Breast cancer incidence, stage distribution, and treatment shifts during the 2020 COVID-19 pandemic: a nationwide population-level study.
Breast Cancer
COVID-19 pandemic
Cancer Registry
Diagnostic Delay
National Healthcare
Population-based data
TNM Stage
Journal
Archives of public health = Archives belges de sante publique
ISSN: 0778-7367
Titre abrégé: Arch Public Health
Pays: England
ID NLM: 9208826
Informations de publication
Date de publication:
07 May 2024
07 May 2024
Historique:
received:
28
09
2023
accepted:
23
04
2024
medline:
8
5
2024
pubmed:
8
5
2024
entrez:
7
5
2024
Statut:
epublish
Résumé
The first COVID-19 wave in 2020 necessitated temporary suspension of non-essential medical services including organized cancer screening programs in Belgium. This study assessed the impact of the pandemic on breast cancer (BC) incidence, stage at diagnosis, and management in Belgium in 2020. All Belgian residents diagnosed with in situ or invasive BC in 2015-2020 in the nationwide, population-based cancer registry database were included. Incidence trends for 2015-2019 were extrapolated to predict incidence and stage distribution for 2020 and compared with the observed values. National healthcare reimbursement data were used to examine treatment strategies. Exact tumor diameter and nodal involvement, extracted from pathology reports, were analyzed for 2019 and 2020. 74,975 tumors were selected for analysis of incidence and clinical stage. Invasive BC incidence declined by -5.0% in 2020, with a drop during the first COVID-19 wave (Mar-Jun; -23%) followed by a rebound (Jul-Dec; +7%). Predicted and observed incidence (in situ + invasive) was not different in patients < 50 years. In the 50-69 and 70 + age groups, significant declines of -4.1% and - 8.4% respectively were found. Excess declines were seen in clinical stage 0 and I in Mar-Jun, without excess increases in clinical stage II-IV tumors in Jul-Dec. There was no increase in average tumor diameter or nodal involvement in 2020. Patients diagnosed in Mar-Jun received significantly more neoadjuvant therapy, particularly neoadjuvant hormonal therapy for patients with clinical stage I-II BC. BC incidence decline in 2020 in Belgium was largely restricted to very early-stage BC and patients aged 50 and over. Delayed diagnosis did not result in an overall progression to higher stage at diagnosis in 2020. Observed treatment adaptations in Belgium were successful in prioritizing patients for surgery while preventing tumor progression in those with surgical delay. Continuation of monitoring BC incidence and stage in the future is crucial.
Sections du résumé
BACKGROUND
BACKGROUND
The first COVID-19 wave in 2020 necessitated temporary suspension of non-essential medical services including organized cancer screening programs in Belgium. This study assessed the impact of the pandemic on breast cancer (BC) incidence, stage at diagnosis, and management in Belgium in 2020.
METHODS
METHODS
All Belgian residents diagnosed with in situ or invasive BC in 2015-2020 in the nationwide, population-based cancer registry database were included. Incidence trends for 2015-2019 were extrapolated to predict incidence and stage distribution for 2020 and compared with the observed values. National healthcare reimbursement data were used to examine treatment strategies. Exact tumor diameter and nodal involvement, extracted from pathology reports, were analyzed for 2019 and 2020.
RESULTS
RESULTS
74,975 tumors were selected for analysis of incidence and clinical stage. Invasive BC incidence declined by -5.0% in 2020, with a drop during the first COVID-19 wave (Mar-Jun; -23%) followed by a rebound (Jul-Dec; +7%). Predicted and observed incidence (in situ + invasive) was not different in patients < 50 years. In the 50-69 and 70 + age groups, significant declines of -4.1% and - 8.4% respectively were found. Excess declines were seen in clinical stage 0 and I in Mar-Jun, without excess increases in clinical stage II-IV tumors in Jul-Dec. There was no increase in average tumor diameter or nodal involvement in 2020. Patients diagnosed in Mar-Jun received significantly more neoadjuvant therapy, particularly neoadjuvant hormonal therapy for patients with clinical stage I-II BC.
CONCLUSIONS
CONCLUSIONS
BC incidence decline in 2020 in Belgium was largely restricted to very early-stage BC and patients aged 50 and over. Delayed diagnosis did not result in an overall progression to higher stage at diagnosis in 2020. Observed treatment adaptations in Belgium were successful in prioritizing patients for surgery while preventing tumor progression in those with surgical delay. Continuation of monitoring BC incidence and stage in the future is crucial.
