The COVID-19 pandemic and impact on breast cancer diagnoses: what happened in England in the first half of 2020

AbstractDelays in cancer diagnosis and treatment due to the COVID-19 pandemic is a widespread source of concern, but the scale of the challenge for different tumour sites is not known. Routinely collected NHS England Cancer Waiting Time data were analysed to compare activity for breast cancer in the first 6 months of 2020 compared to the same time period in 2019. The number of referrals for suspected breast cancer was 28% lower (N = 231,765 versus N = 322,994), and the number of patients who received their first treatment for a breast cancer diagnosis was 16% lower (N = 19,965 versus N = 23,881). These data suggest that the number of breast cancers diagnosed during the first half of 2020 is not as low as initially feared, and a substantial proportion of the shortfall can be explained by the suspension of routine screening in March 2020. Further work is needed to examine in detail the impact of measures to manage the COVID-19 pandemic on breast cancer outcomes.

Download Full-text

The clinical impact of ASCO “choosing wisely” recommendations on staging imaging for early stage breast cancers: An interrupted time-series analysis utilizing SEER-Medicare data.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.2078 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. 2078-2078

Author(s):

Alan Baltz ◽

Issam Makhoul ◽

Eric R Siegel

Keyword(s):

Breast Cancer ◽

Cancer Diagnosis ◽

Negative Binomial ◽

Early Stage ◽

Breast Cancer Diagnosis ◽

Choosing Wisely ◽

Breast Cancers ◽

Interrupted Time Series Analysis ◽

Medicare Data ◽

The Impact

2078 Background: The “Choosing Wisely” (CW) list, released by the American Society for Clinical Oncology (ASCO), highlights low-value procedures. In 2012, the CW recommendations advised against the use of staging imaging, including Positron Emission Tomography (PET), Computerized Tomography (CT) and radionuclide bone scans, for the staging of early breast cancer at low risk for metastasis. The objective of this study was therefore to assess the impact of the ASCO CW recommendations on staging imaging among early stage breast cancers. Methods: Women above the age of 66 with an early stage incident breast cancer diagnoses between 2010 and 2015 were identified within the linked SEER-Medicare data. The primary outcome of interest was the proportion of patients with a claim for staging imaging in the six months following the breast cancer diagnosis. Negative binomial regression, adjusting for pre-recommendation trends, was performed to estimate the changes in the rate of imaging staging within each year following the release of the recommendation. Results: A total of 50,004 women were identified during the study period. Prior to the release of the recommendations in 2012, the staging imaging rates among women newly diagnosed with early stage breast cancers were 5% greater in 2010 (p<.01) and 4% greater in 2011 (p<.01). Following the release of the recommendations, staging imaging rates did not decrease significantly in 2013 (2%;p=0.18). Imaging rates did, however, significantly decrease by 13% in 2014 (p<0.01) and by 16% in 2015 (p<0.01). Conclusions: The CW recommendation was associated with a significant decrease in unadvised staging imaging among incident early stage breast cancer diagnosis in the second and third year following its release. These findings demonstrate an improvement in the proportion of potentially inappropriate staging imaging in early stage breast cancers. The creation and dissemination of resources, such as the CW recommendations, serves as a powerful tool to improve clinical practice, quality of care, and patient safety from secondary malignancies, anxiety, and overdiagnosis.

Download Full-text

Economic Crisis: A Factor for the Delayed Diagnosis of Breast Cancer

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18083998 ◽

2021 ◽

Vol 18 (8) ◽

pp. 3998

Author(s):

Iasmina Petrovici ◽

Mihaela Ionica ◽

Octavian C. Neagoe

Keyword(s):

