“We were not surprised by our findings. Certainly the fact that surgical delays in DCIS are associated with a slight increase in pathological upstaging has already been documented, but the fundamental take-home point is that these patients still have an excellent prognosis. In the patients undergoing neoadjuvant endocrine therapy, no significant upstaging was seen, which supports our chosen delay strategy during the pandemic,” Dr Minami explained.

However, she stressed that the patient population in their study differs from patients who received NET during the pandemic. Before the pandemic, NET was not in widespread use in the United States for early-stage ER+ breast cancer. Study participants who received NET between 2010 and 2016 did so for specific reasons, such as older age and coexisting illnesses.

Cautiously Optimistic Perspectives

Lesly Dossett, MD, a breast cancer surgeon, assistant professor of surgery at Michigan Medicine, and a member of the University of Michigan (U-M) Rogel Cancer Center in Ann Arbor, said this study is helpful as it confirms the already widely held belief that short delays in time to surgery in these patients do not change their overall excellent prognosis (email communication, August 2020).


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“Now, we have data to support these necessary changes in practice and reassure our patients that especially in cases where they will receive neoadjuvant endocrine therapy, they are very unlikely to experience tumor progression,” she added.

These study findings are not surprising with respect to upstaging, commented Richard J. Bleicher, MD, professor in the Department of Surgical Oncology and director of the Breast Fellowship Program at Fox Chase Cancer Center in Philadelphia, Pennsylvania (email communication, August 2020). But it is interesting in that it explores the potential of applying data from before the pandemic to the current situation in which surgical treatment may be delayed.

The ER– cohort, for which a survival difference was not noted, was only one-fifth of the study population. This could play a role in the ability to detect small survival differences in this group. “It is surprising and interesting that the invasive cohorts did not see outcome declines, consistent with prior studies,” said Dr Bleicher. “The study ultimately suggests that direct assessment of patient outcomes from 2020 and the consequent changes in care will be important to assess the true impact of the pandemic,” he added.

Although these findings are encouraging and should bring comfort to women whose care is being affected by COVID-19, the study cohort involved women treated up to 10 years ago, noted David Brenin, MD, associate professor of surgery at the University of Virginia (UVA) School of Medicine and chief of breast surgery at UVA Health in Charlottesville, Virginia. “While patients whose surgery was delayed due to COVID-19 are likely to do just as well, it is important to recognize that the study was retrospective, and conducted on a group of patients treated between 2010 and 2016, in a situation that was not the same as what was happening at the beginning of the pandemic,” Dr Brenin pointed out.

References

  1. Minami CA, Kantor O, Weiss A, Nakhlis F, King TA, Mittendorf EA. Association between time to operation and pathological stage in ductal carcinoma in situ and early-stage hormone receptor-positive breast cancer. J Am Coll Surg. Published online August 6, 2020. doi:10.1016/j.jamcollsurg.2020.06.021
  2. Dietz JR, Moran MS, Isakoff SJ, et al. Recommendations for prioritization, treatment and triage of breast cancer patients during the COVID-19 pandemic. the COVID-19 pandemic breast cancer consortium. Accessed August 18, 2020. https://www.facs.org/-/media/files/quality-programs/napbc/asbrs_napbc_coc_nccn_acr_bc_covid_consortium_recommendations.ashx

This article originally appeared on Oncology Nurse Advisor