Hande Melike BÜLBÜL, Nur HÜRSOY, Filiz TAŞÇI, Recep BEDİR, Ogün BÜLBÜL, Esra AYDIN, Ahmet PERGEL

COVID-19 Pandemisinin Meme Kanseri Tarama ve Tanı Sürecine Etkisi

Amaç: COVID-19 pandemisi meme kanseri taramalarında ve tanısal işlemlerinde gecikmeye neden oldu. Bu çalışmanın amacı; pandemi sürecindeki meme kanseri tarama ve tanısal işlemleri ile yeni tanı konan meme kanseri meme kanseri olgularının pandemi öncesindeki dönemle karşılaştırılmasıydı. Gereç ve Yöntem: Bu retrospektif çalışmada pandemi öncesinde (Mart 2019-Şubat 2020) ve pandemi sürecinde (Mart 2020- Şubat 2021) yapılan mamografi taramaları, görüntüleme eşliğinde meme biyopsiler ve yeni tanı alan meme kanseri vakaları değerlendirildi. Mamografi ve biyopsilerin sayıları ve zamana göre dağılımı karşılaştırıldı. Meme kanseri vakalarında ise tümörün histopatolojik özellikleri ve evresi karşılaştırıldı. Bulgular: Pandemi öncesine kıyasla pandemi sürecinde en belirgini Nisan (-%98) ve Mayıs (-%93) aylarında olmak üzere mamografi sayılarında toplamda %44 azalma olduğu görüldü. Görüntüleme eşliğinde biyopsi sayılarında Nisan (-%100) ve Mayıs aylarında önemli miktarda azalma olmakla birlikte Haziran ayında %29 ile başlayan ve devam eden artışla tüm pandemi periyodu değerlendirildiğinde azalma olmadığı görüldü. Meme kanseri grubunda ise pandemi öncesine kıyasla pandemi döneminde tanı anında metastaz ile başvuran hasta sayısında anlamlı artış olduğu görüldü (p=0.001). İki grup arasında tümörün hormon reseptör durumu, HER2 pozitifliği ya da derece açısından anlamlı fark olmadığı görüldü (p>0.05). Sonuç: Bu çalışmada COVID-19 pandemisi sırasında meme kanserinde hem tarama hem de tanı süreçlerinin önemli ölçüde etkilendiği gözlemlendi. Pandeminin ilk aylarında hastaneye başvurunun gecikmesinin tanı anında metastatik olan hastalarda artışa neden olduğu görüldü. Aim: The COVID-19 pandemic has caused delays in breast cancer screening and diagnostic procedures. The aim of this research was to compare the status of breast cancer screenings and newly diagnosed breast cancer cases during the pandemic compared to the pre-pandemic period. Material and method: This retrospective study included patients with screening mammography, imaging-guided biopsies, and newly diagnosed breast cancer from March 2020– February 2021 (during-COVID-19) were compared with March 2019–February 2020 (pre-COVID-19). We compared numbers and distribution over time of mammography and biopsies between the time periods. In the breast cancer group; the stage at diagnosis and histopathological features of the tumor were also compared. Results: Compared to pre-pandemic mammography scans, a 44% decrease was observed in total during pandemic, the most significant being in April (-98%) and May (-93%). While there was a significant decrease in the number of biopsies in April (-100%) and May (-69%), it was seen that there was no decrease in the pandemic period when the whole year was looked at with a rebound increase that started with 29% in June. In the breast cancer group, there was a significant increase in the number of patients who were metastatic at the time of diagnosis compared to the pre-pandemic period (p=0.001). No significant difference was observed between the two groups in terms of tumor grade, hormone receptor status, or HER2 positivity (p>0.05). Conclusions: In this study, it was observed that both screening and diagnosis processes in breast cancer were significantly affected during the COVID-19 pandemic. It was observed that the delay in admission to the hospital in the first months of the pandemic resulted in an increase in patients who were metastatic at the time of diagnosis.

Anahtar Kelimeler:

