Although time to treatment initiation (TTI) remained the same during the coronavirus disease 2019 (COVID-19) pandemic for patients with early-stage breast cancer, there was a shift to greater use of preoperative therapy compared with 2 years earlier, according to the results of a retrospective study published in JCO Oncology Practice.

Healthcare systems have been under substantial pressure during the COVID-19 pandemic, particularly in the early period with many resources diverted to treating the disease. This has raised “concern that related care delays will result in excess cancer-related deaths,” the authors wrote. The aim of this study was to determine if there were treatment delays for patients with early-stage breast cancer.

The retrospective study included a cohort of 164 patients with newly-diagnosed early-stage breast cancer between January 2020 and May 2020, and another cohort of 202 patients diagnosed during the same time period in 2018 at a 6-hospital health system. Early-stage breast cancer included ductal carcinoma in situ (DCIS) or lobular carcinoma in situ (LCIS).  The primary endpoint was TTI.

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Patients in both cohorts had similar characteristics, including age, race, cancer subtype, and histology.

Stage at diagnosis significantly differed between the cohorts (P =.040). Stage 0, or DCIS, was diagnosed more frequently in the 2018 cohort at 26.2% compared with 13.4% in the 2020 cohort. The percentage of patients diagnosed with stage I and II disease were higher in the 2020 cohort (56.7% and 21.3%, respective) compared with the 2018 cohort (50.5% and 16.3%, respectively), but the absolute numbers were similar between the groups.

The TTI remained unchanged during the COVID-19 pandemic. The mean TTI was 44.7 days in the 2018 cohort and 44.4 days in the 2020 cohort (P =.926). However, the TTI among Black patients was 16 days longer compared with White patients in both cohorts (P =.001).

During the pandemic, initial treatment shifted to an increased use of preoperative systemic therapy at 43.9% compared with 16.4% in the 2018 cohort (P <.001). In the 2020 cohort, preoperative therapy comprised 20.7% chemotherapy and 23.2% hormonal therapy. In the 2018 cohort, 12.4% and 4.0% of patients received chemotherapy or hormonal therapy, respectively.

The authors concluded that “patients treated for breast cancer did not experience higher rates of treatment delays during COVID-19.” They attributed this to consensus guidelines and mitigation strategies that were adopted during the pandemic.


Hawrot K, Shulman LN, Bleiweiss IJ, et al. Time to treatment initiation for breast cancer during the 2020 COVID-19 pandemic. JCO Oncol Pract. Published online March 12, 2021. doi:10.1200/OP.20.00807