Breast Cancer ◽

Economic Crisis ◽

Cancer Diagnosis ◽

Breast Cancer Diagnosis ◽

Rural Setting ◽

Disease Stage ◽

Crisis Period ◽

Number Of Patients ◽

The Moment ◽

The Impact

Considering the constant increase in breast cancer patients, identifying factors that influence the moment of diagnosis is essential for optimizing therapeutic management and associated cost. The purpose of the study is to evaluate the impact of the economic crisis on the moment of a breast cancer diagnosis. This retrospective observational study analyzed a cohort of 4929 patients diagnosed with breast cancer over the course of 19 years in the Western region of Romania. The time interval was divided based on the onset of the economic crisis into 3 periods: pre-crisis (2001–2006), crisis (2007–2012), and post-crisis (2013–2019). The disease stage at the moment of diagnosis was considered either early (stages 0, I, II) or advanced (stages III, IV). Although recording a similar mean number of patients diagnosed per year during the pre- and crisis periods, a significantly higher percentage of patients were diagnosed with late-stage breast cancer during the economic crisis period compared to the previous interval (46.9% vs. 56.3%, p < 0.01). This difference was further accentuated when accounting for environmental setting, with 65.2% of patients from a rural setting being diagnosed with advanced disease during the crisis interval. An overall improvement of 12% in early-stage breast cancer diagnosis was recorded in the post-crisis period (55.7%, p < 0.001). The findings of this study support periods of economic instability as potential factors for a delay in breast cancer diagnosis and highlight the need for the development of specific strategies aimed at reducing cancer healthcare and associated financial burden in times of economic crisis.

Download Full-text

Breast cancer ER, PR, and HER2 expression variance by germline cancer predisposition genes.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.10526 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 10526-10526

Author(s):

Grace Wei ◽

Marilin Rosa ◽

Maxine Chang ◽

Brian J. Czerniecki ◽

Xia Wang

Keyword(s):

Breast Cancer ◽

Cancer Diagnosis ◽

Breast Cancer Diagnosis ◽

Cancer Predisposition ◽

Tumor Evolution ◽

Breast Cancers ◽

Her2 Expression ◽

Expression Levels ◽

Genetic Test Results ◽

Predisposition Genes

10526 Background: The association between breast cancer characteristics and survival with estrogen receptor (ER) and progesterone receptor (PR) expression has been primarily studied via binomial categories, ER-positive and ER-negative. In order to better characterize germline genetic influences on these markers, we investigated their IHC expression semi-quantitatively in cancer predisposition germline pathogenic variant (PV) carriers of the following genes: BRCA1, BRCA2, PALB2, TP53, PTEN, CDH1, ATM, CHEK2, and Lynch syndrome genes. The HER2 expression was also analyzed. Methods: We conducted a retrospective chart review of patients with germline panel genetic testing for cancer predisposition genes at Moffitt Cancer Center’s GeneHome clinic. Inclusion criteria included 1) women ≥18 years old, 2) breast cancer diagnosis, 3) cancer predisposition germline panel genetic test results, 4) available ER and PR expression levels, and 5) available HER expression and/or amplification status. ER, PR, and HER2 status were compared between PV carriers and non-PV carriers via Mann-Whitney U at p>0.05. Results: A total of 847 cases were reviewed for the study. Among 658 patients with a breast cancer diagnosis and complete ER PR data, 365 cases (55.5%) were non-PV carriers and 293 cases (44.5%) carried a PV in at least one of the genes listed above. Among 635 cases with available HER2 expression/amplification status, 355 (55.9%) cases were non-PV carriers and 288 (45.4%) cases were PV-carriers. When compared with non-PV carrier controls, BRCA1 PV carriers’ breast tumors had significantly lower ER and/or PR expression. Further, BRCA2 and TP53 PV tumors also displayed moderately lower ER expression. Contrarily, CHEK2 tumors displayed higher ER and PR expression compared to controls. Further, BRCA1 and BRCA2 PV carriers were more likely to have HER2- breast cancers. Conclusions: Differences in ER, PR, HER2 expression levels were observed in germline PV carrier breast cancers, signaling differential impacts by germline PVs on the tumor evolution process. It is likely that tumor differences in PV carriers influence responses to therapies, including hormone therapy, anti-HER2 therapy, and subsequent survival.[Table: see text]

