Impact of the COVID-19 pandemic on breast surgery in a reference service for breast cancer treatment

Introduction: The pandemic caused by the spread of the SARS-CoV-2 virus posed unprecedented challenges to health systems and societies worldwide. Among the greatest challenges was the importance of balancing the treatment of patients with potentially lethal diseases alongside the pandemic. Treatment for breast cancer, a time-dependent disease, was also compromised, as financial resources, supplies, medicines, and, especially, hospital beds needed to be allocated to assist those infected with the new coronavirus. Surgeries were suspended and surgical centers closed. To compare the number of breast surgical procedures before and during the pandemic and assess their impact on the proportional number of surgeries performed. Methods: This is a retrospective cohort study, reviewing procedures recorded from January 2015 to June 2021. Results: A total of 899 patients were included, the majority of whom were female; 58.5% of cases were oncological. The most prevalent surgery in both periods was conservative oncology (sectorectomy or quadrantectomy). There was a significant difference in the number of procedures performed before and during the COVID-19 outbreak, with a 43% drop during the pandemic. There was no significant difference in the pattern of surgeries. Conclusion: The pandemic caused a significant reduction in the total number of elective surgical interventions in the period analyzed ­ a delay that the literature identifies as a potential risk factor for disease progression and increased death rates. (AU)

Evaluation of clinical and pathological response factors to neoadjuvant chemotherapy in breast cancer patients

Objectives: To evaluate breast cancer (BC) patients treated with neoadjuvant chemotherapy (NACT) and to analyze clinicopathological features correlating with pathological complete response (PCR) and survival outcomes. Methods: Observational, descriptive, and retrospective study. The medical records of BC patients who underwent NACT were reviewed and analyzed using the Statistical Package for the Social Sciences (SPSS), version 20.0. Results: Of the 176 BC patints who underwent NACT, 62 patients (35.2%) achieved PCR. The PCR rate was 22% (n = 2) for luminal A, 15% (n = 9) for luminal B/HER2-negative, 45.5% (n = 15) for luminal B/ HER2-positive, 50% (n = 14) for non-luminal/HER2-positive, and 47.8% (n = 22) for triple-negative (p = 0.01). Histological grade, estrogen receptor (ER) expression, progesterone receptor (PR) expression, and HER2 status were significantly associated with PCR (p = 0.022, p = 0.01, p = 0.01, and p = 0.02, respectively). The median follow-up was 35.9 months, the estimated 5-year disease-free survival (DFS) was 96.7% in the PCR group and 83.2% in the non-PCR group (p = 0.05). The estimated 5-year overall survival (OS) was 95.5% in the PCR group and 69.1% in the non-PCR group (p = 0.017). Overall, 11 patients (6.25%) presented with locoregional recurrence (LRR), one (1.6%) in the PCR group and 10 (8.8%) in the non-PCR group (p = 0.10). Conclusion: We observed higher PCR rates in triple-negative and HER2-positive molecular subtypes. DFS and OS were significantly better in patients who achieved PCR, regardless of clinicopathological features. We also observed lower rates of LRR in the population that reached PCR.