Identifiants
pubmed: 38715074
doi: 10.1186/s13690-024-01296-3
pii: 10.1186/s13690-024-01296-3
doi:
Types de publication
Journal Article
Langues
eng
Pagination
66Informations de copyright
© 2024. The Author(s).
Références
Sciensano, COVID-19 SURVEILLANCE FREQUENTLY ASKED QUESTIONS. 2022 [updated 20/10/2022. https://covid-19.sciensano.be/sites/default/files/Covid19/COVID-19_FAQ_ENG_final.pdf
Jidkova S, Hoeck S, Kellen E, et al. Flemish population-based cancer screening programs: impact of COVID-19 related shutdown on short-term key performance indicators. BMC Cancer. 2022;22(1):183.
doi: 10.1186/s12885-022-09292-y
pubmed: 35177021
pmcid: 8853842
http://www.healthybelgium.be; accessed on 6 February 2024.
http:// borstkanker.bevolkingsonderzoek.be/nl/bk/wat-het-bevolkingsonderzoek-borstkanker ; accessed on 6 February 2024.
http://www.depistagecancer.be/ccr/particulier/sein.php ; accessed on 6 February 2024.
Gerkens S, Lefèvre M, Bouckaert N et al. Performance of the Belgian health system: Report 2024. Health Services Research (HSR). Brussels. Belgian Health Care Knowledge Centre (KCE). 2024. KCE Reports 376C. https://doi.org/10.57598/R376C
Belgian Cancer Registry. Short report: Cancer Burden in Belgium, 2004–2019. Brussels: Belgian Cancer Registry; 2022.
Peacock HM, Tambuyzer T, Verdoodt F, et al. Decline and incomplete recovery in cancer diagnoses during the COVID-19 pandemic in Belgium: a year-long, population-level analysis. ESMO Open. 2021;6(4):100197.
doi: 10.1016/j.esmoop.2021.100197
pubmed: 34474811
pmcid: 8411068
Facina G, Marques de Oliveira V. Breast cancer care during the coronavirus pandemic. Mastology. 2020;30.
Sheng JY, Santa-Maria CA, Mangini N, et al. Management of breast Cancer during the COVID-19 pandemic: a stage- and subtype-specific Approach. JCO Oncol Pract. 2020;16(10):665–74.
doi: 10.1200/OP.20.00364
pubmed: 32603252
pmcid: 7564133
Society of Surgical Oncology. Resource for management options of breast cancer during COVID-19 2020 [updated 2020-03-30. https://www.surgonc.org/wp-content/uploads/2020/03/Breast-Resource-during-COVID-19-3.30.20.pdf
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. Breast Cancer Res Treat. 2020;181(3):487–97.
doi: 10.1007/s10549-020-05644-z
pubmed: 32333293
pmcid: 7181102
ESMO. ESMO Management and treatment adapted recommendations in the COVID-19 era: breast cancer: ESMO; [ https://www.esmo.org/guidelines/guidelines-by-topic/breast-cancer/breast-cancer-in-the-covid-19-era
van Dam P, Tomatis M, Ponti A, et al. The impact of the SARS-COV-2 pandemic on the quality of breast cancer care in EUSOMA-certified breast centres. Eur J Cancer. 2022;177:72–9.
doi: 10.1016/j.ejca.2022.09.027
pubmed: 36332437
pmcid: 9554010
Wet Houdende Diverse Bepalingen Betreffende Gezondheid van 13. December 2006 Hoofdstuk VI Artikel 39. B.S.; 2006.
Oken MM, Creec RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5(6):649–56.
doi: 10.1097/00000421-198212000-00014
pubmed: 7165009
Sobin LH, Gospodarowicz MK, Wittekind C, editors. TNM Classification of Malignant Tumours International Union Against Cancer (UICC). 7th ed. Hoboken, NJ:v Wiley-Blackwell (2009).
Brierley JD, Gospodarowicz MK, Wittekind C, editors. TNM classification of malignant tumours, International Union Against Cancer (UICC). 8th ed. Hoboken, NJ: Wiley-Blackwell; 2017.
Organization WH. International Statistical Classification of Diseases and Related Health Problems 10th Revision, 2010.
Fritz A, Percy C, Jack A, et al. International classification of diseases for oncology (ICD-O-3). 3rd ed. Geneva: WHO; 2000.
