Was Your Breast Cancer Surgery Delayed Due To COVID-19?

This [delay in surgery] has been distressing for many patients with newly diagnosed early stage breast cancers.

During the early weeks and months of COVID-19, when hospitals were preparing for or dealing with a surge of very ill patients, all elective surgeries — including early stage breast cancer surgeries — were delayed or cancelled. This generally meant that a surgery that was urgently needed to save a life would be performed, but any surgery that would not damage health by a delay was postponed.

This [delay in surgery] has been distressing for many patients with newly diagnosed early stage breast cancers. Surgery generally was performed for patients with triple negative breast cancers or high-risk situations, but those with early stage ER-positive breast cancers were started on anti-estrogen or hormonal therapies and told that surgery would happen when it was possible.

For a number of years, surgery has sometimes been delayed in order to immediately start a patient on chemotherapy who is deemed to be a particularly high risk of developing metastatic breast cancer or with the hope of reducing the size of the primary tumor to avoid a mastectomy. Even in those situations, the surgical delay was often distressing. When first diagnosed with breast cancer, most want the tumor out. It is very disconcerting to know that a cluster of cancer cells is present in one's breast even if chemotherapy has begun.

Since anti-estrogen/hormonal therapies are so useful for ER-positive breast cancers and since they are virtually always part of treatment, there has not been a concern about prescribing this course of treatment. Generally, chemotherapy has not been immediately initiated over the past few months as that decision relies on the information that is only available from the pathology report after surgery. This information includes the size of the tumor, more specifics of the cells, and whether any axillary lymph nodes are involved with cancer.

A few years ago, there was a study in which women with larger ER-positive breast cancers were put on anti-estrogen/hormonal therapies for several months before surgery; this was a similar strategy to sometimes initiating chemotherapy first for high risk women. In both situations, this was referred to a neo-adjuvant therapy.

As reported in the Journal of the American College of Surgeons, delaying surgery in ER-positive early stage breast cancer and, instead, beginning treatment with an endocrine therapy did not decrease the odds of 5-year survival or increase the odds of a later stage cancer being eventually diagnosed at the time of surgery. The study went back to records of women who were diagnosed with these breast cancers between 2010 and 2016. The average wait until surgery was less than 120 days for 98% of these women. This delay is comparable to what has happened during the pandemic as hospitals have resumed these surgeries after the first weeks of the epidemic.

This information has to be very reassuring for those having a new cancer diagnosis coinciding with the pandemic. Dealing with either crisis is tough enough; contending with both at once is overwhelming. Waiting for surgery has been especially hard, but other aspects of new cancer care during the pandemic have been hard, too.

Several patients have told me how disconcerting it is to have never seen their doctor in person without a mask. Others have commented on the discomfort of not meeting their doctors in person at all but talking with them only on a screen.

Since the human connection and human touch are an enormous part of healing, putting up these artificial barriers has been painful. We need to remind ourselves, over and over, that this, too, will pass.