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Breast Cancer Surgery Delays Don’t Affect Survival in DCIS, Early-Stage Estrogen-Receptor-Positive Disease

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Delaying breast cancer surgery for people diagnosed with DCIS or early-stage estrogen-receptor-positive invasive disease doesn’t seem to affect survival, according to a study.

These results may be reassuring for certain people whose breast cancer surgery was delayed by the COVID-19 pandemic.

The research was published online on Aug. 6, 2020, by the Journal of the American College of Surgeons. Read “Association between Time to Operation and Pathological Stage in Ductal Carcinoma in Situ and Early-Stage Hormone Receptor-Positive Breast Cancer.”

COVID-19 and breast cancer

Coronaviruses are a large group of viruses that can cause respiratory illness in humans and animals. The relatively new coronavirus we’ve all heard so much about is called SARS-CoV-2, and the illness it causes is called coronavirus disease 2019, which is abbreviated as COVID-19.

The virus that causes COVID-19 is very, very contagious — about 3 times as contagious as the flu virus. It spreads mainly through droplets of fluid produced when a person coughs or sneezes. People who are within 6 feet of an infected person may then inhale or otherwise get the droplets into their noses, mouths, or eyes.

To date, there is no vaccine or completely effective treatment for COVID-19.

Because COVID-19 is so contagious, and to save healthcare resources for people diagnosed with COVID-19, many hospitals and other healthcare facilities delayed or cancelled elective procedures beginning in March 2020. Elective procedures included anything that didn’t need to be done to save someone’s life. Breast cancer screening was considered an elective procedure, so many mammograms were delayed or cancelled. Some breast cancer surgeries and other treatments also were delayed, changed, or cancelled.

COVID-19 did not hit the United States evenly. Some states reported thousands of cases, while others reported only a few hundred. So delays in breast cancer care were different in different places.

The researchers who did this study wanted to confirm that delaying surgery for certain types of breast cancer does not affect survival.

About the study

To do the study, the researchers looked at information on people diagnosed with DCIS or early-stage estrogen-receptor-positive invasive breast cancer between 2010 and 2016. All the people had surgery to remove the breast cancer.

The information came from the National Cancer Database, a collection of information on about 70% of newly diagnosed cancer cases maintained by the American Cancer Society and the American College of Surgeons. The information in the database comes from nearly 1,500 Commission on Cancer-accredited programs.

The researchers looked at the time between diagnosis and breast cancer surgery to see if delaying surgery affected survival.

The information analyzed for the study happened before the COVID-19 pandemic. Still, looking at breast cancer cases between 2010 and 2016 gave the researchers a greater amount of data than only looking at cases during the pandemic.

Overall, the study included 378,839 people:

  • 99,749 people were diagnosed with DCIS
  • 279,090 were diagnosed with early-stage estrogen-receptor-positive invasive disease

Of the people diagnosed with DCIS:

  • 83,754 (84%) were diagnosed with estrogen-receptor-positive disease
  • 15,995 (16%) were diagnosed with estrogen-receptor-negative disease

Of the people diagnosed with early-stage estrogen-receptor-positive disease:

  • 3,471 (1.24%) were treated with hormonal therapy medicine before surgery

Of the people diagnosed with DCIS, 98.2% had surgery within 120 days of diagnosis.

Of the people diagnosed with early-stage estrogen-receptor-positive invasive breast cancer:

  • about 99% who were not treated with hormonal therapy before surgery had surgery within 120 days of diagnosis
  • about 44% of people treated with hormonal therapy before surgery had surgery within 120 days of diagnosis; this means that about 56% had surgery more than 120 days after diagnosis

Follow-up time ranged from about 3 to 4 years.

The researchers found no difference in survival based on the time to surgery after diagnosis for either DCIS or early-stage estrogen-receptor-positive invasive breast cancer.

“No survival differences in patients with DCIS or early-stage [estrogen-receptor-positive] breast cancer [treated with hormonal therapy before surgery] were noted by time to surgery,” the researchers wrote. “While the applicability of these data to the patients experiencing surgical delays during the COVID-19 pandemic is limited, surgeons and patients may find some reassurance in these findings, as these two groups represent patients significantly affected by the surgical triage recommendations of the COVID-19 Pandemic Breast Cancer Consortium.”

Though the study has limitations, senior author Elizabeth Mittendorf, M.D., professor of surgery at Brigham and Women's Hospital, said she found the study findings helpful to share with people who had breast cancer surgery delays.

“We can tell our patients they can still expect an excellent prognosis from their early-stage hormone receptor-positive cancer and that their excellent prognosis is not negatively impacted by this delay they have experienced,” Mittendorf said in a statement.

What this means for you

If you were diagnosed with DCIS or early-stage hormone-receptor-positive invasive breast cancer and had breast cancer surgery delayed by the COVID-19 pandemic, this study is reassuring.

This study does have some limitations, and studies on people treated for breast cancer during the pandemic need to be done. Still, the study used the best information currently available to study the affect of COVID-19 surgery delays on breast cancer survival.

As time has passed, doctors have seen how protective procedures, such as wearing a face mask, washing your hands, maintaining physical distancing, and avoiding gathering with people in a group, have helped slow the spread of the virus. So most facilities are once again doing breast cancer surgeries.

If you’re concerned about COVID-19, it makes sense to ask what steps are being taken to protect you from the virus. Many facilities have hotlines you can call. It’s likely that you will have to wear a mask while you are in the hospital. You also may not be allowed to have anyone come with you or visit you on the day of your surgery.

For more information, read’s Special Report: COVID-19’s Impact on Breast Cancer Care.

Written by: Jamie DePolo, senior editor

Reviewed by: Brian Wojciechowski, M.D., medical adviser

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