COVID-19-related surgical delays for early breast cancer may not affect OS, data suggest
Click Here to Manage Email Alerts
Increased time to surgery for ductal carcinoma in situ appeared associated with a small increase in pathologic upstaging but did not impact OS, according to a retrospective study published in Journal of the American College of Surgeons.
Additionally, use of neoadjuvant endocrine therapy — recommended as initial treatment of early-stage, ER-positive breast cancer amid surgical delays due to the COVID-19 pandemic — had no effect on stage of disease or OS, which supports the safety of that strategy for this patient population, according to researchers.
“The most pressing question today is what will surgical delays due to the pandemic mean for patient outcomes; and the reality is that we will only have the answers years from now,” Christina A. Minami, MD, MS, surgeon in the division of breast surgery at Brigham and Women’s Hospital, said in a press release. “In the meantime, these data should provide some reassurance and encouragement — they don’t indicate that outcomes will be changed dramatically. But we do encourage patients to follow-up with their surgeons on a care plan as COVID-19 surges grow or subside locally.”
Surgical delays have been common for women with ductal carcinoma in situ (DCIS) and early stage ER-positive breast cancer during the COVID-19 pandemic.
Minami and colleagues sought to determine the possible effect of such delays on outcomes by analyzing data of 378,839 patients with DCIS or early-stage ER-positive breast cancer who received treatment between 2010 and 2016 and were included in the National Cancer Database.
Researchers examined factors linked to pathologic upstaging using logistic regression analyses, and they used Cox proportional hazard models to analyze OS.
Nearly all patients with DCIS (98.2%) underwent surgery within 120 days.
Among those with early-stage, ER-positive breast cancer selected for neoadjuvant endocrine therapy, 59.6% with cT1N0 and 30.9% with cT2N0 underwent surgery within 120 days.
Results showed increased time to surgery increased the odds of pathologic upstaging among patients with DCIS, but not among patients with invasive cancer, irrespective of initial treatment strategy.
Researchers observed higher odds of upstaging among patients with ER-positive DCIS whose time to treatment was 60 to 120 days (OR = 1.15; 95% CI, 1.08-1.22) or more than 120 days (OR = 1.44; 95% CI, 1.24-1.68) from time of diagnosis compared with those treated during the first 60 days. Delays in time to surgery appeared significant only for patients with ER-negative breast cancer treated more than 120 days after diagnosis (OR = 1.36; 95% CI, 1.01-1.82).
The investigators observed no associations between time to surgery and OS among patients with DCIS or patients selected for neoadjuvant endocrine therapy.
“Anxiety for both surgeons and patients alike stems from the unknown,” Minami said. “We sought to help address questions about outcomes. Ideally, we’d like to have randomized controlled studies, but under the circumstances, we needed to take the more uncommon approach by looking at retrospective data.”
Collapse
Read more about
Click Here to Manage Email Alerts