COVID-19, meme kanseri, kanser taraması

Impact of COVID-19 Pandemic on Breast Cancer Screening and Diagnosis Process

Aim: The COVID-19 pandemic has caused delays in breast cancer screening and diagnostic procedures. The aim of this research was to compare the status of breast cancer screenings and newly diagnosed breast cancer cases during the pandemic compared to the pre-pandemic period. Material and method: This retrospective study included patients with screening mammography, imaging-guided biopsies, and newly diagnosed breast cancer from March 2020– February 2021 (during-COVID-19) were compared with March 2019–February 2020 (pre-COVID-19). We compared numbers and distribution over time of mammography and biopsies between the time periods. In the breast cancer group; the stage at diagnosis and histopathological features of the tumor were also compared. Results: Compared to pre-pandemic mammography scans, a 44% decrease was observed in total during pandemic, the most significant being in April (-98%) and May (-93%). While there was a significant decrease in the number of biopsies in April (-100%) and May (-69%), it was seen that there was no decrease in the pandemic period when the whole year was looked at with a rebound increase that started with 29% in June. In the breast cancer group, there was a significant increase in the number of patients who were metastatic at the time of diagnosis compared to the pre-pandemic period (p=0.001). No significant difference was observed between the two groups in terms of tumor grade, hormone receptor status, or HER2 positivity (p>0.05). Conclusions: In this study, it was observed that both screening and diagnosis processes in breast cancer were significantly affected during the COVID-19 pandemic. It was observed that the delay in admission to the hospital in the first months of the pandemic resulted in an increase in patients who were metastatic at the time of diagnosis.

Keywords:

