What impact of Covid 19 on breast cancer?
Even if the health crisis linked to Covid 19 is not yet over, some epidemiologists are trying to draw an initial assessment in terms of public health. If the direct consequences are easy to analyze, the indirect impact is on the other hand more complex to apprehend, even if the figures are telling: from HIV diagnostic tests to cardiological examinations, all the screening indicators seem to be in sharp decline. What impact has Covid-19 had on breast cancer screening and treatment?
A quick rundown with Dr. Anne Sabaila Ollier, a breast reconstruction surgeon at the Breast Center.
The indirect consequences of Covid-19
A few figures suffice to show how much the Covid crisis has indeed impacted the entire healthcare system: on the one hand, infectious diseases and intensive care departments have been overwhelmed, on the other hand, the French have slowed down their demand for care and some procedures have been deprogrammed.
Thus, in 2020, the consumption of medical procedures dropped significantly in the city, particularly among dentists (-8.9%), doctors (-5%), medical transport (-9.4%) and physiotherapists (-11.9%). The same is true in hospitals, since for example hospitalizations for stroke have dropped by 40% over the 1st confinement, a phenomenon that is observed worldwide.
A pathology such as breast cancer has obviously also been impacted in its management, both in prevention and treatment.
The impact of Covid 19 on breast cancer screening
The importance of early diagnosis of breast cancer, particularly by mammography or ultrasound, is rightly emphasized over and over again.
Confinements, health restrictions, fear of going outside have obviously broken this momentum.
In a complete podcast, Dr Anne Sabaila talks about international studies estimating that out of 10,000 women operated on, a 3-month delay in treatment would lead to around 30 more deaths.
A study published on July 14, 2021 in the Journal of the National Cancer Center estimated the increase in the number of deaths to be at least 0.52% between 2020 and 2030, with according to the model 950 additional deaths linked to reduced screening, and 151 more linked to stage-reduced chemotherapy. early.
But as Dr. Sabaila Ollier points out, it is impossible to generalize to individual cases, because the loss of chance occurs mainly on aggressive and rapidly evolving breast tumors, while the impact is almost nil on minimally invasive lesions. .
The consequences for the treatment of breast cancer
It is also estimated that there is potentially a loss of opportunity linked to the delay in treatment, in particular with delayed or reduced chemotherapy. On the other hand, we can consider that there is no consequence on radiotherapy care.
Regarding surgery, you should be aware that in total, only 20% of surgeries were deprogrammed.
For breast cancer, these deprogrammings related almost exclusively to breast reconstruction surgeries, for which there was no urgency. On the other hand, any surgery whose delay could alter the prognosis was maintained: for this, the surgeons of the Breast Center used the criteria established by learned societies and consensus conferences, in accordance with the medical and epidemiological data which they had.
The real problem sometimes arose with a few patients who preferred to give up surgery, in an anxiety-provoking climate that probably added to their concern about the disease.
Breast cancer care adapted to Covid19
Fortunately, as Dr. Anne Sabaila Ollier explains with great positivity in her podcast “Breast cancer and Covid 19”, practitioners were able to adapt quickly, to guarantee the continuity of care for patients who were considered, a priori, to be suffering of a co-morbidity that could put them at greater risk. Even if it is actually less decided on breast cancer, fortunately.
A safer hospital and clinics
In medical-surgical care establishments, a major effort has been made to reinforce hygiene rules and sanitary protocols: ventilation of waiting rooms, increased disinfection of surfaces, respect for barrier gestures…
Circuits have been established by sector, in order to separate covid patients from other patients. Their temperature is controlled and they are sometimes asked to undergo pre-operative screening by PCR test for scheduled procedures.
Obviously, as a surgeon specializing in breast cancer, Dr. Sabaila Ollier explains that one must also know how to adapt to the patient and his pathology.
If the rule is to come unaccompanied, this is obviously waived in certain situations, where the psychological support of a loved one is essential.
The objective is always to care for the patient in his or her entirety.
Translated with www.DeepL.com/Translator (free version)