Wet houdende diverse bepalingen betreffende gezondheid van 13 december. 2006, artikel 39. Belgisch Staatsblad, 22 december 2006. Loi portant dispositons diverses en matière de santé du 13 décembre 2006, article 39. Moniteur Belge, 22 décembre 2006.
Commissie voor de bescherming van de persoonlijke levenssfeer. Beraadslaging nr 09/071 van 15 september 2009, laatst gewijzigd op 18 februari 2014, met betrekking tot de mededeling van persoonsgegevens door de verzekeringsinstellingen aan de Stichting Kankerregister in het kader van artikel 45 quinquies van het KB nr. 78 van 10 november 1967 betreffende de uitoefening van de gezondheidsberoepen / Délibération n◦09/071 du 15 septembre 2009, modifiée le 18 février 2014, relative à la communication de données à caractère personnel par les organismes assureurs à la Fondation Registre du Cancer dans le cadre de l’article 45quinquies de l’AR n◦ 78 du 10 novembre 1967 relatif è l’exercice des professions des soins de santé. 2014 [cited; https://www.privacycommission.be/sites/privacycommission/files/documents/d%C3%A9lib%C3%A9ration_SS_071_2009.pdf
Jegou D, Dubois C, Schillemans V, et al. Use of health insurance data to identify and quantify the prevalence of main comorbidities in lung cancer patients. Lung Cancer. 2018;125:238–44.
doi: 10.1016/j.lungcan.2018.10.002
pubmed: 30429027
Peacock HM, De Gendt C, Silversmit G et al. Stage shift and relative survival for head and neck cancer during the 2020 COVID-19 pandemic: a population-based study of temporal trends. 2023 Front Oncol 13:1253968. https://doi.org/10.3389/fonc.2023.1253968
Daly L. Simple SAS macros for the calculation of exact binomial and Poisson confidence limits. Comput Biol Med. 1992;22(5):351–61.
doi: 10.1016/0010-4825(92)90023-G
pubmed: 1424580
Koninklijk besluit nr. 20 houdende tijdelijke maatregelen in de strijd tegen de COVID-19 pandemie en ter verzekering van de continuïteit van zorg in de verplichte verzekering voor geneeskundige verzorging. (2020).
Li T, Nickel B, Ngo P, et al. A systematic review of the impact of the COVID-19 pandemic on breast cancer screening and diagnosis. Breast. 2023;67:78–88.
doi: 10.1016/j.breast.2023.01.001
pubmed: 36646004
pmcid: 9813855
Eijkelboom AH, de Munck L, Lobbes MBI, et al. Impact of the suspension and restart of the Dutch breast cancer screening program on breast cancer incidence and stage during the COVID-19 pandemic. Prev Med. 2021;151:106602.
doi: 10.1016/j.ypmed.2021.106602
pubmed: 34217417
pmcid: 9755636
Eijkelboom AH, de Munck L, Vrancken Peeters M, 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
pubmed: 33865430
pmcid: 8052935
Public Health Scotland. Cancer Staging Data using 2018–2020 DCE Data – the impact of COVID-19. 2021.
Yong JH, Mainprize JG, Yaffe MJ, et al. The impact of episodic screening interruption: COVID-19 and population-based cancer screening in Canada. J Med Screen. 2021;28(2):100–7.
doi: 10.1177/0969141320974711
pubmed: 33241760
IKNL. COVID-19 en borstkanker 2023 [ https://iknl.nl/monitor/covid-19-en-borstkanker
Burki TK. Cancer guidelines during the COVID-19 pandemic. Lancet Oncol. 2020;21(5):629–30.
doi: 10.1016/S1470-2045(20)30217-5
pubmed: 32247319
pmcid: 7270910
Hanna TP, Evans GA, Booth CM, Cancer. COVID-19 and the precautionary principle: prioritizing treatment during a global pandemic. Nat Rev Clin Oncol. 2020;17(5):268–70.
doi: 10.1038/s41571-020-0362-6
pubmed: 32242095
pmcid: 7117554
COVID 19 Pandemic Breast Cancer Consortium. COVID-19 guidelines for triage of breast Cancer patients. American College of Surgeons; 2020 2020-03-24. Contract 2023-01-11.