Download Full-text

The Impact of COVID-19 Outbreak on Emotional and Cognitive Vulnerability in Iranian Women With Breast Cancer

Frontiers in Psychology ◽

10.3389/fpsyg.2021.663310 ◽

2021 ◽

Vol 12 ◽

Author(s):

Mohammad H. Choobin ◽

Vida Mirabolfathi ◽

Bethany Chapman ◽

Ali Reza Moradi ◽

Elizabeth A. Grunfeld ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Diagnosis ◽

Cognitive Vulnerability ◽

Emotional Health ◽

Breast Cancer Diagnosis ◽

Well Being ◽

Emotional Impact ◽

Targeted Interventions ◽

Emotional Vulnerability ◽

The Impact

The psychological cost on emotional well-being due to the collateral damage brought about by COVID-19 in accessing oncological services for breast cancer diagnosis and treatment has been documented by recent studies in the United Kingdom. The current study set out to examine the effect of delays to scheduled oncology services on emotional and cognitive vulnerability in women with a breast cancer diagnosis in Iran, one of the very first countries to be heavily impacted by COVID-19. One hundred thirty-nine women with a diagnosis of primary breast cancer answered a series of online questionnaires to assess the current state of rumination, worry, and cognitive vulnerability as well as the emotional impact of COVID-19 on their mental health. Results indicated that delays in accessing oncology services significantly increased COVID related emotional vulnerability. Regression analyses revealed that after controlling for the effects of sociodemographic and clinical variables, women’s COVID related emotional vulnerability explained higher levels of ruminative response and chronic worry as well as poorer cognitive function. This study is the first in Iran to demonstrate that the effects of COVID-19 on emotional health amongst women affected by breast cancer can exaggerate anxiety and depressive related symptoms increasing risks for clinical levels of these disorders. Our findings call for an urgent need to address these risks using targeted interventions exercising resilience.

Download Full-text

Divorce after breast cancer diagnosis and its impact on quality of life

Palliative & Supportive Care ◽

10.1017/s1478951521001711 ◽

2021 ◽

pp. 1-6

Author(s):

Danbee Kang ◽

Nayeon Kim ◽

Gayeon Han ◽

Sooyeon Kim ◽

Hoyoung Kim ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Cancer Survivors ◽

Cancer Diagnosis ◽

Breast Cancer Survivors ◽

Breast Cancer Diagnosis ◽

Factors Associated ◽

After Cancer ◽

The Impact

Abstract Objective This study aims to identify factors associated with divorce following breast cancer diagnosis and measures the impact of divorce on the quality of life (QoL) of patients. Methods We used cross-sectional survey data collected at breast cancer outpatient clinics in South Korea from November 2018 to April 2019. Adult breast cancer survivors who completed active treatment without any cancer recurrence at the time of the survey (N = 4,366) were included. The participants were classified into two groups: “maintaining marriage” and “being divorced,” between at the survey and at the cancer diagnosis. We performed logistic regression and linear regression to identify the factors associated with divorce after cancer diagnosis and to compare the QoL of divorced and nondivorced survivors. Results Approximately 11.1/1,000 of married breast cancer survivors experienced divorce after cancer diagnosis. Younger age, lower education, and being employed at diagnosis were associated with divorce. Being divorced survivors had significantly lower QoL (Coefficient [Coef] = −7.50; 95% CI = −13.63, −1.36), social functioning (Coef = −9.47; 95% CI = −16.36, −2.57), and body image (Coef = −8.34; 95% CI = −6.29, −0.39) than survivors who remained married. They also experienced more symptoms including pain, insomnia, financial difficulties, and distress due to hair loss. Conclusion Identifying risk factors of divorce will ultimately help ascertain the resources necessary for early intervention.

Download Full-text

How do women with secondary breast cancer experience telling their adolescent children about their diagnosis?

