With a deeper understanding of the disease and new drugs available today, breast cancer is no longer a fatal diagnosis. Early detection of breast cancer makes all the difference to a patient’s survival. If breast cancer is detected at an early stage, the chances of effective treatment and cure are very high. In India, 1 in 2 breast cancer patients die, mostly because they are detected in late stages when it is often too late. Women need to be proactive about their health and seek medical help as soon as possible.

If a patient is diagnosed with early-stage disease, they have the chance to opt for breast conservation surgery rather than mastectomy. Many studies have demonstrated that breast conservation is associated with better body image scores and psychosocial outcomes in women when compared with mastectomy. Women also have the option of avoiding chemotherapy if detected with early-stage breast cancer. A study by Verma et al. published in Breast Cancer Research has reported shown that chemotherapy given to treat breast cancer can weaken the immune system of a woman for up to nine months after completion of treatment. It is already known that the case fatality rate increases if cancer patients contract COVID-19. This is because of the immunosuppression caused by the underlying malignancy, cancer treatments and also co-morbidities. De-escalated and shortened duration treatment modalities during this time can make a huge difference.

Therefore, early detection is even more important during the ongoing COVID-19 pandemic. Women need to prioritize their health, continue to perform self breast exams and not ignore any symptoms of breast cancer. Fear of visiting a hospital due to coronavirus should not delay getting medical advice, especially when it comes to cancer. Women can make use of teleconsultation facilities offered by most hospitals today, to discuss their concerns with their doctor and get the appropriate tests and scans done if required.

Cancer care experts advocate for triaging and prioritizing of patients based on the severity of the disease, underlying health of the patient and also the transmission rate of COVID-19 in the region. For early-stage breast cancer patients, certain de-escalation measures have been suggested in the treatment guidelines issued by bodies like ESMO, ASCO, ASTRO and NCCN:

1. Based on assessment of patient’s individual risks and co-morbidities, patients can potentially receive neoadjuvant therapies during the pandemic. For example, for patients with early stage hormone receptor-positive breast cancer, neoadjuvant endocrine therapy can be prescribed to defer surgery until after the COVID-19 outbreak.
2. Early stage hormone receptor-positive breast cancer patients who are low-risk as per a prognostic test, can be prescribed endocrine therapy alone. There is a prognostic test called CanAssist Breast offered by an Indian company called OncoStem Diagnostics that is affordable and has a quick turnaround time.
3. For patients where chemotherapy is required, chemotherapy schedules may be shortened or modified to reduce accesses to hospital. Patients should receive G-CSF growth factor and, eventually, antibiotics support to minimise effects of immunosuppression. Oral chemotherapy agents should be prioritized, whenever possible, and managed via telemedicine, for the predictable and manageable toxicities.
4. If hypofractionated radiation therapy schedules are considered reasonable, they should be considered. Especially for early stage breast cancer, given the results of clinical trials like FAST- FORWARD, hypofractionated schedules of 1 week can now be considered versus the traditional 3 weeks.                                                                               

Hospitals, especially those that specialize in cancer treatment, are taking additional measures to ensure the safety of patients and reduce exposure to the coronavirus. Patient safety is prioritized by the entire staff at our facility through regular sanitization of surfaces and equipment, restricted entry into the hospital and use of appropriate PPE. Women who have any symptoms of breast cancer including a lump, nipple discharge or rash should not delay seeking medical advice. Early detection can lead to less aggressive treatment and quicker return to good health.

Dr Shona Nag,  Consultant Medical Oncologist and Director of Oncology, Sahyadri Group of Hospitals, Pune