The pressure on breast screening programmes across many European countries during the COVID-19 pandemic could lead to an increase in deaths from cancer, a conference will hear today.
A new study, which is to be presented at the 12th European Breast Cancer Conference, says the risk could be reduced if all women who would have been screened during the pandemic do not miss out, even if they are now older than the upper age limit for screening.
Lindy Kregting, a PhD student at Erasmus MC, University Medical Centre Rotterdam, The Netherlands, and colleagues used MISCAN-Breast to simulate four different strategies for re-starting breast screening following six months of disruption.
These were: a restart, with all screening continuing in the order it was planned, which would result in one in every four women would having screening one less time in her life; a delay to screening, except for women due to have their first screening; a delay to screening, but temporarily raising the upper age limit to ensure women do not miss their final screen; and increasing capacity to ensure delayed screens catch up in a six-month period following the disruption.
Researchers found that the first scenario had the most damaging effect, with an estimated increase of 2.35 deaths from breast cancer for every 100,000 women in the next ten years, while the best-case scenario was increasing capacity to achieve a full catch-up, which would lead to an increase of only 0.13 deaths from breast cancer out of every 100,000 women in the next ten years.
The other two scenarios showed respective increases of 1.98 and 1.85 in breast cancer deaths per 100,000 in the next ten years.
A second study to be presented at the conference examined how the COVID-19 pandemic affected the daily lives of 1051 women diagnosed with breast cancer from Utrecht.
It found that 48% of women felt lonely during the pandemic, 31% were less likely to seek help from their GP, 27% were worried about the effects of the pandemic on their aftercare and 15% were less likely to seek help from their breast cancer physician.
A third study compared 41 women treated for breast cancer in March and April 2020 at the University Hospital of Sassari, Italy, with 42 who were treated in March and April of the previous year.
While there was no difference in how many women had surgery for breast cancer, how long they waited for surgery or whether they had a sentinel node biopsy, the researchers found that women operated on during the peak of the COVID-19 pandemic were less likely to receive immediate breast reconstruction following mastectomy or to receive an intraoperative regional nerve block.
Dr Alessandro Fancellu, associate professor of surgery at the University of Sassari, Italy, said: “These two procedures do not have an effect on the risk of breast cancer returning; however, they do have an effect on women’s quality of life following breast cancer surgery. We know that there could be a second peak of COVID-19 and, if that happens, we want maintain the highest possible standards for our patients.”
The conference will also hear about a new test that could identify patients with invasive lobular carcinoma (ILC) that is at high risk of recurring and progressing.
Adjuvant treatments are not usually offered to ILC patients after surgery because the disease is slow growing and often responds well to hormone treatment alone.
But a 70-gene signature test identified some ILC patients whose genetic make-up puts them at high risk of the cancer recurring if they are only treated with hormone therapy.
Professor Fatima Cardoso, director of the breast unit of the Champalimaud Clinical Centre in Lisbon, Portugal, and principle investigator of the international MINDACT trial, said they identified a subset of ILC patients who could potentially benefit from chemotherapy or other adjuvant treatments.
The trial included 6,693 women with early-stage breast cancer, of whom 5,313 patients were included in the current analysis. 487 women had ILC, including 255 classic cases of the disease and 232 variants, and 4,826 had IDC.
The 70-gene signature test classified 16.2% of ILC as high genomic risk and 39.1% of IDC as high genomic risk. By comparing classic ILC to variants of ILC, 10.2% of classic ILC and 22.8% of ILC variants were found to be high genomic risk.
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