Habbous S, Tai X, Beca JM, et al. Comparison of Use of Neoadjuvant systemic treatment for breast Cancer and short-term outcomes before vs during the COVID-19 era in Ontario, Canada. JAMA Netw Open. 2022;5(8):e2225118.
doi: 10.1001/jamanetworkopen.2022.25118
pubmed: 35917122
pmcid: 9346546
Park KU, Gregory M, Bazan J, et al. Neoadjuvant endocrine therapy use in early stage breast cancer during the covid-19 pandemic. Breast Cancer Res Treat. 2021;188(1):249–58.
doi: 10.1007/s10549-021-06153-3
pubmed: 33651271
pmcid: 7921279
Tonneson JE, Hoskin TL, Day CN, et al. Impact of the COVID-19 pandemic on breast Cancer stage at diagnosis, presentation, and Patient Management. Ann Surg Oncol. 2022;29(4):2231–9.
doi: 10.1245/s10434-021-11088-6
pubmed: 34812981
Coles CE, Aristei C, Bliss J, et al. International guidelines on Radiation Therapy for breast Cancer during the COVID-19 pandemic. Clin Oncol (R Coll Radiol). 2020;32(5):279–81.
doi: 10.1016/j.clon.2020.03.006
pubmed: 32241520
Alaidy Z, Mohamed A, Euhus D. Breast cancer progression when definitive surgery is delayed. Breast J. 2021;27(4):307–13.
doi: 10.1111/tbj.14177
pubmed: 33501676
Borsky K, Shah K, Cunnick G, et al. Pattern of breast cancer presentation during the COVID-19 pandemic: results from a cohort study in the UK. Future Oncol. 2022;18(4):437–43.
doi: 10.2217/fon-2021-0970
pubmed: 35018787
Ilgun AS, Ozmen V. The impact of the COVID-19 pandemic on breast Cancer patients. Eur J Breast Health. 2022;18(1):85–90.
doi: 10.4274/ejbh.galenos.2021.2021-11-5
pubmed: 35059596
Mentrasti G, Cantini L, Vici P, et al. Rising incidence of late stage breast cancer after COVID-19 outbreak. Real-world data from the Italian COVID-DELAY study. Breast. 2022;65:164–71.
doi: 10.1016/j.breast.2022.08.007
pubmed: 35998429
pmcid: 9388078
Lloyd MR, Stephens SJ, Hong JC, et al. The impact of COVID-19 on breast cancer stage at diagnosis. J Clin Oncol. 2021;39(15suppl):528.
doi: 10.1200/JCO.2021.39.15_suppl.528
Trojanowski M, Radomyski P, Matuszewski K et al. Impact of the COVID-19 pandemic on breast Cancer stage at diagnosis in a Regional Cancer Center in Poland between 2019 and 2021. J Pers Med. 2022;12(9).
Zhou JZ, Kane S, Ramsey C, et al. Comparison of early- and late-stage breast and Colorectal Cancer diagnoses during vs before the COVID-19 pandemic. JAMA Netw Open. 2022;5(2):e2148581.
doi: 10.1001/jamanetworkopen.2021.48581
pubmed: 35166787
pmcid: 8848202
Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.
doi: 10.3322/caac.21492
pubmed: 30207593
Meurisse M, Lajot A, Devleesschauwer B, et al. The association between area deprivation and COVID-19 incidence: a municipality-level spatio-temporal study in Belgium, 2020–2021. Arch Public Health. 2022;80(1):109.
doi: 10.1186/s13690-022-00856-9
pubmed: 35366953
pmcid: 8976211
Rosskamp M, Verbeeck J, Gadeyne S, et al. Socio-Economic position, Cancer incidence and stage at diagnosis: a Nationwide Cohort Study in Belgium. Cancers. 2021;13(5):933.
doi: 10.3390/cancers13050933
pubmed: 33668089
pmcid: 7956180
Smith D, Thomson K, Bambra C, et al. The breast cancer paradox: a systematic review of the association between area-level deprivation and breast cancer screening uptake in Europe. Cancer Epidemiol. 2019;60:77–85.
doi: 10.1016/j.canep.2019.03.008
pubmed: 30927689
pmcid: 6547165
Monsivais P, Amiri S, Robison J, et al. Racial and socioeconomic inequities in breast cancer screening before and during the COVID-19 pandemic: analysis of two cohorts of women 50 years +. Breast Cancer. 2022;29(4):740–6.
doi: 10.1007/s12282-022-01352-2
pubmed: 35366175
Amram O, Robison J, Amiri S, et al. Socioeconomic and racial inequities in breast Cancer Screening during the COVID-19 pandemic in Washington State. JAMA Netw Open. 2021;4(5):e2110946.
doi: 10.1001/jamanetworkopen.2021.10946
pubmed: 34028552
pmcid: 8144923