Breast cancer presentation, diagnosis and outcomes during COVID-19 pandemic - a single center case control study in Hong Kong

Abstract

Aim: Behavioral changes in seeking medical attention during COVID‐19 pandemic and its impact on breast cancer outcomes has never been studied. Methods: This is a case‐control study comparing breast cancer patients treated between Quarter 1 2020 (Case, COVID‐19 pandemic) and Quarter 1 2019 (Control). Clinical and pathological data between the two groups were compared. Patients from the case group were interviewed using a standardized questionnaire. Results: There were 57 patients in the case group and 101 patients in the control group. Mean ages of diagnosis were 56.1 (Range 34–75) and 57.4 (Range 30–84) years old respectively. Mean duration of symptom prior to the first specialist consultation in the case group was 6.4 weeks (2–32 weeks) while that in the control group was 3.1 weeks. 12/57 (21.1%) patients had delayed presentation for their breast symptoms during COVID‐19 outbreak. The mean score of anxiety on hospital acquired COVID‐19 infection was 3.3 out of 5 (Range 1–5) There were significantly less DCIS in the case group (N = 5 vs 32, 8.8% vs 31.7%) (P = .0009). However, there were more T2 or above cancers in the case group (N = 32 vs 28, 56.1% vs 27.7%) (P = .0008). N stage was not significantly different between the two groups. Mean surgery waiting time were similar (2.6 and 2.5 weeks respectively). Mastectomy rate was lower in the case group (42% vs 75.4%). There was no difference in reconstruction rate (19.2% vs 16.8%). Conclusions: Breast cancer patients tends to present late during COVID‐19 pandemic.