Rising incidence of late stage breast cancer after COVID-19 outbreak. Real-world data from the Italian COVID-DELAY Study

Abstract Purpose Breast cancer (BC) patients’ (pts) management was affected by a global reorganization after Coronavirus disease 2019 (COVID-19). Our multicenter study aimed to assess the impact of COVID-19 on access to diagnosis, staging and treatment for BC pts compared to pre-pandemic. Methods Medical records of all consecutive newly diagnosed BC pts referred to 6 Italian Institutions between March and December 2020 were assessed. Monthly access rate and temporal intervals between date of symptoms onset, radiological, cytohistological diagnosis and treatment start were analyzed and compared with those of 2019. Results A reduction (25%) in newly diagnosed BC pts was observed compared to 2019 (666 vs 890). New BC pts in 2020 were less likely to be diagnosed with early stage (stage 0-I-II) BC (77% vs 83%, p0 in 2020 vs 16.5% in 2019, p<0.01) and fewer patients were asymptomatic at diagnosis in 2020 (54% vs 71%, p<0.01). COVID-19 did not negatively impact in terms of access to diagnosis, staging and treatment. Time intervals between symptom onset and radiological diagnosis, symptom onset and cytohistological diagnosis, cytohistological diagnosis and treatment start were maintained or even improved. However, less BC cases were discussed in multidisciplinary tumor meetings during 2020 (60% vs 73%, p<0.01). Conclusions Our data proved an alarming reduction of BC early stage diagnoses in 2020. Despite the upheaval generated by COVID-19, our study shed light on the effective performance delivered by Italian Oncology Departments to guarantee diagnostic-therapeutic pathways.