COVID-19 delays for early stage breast cancer surgery unlikely to impact survival

CANCER DIGEST – Aug. 7, 2020 – Delays in breast cancer surgeries for very early stage

cancer may not affect overall survival, a new study shows, which is reassuring news for women’s the earliest stage of breast cancer whose surgeries were postponed due to the COVID-19 pandemic.

When the COVID-19 pandemic hit, many elective surgeries were postponed to ensure hospitals had staff capacity to deal with virus patients. Surgeries in the gray area between essential and elective, however concerned many, including breast cancer surgeons. Ductal carcinoma in situ (DCIS) was one such surgery.

Sometimes called Stage 0 breast cancer, DCIS is non-invasive cancer that starts in the milk ducts. It is usually easily treated with surgery to remove the tumor, however in approximately 20 percent of such surgeries, the surgeon finds evidence of invasive cancer that needs to be removed. Consequently, when Brigham and Women’s Hospital made the decision to include DCIS in the surgeries that could be delayed, may surgeons expressed concern.

Thanks to a study by Brigham’s own researchers that looked into the survival outcomes of 378,000 patients who were diagnosed with very early breast cancer between 2010 and 2016 they found that short delays in surgery resulted in very little impact on survival. They did find that increased time to surgery for DCIS was linked to a small increase in upstaging the diagnosis, meaning the tumor was found to be at higher stage. The study appears in the Journal of the American College of Surgeons.

"Usually we take these patients with very small tumors directly to surgery, so it is a big change in practice to first put those patients on tamoxifen or an aromatase inhibitor," lead author Dr. Christina Minami, MD, MS, an associate surgeon at Brigham and Women's Hospital said in a press release. "What we can say from our findings is that despite the delay in surgical therapy, because you were on neoadjuvant endocrine therapy, we do not think that your survival will at all be impacted."

While the results are reassuring, Dr. Minami stressed that the patient population in the study differs from patients whose DCIS has been delayed during the current pandemic, but these results show that patients can still expect an excellent prognosis.

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Source: EurekAlert press releases and Journal of the American College of Surgeons