Breast cancer diagnosis in coronavirus-era: alert from italy

G Vanni, M Pellicciaro, M Materazzo, L Palombi… - Frontiers in …, 2020 - frontiersin.org
G Vanni, M Pellicciaro, M Materazzo, L Palombi, OC Buonomo
Frontiers in oncology, 2020frontiersin.org
SARS-COV-2 is currently spreading all over the world, exhibiting a trend that has been
defined by the WHO as a pandemic. Italy was the first European country to be involved in
this outbreak. Based on the latest data, in our country, 224,760 people have been confirmed
positive for SARSCOV-2 with a case fatality rate reaching up to 10%(1). These numbers
define what is called a national emergency, which consequentially implies a total
reorganization of the Health System. In this regard, most routine preventive activities have …
SARS-COV-2 is currently spreading all over the world, exhibiting a trend that has been defined by the WHO as a pandemic. Italy was the first European country to be involved in this outbreak. Based on the latest data, in our country, 224,760 people have been confirmed positive for SARSCOV-2 with a case fatality rate reaching up to 10%(1). These numbers define what is called a national emergency, which consequentially implies a total reorganization of the Health System. In this regard, most routine preventive activities have been scaled down, including active screening campaigns. Breast Units have been strongly affected by the emergency and its consequential restrictions and constraints. Breast pathology, as is well-known, has a strong impact on women health, survival, and quality of life. In fact, Breast Cancer is the most common neoplasia in females, affecting approximately one out of nine women (2). The breast-diagnostic path may begin in three different ways: screening, follow-up with clinical examination, or emergencies related to a new palpable nodule. Every year, around 53,000 women receive a breast cancer diagnosis in Italy (2). From 2015 to 2018, around 74% of women aged between 50 and 69 underwent preventive screening: 54.6% belonged to organized programs while 19.3% performed it voluntarily (3). This method enabled the diagnosis of around 16% of breast cancer (2). Over the years, the National Health System has invested many resources in order to provide early diagnoses of breast cancer. This has been made possible thanks to the empowerment of screening campaigns and through patients’ sensibilization to follow periodical controls. As a consequence, the increase in early diagnoses of breast cancer lead to improved prognoses, more conservative surgical treatments with better aesthetical results, as well as reduced health system costs (4). Long-term screening resulted in a reduction of up to 30% in 8 years among the incidence of local advanced breast cancer rate (5). In the pre-screening era, more than 50% of breast cancer presented with a primary tumor sized more than 2cm and/or an associated axillary lymphadenopathy (6). Around 44% of women, during the screening program, receive an early diagnosis for breast cancer, and this, together with the evolution and progress of treatments, has resulted in a drastic reduction in patient mortality, with an overall survival rate of 87% at 5 years (2, 7).
In view of the above, during this healthcare emergency, surgical ambulatory activities as well as radiological exams are currently granted only for emergencies; screening and elective activities are suspended, shifting all the resources to be made available to the essential services. Cessation of elective activities, screening programs, and the drastic reduction of services restrict the evaluation to only clinical observation of palpable lesions.
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