Management of Breast Cancer During the COVID-19 Pandemic: A Stage- and Subtype-Specific Approach

The COVID-19 pandemic has rapidly changed delivery of cancer care. Many nonurgent surgeries are delayed to preserve hospital resources, and patient visits to health care settings are limited to reduce exposure to SARS-CoV-2. Providers must carefully weigh risks and benefits of delivering immunosuppressive therapy during the pandemic. For breast cancer, a key difference is increased use of neoadjuvant systemic therapy due to deferral of many breast surgeries during the pandemic. In some cases, this necessitates increased use of genomic tumor profiling on core biopsy specimens to guide neoadjuvant therapy decisions. Breast cancer treatment during the pandemic requires multidisciplinary input and varies according to stage, tumor biology, comorbidities, age, patient preferences, and available hospital resources. We present here the Johns Hopkins Women’s Malignancies Program approach to breast cancer management during the COVID-19 pandemic. We include algorithms based on tumor biology and extent of disease that guide management decisions during the pandemic. These algorithms emphasize medical oncology treatment decisions and demonstrate how we have operationalized the general treatment recommendations during the pandemic proposed by national groups, such as the COVID-19 Pandemic Breast Cancer Consortium. Our recommendations can be adapted by other institutions and medical oncology practices in accordance with local conditions and resources. Guidelines such as these will be important as we continue to balance treatment of breast cancer against risk of SARS-CoV-2 exposure and infection until approval of a vaccine.

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Management of Breast Cancer in Nepal

Journal of Nepal Medical Association ◽

10.31729/jnma.197 ◽

2009 ◽

Vol 48 (175) ◽

Author(s):

Yogendra P Singh ◽

P Sayami

Keyword(s):

Breast Cancer ◽

Early Detection ◽

Cancer Education ◽

Tumor Biology ◽

Metastatic Breast ◽

Premenopausal Women ◽

Clinical Breast Examination ◽

Cancer Management ◽

Breast Cancer Management ◽

Clinical Breast

Breast cancer is the second most common malignancy among women in Nepal. It is more commonin young premenopausal women. Breast cancer continues to increase in incidence due to lifestylechanges in Nepalese women despite constant remarkable development in the management of thisdisease over the past three decades. Breast cancer was diagnosed solely clinically and surgery wasthe only treatment option until fi fty years ago. Multidisciplinary approach has been adopted fordiagnosis and treatment of breast cancer in Nepal. Imaging is required for the diagnosis, appropriatetreatment decision and proper follow up. Treatment modality depends upon the extent of thedisease and tumor biology. However, there is a strong need for standard guidelines for the propermanagement of breast cancer in Nepal so that surgeries, chemotherapy, hormone therapy andradiotherapy are standardized in the country. Palliative care has been initiated to provide to somepatients with metastatic breast cancer recently.The breast cancer management in Nepal is a little different when compared with the centers in thedeveloped countries. The reasons are socioeconomic status, lack of education and lack of facilities.Although cancer care is on the rise in Nepal, the optimal facility for centers managing breast cancerhas to be improved signifi cantly.Cancer education, screening and early detection are the keyelements to infl uence the diagnosis, treatment and prognosis of breast cancer in Nepal. Breast cancerawareness and clinical breast examination are important tools for early detection in our resourcelimited context. Breast cancer can be cured in majority of the cases if diagnosed in early stages.This review will focus on relevant patient data along with future recommendation regarding breastcancer treatment in Nepal.Key Words: Breast cancer, cancer education, chemotherapy, imaging, radiotherapy, surgery

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Breast Cancer Surgery: New Issues

Current Oncology ◽

10.3390/curroncol28050344 ◽

2021 ◽

Vol 28 (5) ◽

pp. 4053-4066

Author(s):

Francesca Magnoni ◽

Sofia Alessandrini ◽

Luca Alberti ◽

Andrea Polizzi ◽

Anna Rotili ◽

...

Keyword(s):

Breast Cancer ◽

Tumor Biology ◽

Surgical Techniques ◽

Well Being ◽

Cancer Surgery ◽

Breast Cancer Surgery ◽

Cancer Management ◽

Breast Cancer Management ◽

Ancient Times ◽

Personalized Approach

Since ancient times, breast cancer treatment has crucially relied on surgeons and clinicians making great efforts to find increasingly conservative approaches to cure the tumor. In the Halstedian era (mid-late 19th century), the predominant practice consisted of the radical and disfiguring removal of the breast, much to the detriment of women’s psycho-physical well-being. Thanks to enlightened scientists such as Professor Umberto Veronesi, breast cancer surgery has since impressively progressed and adopted a much more conservative approach. Over the last three decades, a better understanding of tumor biology and of its significant biomarkers has made the assessment of genetic and molecular profiles increasingly important. At the same time, neo-adjuvant treatments have been introduced, and great improvements in genetics, imaging technologies and in both oncological and reconstructive surgical techniques have been made. The future of breast cancer management must now rest on an ever more precise and targeted type of surgery that, through an increasingly multidisciplinary and personalized approach, can ensure oncological radicality while offering the best possible quality of life.

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Neoadjuvant Chemotherapy in Breast Cancer: Review of the Evidence and Conditions That Facilitated Its Use during the Global Pandemic

Current Oncology ◽

10.3390/curroncol28020127 ◽

2021 ◽

Vol 28 (2) ◽

pp. 1338-1347

Author(s):

Tabitha Tse ◽

Sandeep Sehdev ◽

Jean Seely ◽

Denis H. Gravel ◽

Mark Clemons ◽

...

Keyword(s):

Breast Cancer ◽

Neoadjuvant Chemotherapy ◽

Early Stage ◽

Locally Advanced ◽

Tumor Biology ◽

Practice Change ◽

Her2 Positive ◽

Local Conditions ◽

Early Stage Disease ◽

Cancer Management

Practice and behaviour change in healthcare is complex, and requires a set of critical steps that would be needed to implement and sustain the change. Neoadjuvant chemotherapy for breast cancer is traditionally used for locally advanced disease and is primarily advantageous for surgical downstaging purposes. However, it does also offer patients with certain biologic subtypes such as the triple negative or Her2 positive breast cancers the opportunity to improve survival, even in early stage disease. During the height of the pandemic, an opportunity and motivation for the increased use of neoadjuvant therapy in breast cancer was identified. This paper describes the conditions that have supported this practice change at the provider and institutional levels. We also include our own institutional algorithm based on tumor biology and extent of disease that have guided our decisions on breast cancer management during the pandemic. Our processes can be adapted by other institutions and breast oncology practices in accordance with local conditions and resources, during and beyond the pandemic.

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