The COVID-19 pandemic and impact on breast cancer diagnoses: what happened in England in the first half of 2020.

Delays in cancer diagnosis and treatment due to the COVID-19 pandemic is a widespread source of concern, but the scale of the challenge for different tumour sites is not known. Routinely collected NHS England Cancer Waiting Time data were analysed to compare activity for breast cancer in the first 6 months of 2020 compared to the same time period in 2019. The number of referrals for suspected breast cancer was 28% lower (N = 231,765 versus N = 322,994), and the number of patients who received their first treatment for a breast cancer diagnosis was 16% lower (N = 19,965 versus N = 23,881). These data suggest that the number of breast cancers diagnosed during the first half of 2020 is not as low as initially feared, and a substantial proportion of the shortfall can be explained by the suspension of routine screening in March 2020. Further work is needed to examine in detail the impact of measures to manage the COVID-19 pandemic on breast cancer outcomes.

The Challenge of COVID-19: The Biological Characteristics and Outcomes in a Series of 130 Breast Cancer Patients Operated on During the Pandemic.

Background: The worldwide outbreak of the 2019 novel coronavirus disease (COVID-19) emerged in Wuhan, China close to the end of 2019. We analyse the clinical characteristics and management outcomes of a small group of patients who have been treated in the early stage of the COVID-19 disease, and discuss the impact of the pandemic on the service delivered to breast cancer patients. Material Methods: We analysed a cohort of 130 breast cancer patients who underwent elective surgical procedures during the early period of COVID-19. The patients were operated on in the period from March 16th, 2020 to May 18th, 2020. Results: All the patients were female, with an age range of 33-88 years, with a median age of 57.6 years. Most of the cases were admitted as a day case surgery after passing through a preoperative screening pathway, which was developed gradually. Patients were contacted by phone after their surgery to ensure that they have had no symptoms and were reviewed in person two weeks after the procedure with histology results. Only one patient developed COVID-19 symptoms after surgery and recovered. Conclusions: Early and careful implementation of modified practice policies during emerging situation of viral pandemics will reduce the risk of perioperative complications, reduce the risk of patient to staff to patient transmission and minimize the negative impact of COVID-19 on breast cancer management.

Safety of radioactive sentinel node biopsy for breast cancer and the pregnant surgeon - A review.

INTRODUCTION: Sentinel node biopsy is an established key element in the surgical management of breast cancer and melanoma. Several studies have assessed radiation exposure during sentinel node biopsy and confirmed it to be safe for health workers. Recent demographic changes amongst surgeons has resulted in increasing numbers of women of childbearing age performing sentinel node procedures as a regular part of their surgical practice. We aimed to assess the radiation risk posed by sentinel node biopsy in breast cancer surgery to pregnant surgeons. METHODS: A search of indexed citations from PUBMED and Cochrane databases for studies assessing the radiation exposure to the primary surgeon during sentinel node biopsy was undertaken. Due to the variability of melanoma location in relation to nodal basins, we have focused on sentinel node biopsy for breast cancer where surgeon positioning, radiopharmaceutical injection and nodal dissection sites are consistent. RESULTS: From the eleven studies totalling 344 procedures, exposure doses to the abdomens and fingers of surgeons undertaking sentinel node biopsy were within the guideline maximum recommended exposure limit of 1 mSv as set out by the International Committee on Radiation Protection (ICRP) 107 recommendations as long as fewer than one hundred procedures are performed throughout the duration of the pregnancy. Of note the radiation doses in the newer studies were much lower and used more sensitive instruments to detect radiation exposure. CONCLUSIONS: Providing the numbers of procedures are within defined limits, the radiation risks posed to pregnant surgeons undertaking sentinel node procedures are limited and within the regulatory guidelines for pregnancy.