Breast Cancer Awareness Month: How Covid-19 Impacted Breast Cancer Treatment, Leading To Metastatic Stage

Covid-19 pandemic has affected just about every aspect of life, including screening, diagnosis, treatment, and follow-up care for breast cancer patients

October is Breast Cancer Awareness Month | Original Image: Getty

New Delhi: On March 11, 2020, the World Health Organization (WHO) said that Covid-19 had become a pandemic — a disease that has spread across multiple countries. The US declared a national emergency shortly after. 

Shutdowns began and many of us started to learn the term, “social distancing”.

While this was important to contain the virus, which had started to claim lives at an alarming rate soon, the measures took a toll on the health of non-Covid patients as many hospitals closed OPDs and put off elective surgeries.

Early-stage cancer is curable through surgery, but the patient’s condition could worsen if there is a delay.

And this has happened during the pandemic.

Covid-19 and its causative virus, SARS-CoV-2, also pose considerable challenges for the management of oncology patients. Covid-19 presents as a particularly severe respiratory and systemic infection in aging and immunosuppressed individuals, including patients with cancer.

For many breast cancer patients, the disease reached metatastic stage due to delay in treatment.

Breast Cancer: How Pandemic Affected Treatment, Follow-Up Care 

The pandemic has affected just about every aspect of life, including screening, diagnosis, treatment, and follow-up care for breast cancer patients.

In India, breast cancer is the most common in women in urban areas, while cervical cancer is still the most common in rural areas. Incidence of breast cancer has increased sharply over the past two decades.

The approximate number of cases of breast cancer in India in the year 2020 was 1,79,790 and this is about 10 per cent of all cancers. Indian women affected with breast cancer are of younger age group and are normally in advanced stage. Younger patients tend to have aggressive disease, larger size of tumor, worse tumor grade, a greater number of positive lymph nodes, more hormone receptor negative status and early recurrence with poorer prognosis.

People who have been diagnosed with breast cancer and people who are at high risk for breast cancer have found themselves in a uniquely difficult and sometimes frightening position since the coronavirus crisis began. 

Many of you might be wondering if it’s safe to go to certain medical appointments or if you should postpone treatments or screening. Others have already had their treatments delayed or changed.

Unique Risks Of Covid-19 For People With Breast Cancer

Most people infected with Covid-19 virus will have mild to moderate respiratory symptoms and

recover without requiring special treatment or hospitalisation. Some will have no symptoms at all.

According to the US Centers for Disease Control and Prevention, currently having cancer increases your risk of having serious complications if you do become infected with Covid-19. At this time, it’s not known if having a history of cancer increases your risk of serious complications.

This higher risk for serious complications from Covid-19 for people currently diagnosed with cancer is likely because having cancer puts a strain on the body and because certain treatments can cause people to become immunocompromised (have a weakened immune system) or have lung problems.

How Healthcare Is Changing To Keep People Safe From Covid

As anyone who has gone to a clinic or hospital in recent months knows, the pandemic is changing how healthcare is delivered. Healthcare facilities of all types and sizes are taking new steps to keep patients and staff from getting Covid-19.

How Covid-19 Has Changed Breast Cancer Care?

The pandemic has affected many aspects of breast cancer care in India and across the globe.

There were delays in many aspects of breast cancer care, including routine clinical visits,

surveillance imaging, routine mammograms, reconstruction, radiation therapy, hormonal therapy, mastectomy, and chemotherapy.

Many patients chose or considered delaying or changing their own treatment plans due to concerns about contracting Covid-19.

Patients reported feeling some level of anxiety about their care being affected by the pandemic.

Some breast cancer treatments can weaken the immune system and possibly cause lung problems.

People who have weakened immune systems or lung problems have a much higher risk of serious complications if they become infected with this virus. For most people, the immune system recovers within a couple of months after completing these treatments. But your immune system’s recovery time can vary and depends on several factors. If you have received these treatments in the past, it’s not clear if you are at higher risk of serious complications from Covid-19.

People with breast cancer that has metastasised (spread) to the lungs also can have lung problems that may get worse if they develop Covid-19.

Precautions Breast Cancer Patients Should Take During Pandemic  

If you are receiving treatment for breast cancer, are immunocompromised, or if you are living with breast cancer that has metastasised (spread) to the lungs, the following extra precautions may help you protect yourself:

• Be extra vigilant about hand hygiene and not touching your face
• Avoid close contact with friends and family and take precautions if you depend on them for medical care
• Plan with your doctor to monitor for symptoms
• Plan with your caregiver or other loved ones in case you or they get sick
• Plan with your employer to work from home if you’re not already doing so
• Stock up on medications
• Ask a friend or family member to shop for groceries or pick up medications for you

In general, we agree with recommendations for metastatic breast cancer (MBC) management proposed by the Covid-19 Pandemic Breast Cancer Consortium. We recommend that patients receiving early-line palliative systemic therapy that is likely to improve outcomes continue therapy, but risks and benefits of later-line therapy must be considered carefully. 

As per routine, we assess tumor genomics with next-generation sequencing when indicated. For HER2-positive MBC with minimal disease burden and an extended period of stability, we consider holding therapy with surveillance for progression every 3-6 months.

(Dr Atul Batra is Associate Professor, Department of Medical Oncology, AIIMS, New Delhi.)