affected whether the specialists changed their approach (p<0.00001). For tumors ≥1.0 cm, 42.9% of respondents would recommend neoadjuvant systemic therapy for triple-negative tumors and 39.6% for HER2+ tumors. Overall, 63.4% would recommend immediate total breast reconstruction, while only 3.4% would recommend autologous reconstruction. In breast-conserving surgery, 75% would recommend partial breast reconstruction; however, 54.1% would contraindicate mammoplasty. Furthermore, 84.9% of respondents would not recommend prophylactic mastectomy in cases of BRCA mutation.Conclusions: Important changes occurred in EBC treatment, particularly for hormone receptor-positive tumors, as the outbreak progressed in each region. Systematic monitoring could assure appropriate breast cancer treatment, mitigating the impact of the pandemic.

Impact of the COVID-19 pandemic on breast surgery and breast reconstruction in a Japanese university hospital setting

“…Autologous tissue reconstruction, which is particularly time-consuming, was discouraged. According to an opinion survey, 63.4% of breast cancer specialists in Brazil recommended immediate reconstruction, but only 3.4% recommended autologous tissue reconstruction 17 . Some reports have indicated that breast reconstruction during the COVID-19 pandemic was limited to immediate tissue expander insertion and silicone breast implant replacement only 3 4 .…”

Breast cancer and COVID‐19 pandemic in Brazil

“…The results were submitted to a scientific journal, but we have an online "preprint" publication of the study data. 5 There were 503 responders These findings highlight important changes in the approach of the mastologists at the beginning and during the pandemic, particularly with respect to HR-positive tumors, and reflects, in our opinion, the disagreements between the emergency guidelines described by Garg et al 1 However, since the data were developed from a survey, we cannot confirm that these recommendations translated into treatment recommendations for actual patients. More studies are needed to know the real impact of the pandemic on patients treated with breast cancer in the pandemic period.…”