Journal of Health Psychology ◽

10.1177/1359105316648484 ◽

2016 ◽

Vol 23 (9) ◽

pp. 1223-1233 ◽

Cited By ~ 1

Author(s):

Leonie Lalayiannis ◽

Nicky Asbury ◽

Graham Dyson ◽

Amanda Walshe

Keyword(s):

Breast Cancer ◽

Cancer Diagnosis ◽

Interpretative Phenomenological Analysis ◽

Breast Cancer Diagnosis ◽

Phenomenological Analysis ◽

Primary Cancer ◽

Structured Interviews ◽

Cancer Experience ◽

Secondary Breast Cancer ◽

The Impact

This study investigated how women with secondary breast cancer experience telling their adolescent children. Semi-structured interviews were conducted with women who had been diagnosed with secondary breast cancer at least 1 year prior to the interview. Seven women, who had at least one child between 12 and 19 years old living at home at the time of diagnosis, were interviewed. The interviews were analysed using interpretative phenomenological analysis for an in-depth understanding of women’s experiences. Women found that it was easier to tell their children of their secondary breast cancer diagnosis compared to their primary cancer. However, they talked about the impact the diagnosis had on their family.

Download Full-text

Pregnancy After Breast Cancer in Patients With Germline BRCA Mutations

Journal of Clinical Oncology ◽

10.1200/jco.19.02399 ◽

2020 ◽

Vol 38 (26) ◽

pp. 3012-3023 ◽

Cited By ~ 9

Author(s):

Matteo Lambertini ◽

Lieveke Ameye ◽

Anne-Sophie Hamy ◽

Anna Zingarello ◽

Philip D. Poorvu ◽

...

Keyword(s):

Breast Cancer ◽

Pregnancy Rate ◽

Disease Free Survival ◽

Breast Cancer Diagnosis ◽

Brca Mutations ◽

End Points ◽

Breast Cancer Outcomes ◽

Future Fertility ◽

Induced Abortions ◽

The Impact

PURPOSE Young women with germline BRCA mutations have unique reproductive challenges. Pregnancy after breast cancer does not increase the risk of recurrence; however, very limited data are available in patients with BRCA mutations. This study investigated the impact of pregnancy on breast cancer outcomes in patients with germline BRCA mutations. PATIENTS AND METHODS This is an international, multicenter, hospital-based, retrospective cohort study. Eligible patients were diagnosed between January 2000 and December 2012 with invasive early breast cancer at age ≤ 40 years and harbored deleterious germline BRCA mutations. Primary end points were pregnancy rate, and disease-free survival (DFS) between patients with and without a pregnancy after breast cancer. Pregnancy outcomes and overall survival (OS) were secondary end points. Survival analyses were adjusted for guarantee-time bias controlling for known prognostic factors. RESULTS Of 1,252 patients with germline BRCA mutations ( BRCA1, 811 patients; BRCA2, 430 patients; BRCA1/2, 11 patients) included, 195 had at least 1 pregnancy after breast cancer (pregnancy rate at 10 years, 19%; 95% CI, 17% to 22%). Induced abortions and miscarriages occurred in 16 (8.2%) and 20 (10.3%) patients, respectively. Among the 150 patients who gave birth (76.9%; 170 babies), pregnancy complications and congenital anomalies occurred in 13 (11.6%) and 2 (1.8%) cases, respectively. Median follow-up from breast cancer diagnosis was 8.3 years. No differences in DFS (adjusted hazard ratio [HR], 0.87; 95% CI, 0.61 to 1.23; P = .41) or OS (adjusted HR, 0.88; 95% CI, 0.50 to 1.56; P = .66) were observed between the pregnancy and nonpregnancy cohorts. CONCLUSION Pregnancy after breast cancer in patients with germline BRCA mutations is safe without apparent worsening of maternal prognosis and is associated with favorable fetal outcomes. These results provide reassurance to patients with BRCA-mutated breast cancer interested in future fertility.