COVID-19, meme kanseri, kanser taraması,

PDF

___

1. Roberts DL, Rossman JS, Jarić I. Dating first cases of COVID-19. PLoS Pathog. 2021;17(6):e1009620. doi:10.1371/journal.ppat.1009620
2. Citgez B, Yigit B, Capkinoglu E, Yetkin SG. Management of Breast Cancer during the COVID-19 Pandemic. Sisli Etfal Hastan Tip Bul. 2020;54(2):132-135. doi:10.14744/SEMB.2020.23326
3. Prabhakar AM, Glover M 4th, Schaefer PW, Brink JA. Academic Radiology Departmental Operational Strategy Related to the Coronavirus Disease 2019 (COVID-19) Pandemic. J Am Coll Radiol. 2020;17(6):730-733. doi:10.1016/j.jacr.2020.04.004
4. Vanni G, Pellicciaro M, Materazzo M, et al. Lockdown of Breast Cancer Screening for COVID-19: Possible Scenario. In Vivo. 2020;34(5):3047-3053. doi:10.21873/invivo.12139
5. TR Ministry of Health. Turkey Cancer Control Programme. Ankara, Turkey, 2021.
6. Caplan L. Delay in breast cancer: implications for stage at diagnosis and survival. Front Public Health. 2014;2:87. doi:10.3389/fpubh.2014.00087.
7. Puliti D, Bucchi L, Mancini S, et al. Advanced breast cancer rates in the epoch of service screening: The 400,000 women cohort study from Italy. Eur J Cancer. 2017;75:109-116. doi:10.1016/j.ejca.2016.12.030
8. Tonneson JE, Hoskin TL, Day CN, Durgan DM, Dilaveri CA, Boughey JC. Impact of the COVID-19 Pand emic on Breast Cancer Stage at Diagnosis, Presentation, and Patient Management. Ann Surg Oncol. 2022;29(4):2231-2239. doi:10.1245/s10434-021-11088-6
9. Eijkelboom AH, de Munck L, Vrancken Peeters MTFD, et al. Impact of the COVID-19 pandemic on diagnosis, stage, and initial treatment of breast cancer in the Netherlands: a population-based study. J Hematol Oncol. 2021;14(1):64. doi:10.1186/s13045-021-01073-7
10. Gathani T, Clayton G, MacInnes E, Horgan K. The COVID-19 pandemic and impact on breast cancer diagnoses: what happened in England in the first half of 2020. Br J Cancer. 2021;124(4):710-712. doi:10.1038/s41416-020-01182-z
11. McBain RK, Cantor JH, Jena AB, Pera MF, Bravata DM, Whaley CM. Decline and Rebound in Routine Cancer Screening Rates During the COVID-19 Pandemic. J Gen Intern Med. 2021;36(6):1829-1831. doi:10.1007/s11606-021-06660-5
12. Linck PA, Garnier C, Depetiteville MP, et al. Impact of the COVID-19 lockdown in France on the diagnosis and staging of breast cancers in a tertiary cancer centre. Eur Radiol. 2022;32(3):1644-1651. doi:10.1007/s00330-021-08264-3
13. Simão D, Sardinha M, Reis AF, Spencer AS, Luz R, Oliveira S. What Has Changed During the COVID-19 Pandemic? - The Effect on an Academic Breast Department in Portugal. Eur J Breast Health. 2021;18(1):74-78. doi:10.4274/ejbh.galenos.2021.2021-11-1
14. Maringe C, Spicer J, Morris M, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study Lancet Oncol. 2020;21(8):1023-1034. doi:10.1016/S1470-2045(20)30388-0
15. Hamilton W. Cancer diagnostic delay in the COVID-19 era: what happens next?. Lancet Oncol. 2020;21(8):1000-1002. doi:10.1016/S1470-2045(20)30391-0
16. Kalli S, Semine A, Cohen S, Naber SP, Makim SS, Bahl M. American Joint Committee on Cancer's Staging System for Breast Cancer, Eighth Edition: What the Radiologist Needs to Know. Radiographics. 2018;38(7):1921-1933. doi:10.1148/rg.2018180056
17. Kolak A, Kamińska M, Sygit K, et al. Primary and secondary prevention of breast cancer. Ann Agric Environ Med. 2017;24(4):549-553. doi:10.26444/aaem/75943
18. Lebron-Zapata L, Jochelson MS. Overview of Breast Cancer Screening and Diagnosis. PET Clin. 2018;13(3):301-323. doi:10.1016/j.cpet.2018.02.001.
19. Cedolini C, Bertozzi S, Londero AP, et al. Type of breast cancer diagnosis, screening, and survival. Clin Breast Cancer. 2014;14(4):235-240. doi:10.1016/j.clbc.2014.02.004
20. Puliti D, Bucchi L, Mancini S, et al. Advanced breast cancer rates in the epoch of service screening: The 400,000 women cohort study from Italy. Eur J Cancer. 2017;75:109-116. doi:10.1016/j.ejca.2016.12.030
21. Naidich JJ, Boltyenkov A, Wang JJ, Chusid J, Hughes D, Sanelli PC. Impact of the Coronavirus Disease 2019 (COVID-19) Pandemic on Imaging Case Volumes. J Am Coll Radiol. 2020;17(7):865-872. doi:10.1016/j.jacr.2020.05.004
22. Norbash AM, Moore AV Jr, Recht MP, et al. Early-Stage Radiology Volume Effects and Considerations with the Coronavirus Disease 2019 (COVID-19) Pandemic: Adaptations, Risks, and Lessons Learned. J Am Coll Radiol. 2020;17(9):1086-1095. doi:10.1016/j.jacr.2020.07.001
23. Nyante SJ, Benefield TS, Kuzmiak CM, Earnhardt K, Pritchard M, Henderson LM. Population-level impact of coronavirus disease 2019 on breast cancer screening and diagnostic procedures. Cancer. 2021;127(12):2111-2121. doi:10.1002/cncr.33460
24. The American Society of Breast Surgeons and The American College of Radiology. Joint Statement on Breast Screening Exams During the Covid-19 Pandemic. https://www.breastsurgeons.org/news/?id=45. Accessed May 29,2022.
25. Madhuripan N, Cheung HMC, Alicia Cheong LH, Jawahar A, Willis MH, Larson DB. Variables Influencing Radiology Volume Recovery During the Next Phase of the Coronavirus Disease 2019 (COVID-19) Pandemic. J Am Coll Radiol. 2020;17(7):855-864. doi:10.1016/j.jacr.2020.05.026
26. Tachibana BMT, Ribeiro RLM, Federicci ÉEF, et al. The delay of breast cancer diagnosis during the COVID-19 pandemic in São Paulo, Brazil. Einstein (Sao Paulo). 2021;19:eAO6721. doi:10.31744/einstein_journal/2021AO6721
27. Coskun Bilge A, Aydin H, Esen Bostanci I. Impact Of The First Wave Of The Covid - 19 Pandemic On Breast Imaging Practice – A Tertiary Cancer Care Hospital Experience. Ankara Eğt. Arş. Hast. Derg., 2022 ; 55(3) : 175-178. doi: 10.20492/aeahtd.1025814
28. İlgün AS, Özmen V. The Impact of the COVID-19 Pandemic on Breast Cancer Patients. Eur J Breast Health. 2021;18(1):85-90. doi:10.4274/ejbh.galenos.2021.2021-11-5
29. Vanni G, Tazzioli G, Pellicciaro M, et al. Delay in Breast Cancer Treatments During the First COVID-19 Lockdown. A Multicentric Analysis of 432 Patients. Anticancer Res. 2020;40(12):7119-7125. doi:10.21873/anticanres.14741
30. Gürsoy M, Aslan Ö, Oktay Alfatlı A, Zekioğlu O, Göktepe B. Radiological and clinicopathological findings of breast cancer during the COVID-19 pandemic: a comparative study with the pre-pandemic era. Diagn Interv Radiol. 2023;29(1):53-58. doi:10.5152/dir.2022.21646
31. Mariotto AB, Etzioni R, Hurlbert M, Penberthy L, Mayer M. Estimation of the Number of Women Living with Metastatic Breast Cancer in the United States. Cancer Epidemiol Biomarkers Prev. 2017;26(6):809-815. doi:10.1158/1055-9965.EPI-16-0889
32. Maringe C, Spicer J, Morris M, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study Lancet Oncol. 2020;21(8):1023-1034. doi:10.1016/S1470-2045(20)30388-0