A prospective cohort study of the safety of breast cancer surgery during COVID-19 pandemic in the West of Scotland

• Main Authors: Laszlo Romics, Julie Doughty, Sheila Stallard, James Mansell, Vivienne Blackhall, Alison Lannigan, Suzanne Elgammal, Judith Reid, Marie-Claire McGuigan, Francesca Savioli, Sian Tovey, Dermott Murphy, Iona Reid, Andy Malyon, Jennifer McIlhenny, Christopher Wilson
• Format: Article
• Language: English
• Published: Elsevier 2021-02-01
• Series: Breast
• Subjects: Breast conservation therapy; Breast surgery; Mammaplasty; Pandemics; Breast cancer; COVID-19
• Online Access: http://www.sciencedirect.com/science/article/pii/S0960977620302216

Introduction: In order to minimise the risk of breast cancer patients for COVID-19 infection related morbidity and mortality prioritisation of care has utmost importance since the onset of the pandemic. However, COVID-19 related risk in patients undergoing breast cancer surgery has not been studied yet. We evaluated the safety of breast cancer surgery during COVID-19 pandemic in the West of Scotland region. Methods: A prospective cohort study of patients having breast cancer surgery was carried out in a geographical region during the first eight weeks of the hospital lockdown and outcomes were compared to the regional cancer registry data of pre-COVID-19 patients of the same units (n = 1415). Results: 188 operations were carried out in 179 patients. Tumour size was significantly larger in patients undergoing surgery during hospital lockdown than before (cT3-4: 16.8% vs. 7.4%; p < 0.001; pT2 – pT4: 45.5% vs. 35.6%; p = 0.002). ER negative and HER-2 positive rate was significantly higher during lockdown (ER negative: 41.3% vs. 17%, p < 0.001; HER-2 positive: 23.4% vs. 14.8%; p = 0.004). While breast conservation rate was lower during lockdown (58.6% vs. 65%; p < 0.001), level II oncoplastic conservation was significantly higher in order to reduce mastectomy rate (22.8% vs. 5.6%; p < 0.001). No immediate reconstruction was offered during lockdown. 51.2% had co-morbidity, and 7.8% developed postoperative complications in lockdown. There was no peri-operative COVID-19 infection related morbidity or mortality. Conclusion: breast cancer can be safely provided during COVID-19 pandemic in selected patients.