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Breast Cancer Management During COVID-19 Pandemic

Objective: To communicate interim guidelines to safely manage breast cancer patients.

The coronavirus disease of 2019 (COVID-19) pandemic has posed many challenges for patients, clinicians and health care systems. Amid the COVID-19 pandemic, various cancer care organizations with expertise in the multidisciplinary management of breast disease came together to give initial recommendations for the triage and treatment of patients with breast disease. These do not supersede individual physician judgement, or institutional policy or guidelines. These are just recommendations and should be taken in respect of each institution’s resources and prevalence of the COVID-19 pandemic in their region. The association highly recommends multidisciplinary discussion for breast cancer patients concerning importance for elective surgery and adjuvant treatments. These recommendations are subjected to change with changing COVID-19 pandemic severity.

Recommendations are divided into the following priority categories based on patient condition:

  • Priority A includes patient whose condition is immediately life threatening, clinically unstable
  • Priority B includes patient whose situation is noncritical but delay beyond 6-8 weeks could potentially impact overall outcome
  • Priority C includes patient whose condition is stable enough to delay the services for the duration of the COVID-19 pandemic

Following are the some priorities for breast disease focused outpatient visits and medical treatment:

  • Priority A:
    Includes potentially unstable (e.g. hematoma, infection) patients.
    New diagnosis of invasive cancer-may convert to telemedicine visit.
    Early line chemotherapy expected to improve outcomes in metastatic disease.
  • Priority B:
    Includes post-op patients.
    New diagnosis of non-invasive cancer-convert as many visits to telemedicine visits.
    Established patients with new problems or symptoms from treatment-convert as many visits to telemedicine visits.
    Biopsies to be done for abnormal mammograms or breast symptoms.
  • Priority C:
    Includes established patients with no new issues.
    Survivorship visits.
    Patients at high risk for breast cancer (BReast CAncer gene carriers, etc.).
    Well breast visits.
    Benign breast follow-up visits (including atypia and other benign lesions). Defer all screening with other modalities.

Reference: The COVID-19 Pandemic Breast Cancer Consortium. Available from: https://www.facs.org/quality-programs/cancer/executive-summary. Accessed on Apr 30, 2020.