The COVID-19 pandemic had a significant impact on the diagnosis and management of breast cancer, according to a new study from researchers in Germany. The study, published in the journal Scientific Reports, analyzed data from the Baden-Württemberg Cancer Registry to investigate changes in breast cancer incidence and surgical treatment during the pandemic years of 2020 and 2021 compared to the pre-pandemic period of 2018-2019. The findings provide valuable insights into how the pandemic affected cancer care and highlight the importance of maintaining essential health services even in times of crisis. Breast cancer is the most common cancer among women worldwide, and understanding the pandemic’s influence on its diagnosis and treatment is crucial for ensuring optimal patient outcomes.
Decline and Recovery in Breast Cancer Incidence
The researchers found that the age-standardized incidence of invasive breast cancer decreased significantly in 2020, dropping by 7% compared to the pre-pandemic period. This decline was most pronounced in April 2020, with a 40% decrease in incidence observed during that month. However, the incidence quickly rebounded, and by the summer of 2020, it was already comparable to pre-pandemic levels. In 2021, the incidence of invasive breast cancer was on par with the 2018-2019 period, suggesting a rapid recovery.
The researchers also analyzed the incidence of non-invasive breast cancer and found a similar pattern, with a 69% decrease in April 2020 followed by a return to pre-pandemic levels by 2021. These trends were consistent across different age groups and cancer stages, with the exception of women aged 80 years and older, who continued to have a lower incidence of invasive breast cancer in 2021.
Changes in Surgical Treatment
In addition to examining incidence, the study also looked at the impact of the pandemic on the surgical treatment of early-stage breast cancer patients. The researchers found that the median time from diagnosis to surgery was slightly shorter in 2020 compared to the pre-pandemic period, likely due to the reduced caseload during the initial lockdown. However, in 2021, the time to surgery was longer, particularly for patients aged 70 and older, as well as those with intermediate-grade tumors and hormone receptor-negative or HER2-negative cancers.
Interestingly, the researchers also observed a small but significant increase in the proportion of patients who underwent mastectomy rather than breast-conserving surgery in 2021, even though this change was not recommended in the adapted treatment guidelines. The increase was most pronounced for patients with high-grade tumors, those aged 50-59 years, and those with hormone receptor-positive and HER2-negative cancers.
Implications and Future Directions
The findings of this study highlight the resilience of the healthcare system in adapting to the challenges posed by the COVID-19 pandemic, as well as the potential long-term consequences of disruptions to essential cancer services. While the rapid recovery in breast cancer incidence is a positive sign, the researchers caution that the missed diagnoses during the pandemic may lead to a stage shift in the coming years, with more patients presenting with advanced disease.
The observed increase in mastectomy rates, even in the absence of a recommended change in surgical guidelines, underscores the importance of clear communication and the dissemination of adapted treatment protocols during exceptional circumstances. Maintaining high-quality cancer care, including timely diagnosis and appropriate surgical management, is crucial for ensuring the best possible outcomes for breast cancer patients.
Broader Implications and Future Research
The findings of this study have broader implications for the management of cancer care during public health emergencies. The researchers highlight the need for healthcare systems to be prepared to maintain essential services, even in the face of disruptions, to prevent delays in diagnosis and suboptimal treatment. Additionally, the study emphasizes the importance of robust cancer registries, which can provide valuable data for monitoring the impact of such events and informing future policy decisions.
Ongoing research in this area will be crucial for understanding the long-term consequences of the COVID-19 pandemic on cancer care and outcomes. Future studies may explore the impact of missed diagnoses on stage distribution and survival, as well as the potential for targeted interventions to address any disparities in care that may have emerged during the pandemic.
Overall, this study provides a valuable snapshot of the changes in breast cancer incidence and surgical treatment during the COVID-19 pandemic, offering important insights for healthcare providers, policymakers, and the scientific community as they work to ensure the continued delivery of high-quality cancer care, even in the face of unprecedented challenges.
Author credit: This article is based on research by Lina Jansen, Silke Hermann, Susanne Bergbold, Volker Arndt.
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