Download Full-text

Institutional racism, segregation, and breast cancer outcomes.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.199 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 199-199

Author(s):

Kirsten M. M. Beyer ◽

Amin Bemanian ◽

Emily L McGinley ◽

Ann B Nattinger

Keyword(s):

Breast Cancer ◽

Cancer Diagnosis ◽

Breast Cancer Diagnosis ◽

Institutional Racism ◽

Tumor Type ◽

Tumor Characteristics ◽

Stage At Diagnosis ◽

Cancer Outcomes ◽

Location Quotient ◽

Breast Cancer Outcomes

199 Background: Racial breast cancer mortality disparities are significant vary in magnitude across the US, indicating that place-specific factors may influence mortality. Racism and segregation are widely considered to contribute to health disparities, and may influence breast cancer outcomes. Several pathways linking racism, segregation and health care outcomes have been proposed, including (1) stressors in the local environment, (2) social resources and opportunities, and (3) knowledge and information. Given these hypothesized pathways, it is possible that racism and segregation may also influence elements of the breast cancer diagnosis, such as stage at diagnosis and tumor characteristics. Methods: We examined the influence of measures of institutional racism (racial bias in mortgage lending) and segregation (the Location Quotient) on 4-year mortality after breast cancer diagnosis, stage at diagnosis, and hormone receptor status among a cohort of women diagnosed with breast cancer between 2007 and 2009, included in the SEER-Medicare linked database. Analyses focused on three metropolitan areas: Detroit (MI), Atlanta (GA), and Seattle (WA). Logistic regression analyses were used to predict the odds of each outcome, while controlling for a number of covariates: age, race and ethnicity, ER-/PR- status, diagnosis stage, enrollment in Medicaid, metropolitan area, marital status, diagnosis year, tumor size, histological type, and tumor grade. Results: Results indicate that institutional racism is associated with an increased odds of being diagnosed with an ER-/PR- tumor. No associations were detected for 4-year mortality or diagnosis stage, nor for the Location Quotient and any outcome. Conclusions: Researchers are currently exploring whether social conditions may influence tumor characteristics through pathways such as inflammation and comorbidities. Our results contribute to this growing body of work. Our results can also be interpreted in light of recent studies that identified an association between a different measure of segregation and ER-/PR- tumor type, and no association between census tract level SES and tumor type. Additional study of institutional racism, segregation and breast cancer outcomes is warranted.

Download Full-text

The impact of a breast cancer diagnosis on women’s work status.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.7_suppl.23 ◽

2018 ◽

Vol 36 (7_suppl) ◽

pp. 23-23

Author(s):

Lucinda Barry ◽

Leanne Storer ◽

Meron Pitcher

Keyword(s):

Breast Cancer ◽

Cancer Diagnosis ◽

Financial Stress ◽

Breast Cancer Diagnosis ◽

Work Status ◽

Paid Employment ◽

The Mean ◽

Woman's Work ◽

One Year ◽

The Impact

23 Background: The diagnosis and treatment of cancer often causes financial stress, partly by impacting on the ability to continue in paid employment. Our aim was to identify changes in work status 12 months after a diagnosis of breast cancer. Methods: An audit of the medical records of women who presented to the Western Health (Victoria, Australia) nurse led breast cancer Survivorship Clinic (SC) between October 2015 and October 2016 was performed to identify employment status at diagnosis and at their review at SC 12 months later. Results: 111 records were reviewed. The mean age was 55 (range 28-82yrs). 84 of these women (76%) were 65 years of younger at the time of diagnosis. 46 of the 84 women ≤65 years were in paid employment at diagnosis (55%), and 38 (83%) were still working in some capacity at review in the SC. Of the 38 still working, 28 were working in the same capacity, 8 were working reduced hours, and 2 were working increased hours. Women who had axillary dissections were most likely to have changed work status. Financial stress was reported by 8/19 of women who stopped working or had changed work hours, including 9 no longer in paid employment and 10 with changed hours. 2/28 women working in the same capacity reported financial stress. 65% of those who reported financial stress (11/17) had chemotherapy as part of their treatment. Conclusions: A breast cancer diagnosis has the ability to influence a woman's work status one year after diagnosis. Health professionals should appreciate the potential work concerns and financial stresses continuing to affect their patients.

Download Full-text