TY - JOUR
T1 - Impact of the COVID-19 pandemic on diagnosis, stage, and initial treatment of breast cancer in the Netherlands
T2 - a population-based study
AU - the NABON COVID-19 Consortium and the COVID and Cancer-NL Consortium
AU - Eijkelboom, Anouk H.
AU - de Munck, Linda
AU - Vrancken Peeters, Marie Jeanne T.F.D.
AU - Broeders, Mireille J.M.
AU - Strobbe, Luc J.A.
AU - Bos, Monique E.M.M.
AU - Schmidt, Marjanka K.
AU - Guerrero Paez, Cristina
AU - Smidt, Marjolein L.
AU - Bessems, Maud
AU - Verloop, Janneke
AU - Linn, Sabine
AU - Lobbes, Marc B.I.
AU - Honkoop, Aafke H.
AU - van den Bongard, Desirée H.J.G.
AU - Westenend, Pieter J.
AU - Wesseling, Jelle
AU - Menke-van der Houven van Oordt, C. Willemien
AU - Tjan-Heijnen, Vivianne C.G.
AU - Siesling, Sabine
AU - van Hoeve, Jolanda C.
AU - Merkx, Matthias A.W.
AU - de Wit, Niek J.
AU - Dingemans, Irene
AU - Nagtegaal, Iris D.
AU - Wilbrink, A.
AU - van Gils, Carla H.
AU - van Weert, Henk C.P.M.
AU - Verheij, Marcel
AU - Luiten, Ernest J.T.
AU - van Leeuwen-Stok, A. Elise
AU - Jager, Agnes
AU - Koppert, Linetta B.
AU - Hooning, Maartje J.
AU - Boersma, Liesbeth J.
AU - Schröder, Carolien P.
AU - Verkooijen, Helena M.
AU - van Rossum-Schornagel, Quirine C.
AU - van der Velde, Susanne
AU - Manten-Horst, Eveliene
AU - van Ravensteyn, Nicolien T.
AU - Korevaar, Joke C.
AU - Siemerink, Ester J.M.
AU - van Dalen, Thijs
AU - van der Velden, Annette W.G.
AU - Mureau, Marc A.M.
N1 - Funding Information:
This study has been funded by ZonMw (Grant number: 10430022010014). The funding sources had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.
Funding Information:
We thank the NCR for providing the data and their data managers for collecting that data. We thank Dr Robert Sykes (www.doctored.org.uk), who edited the manuscript before submission. Collaborating authors of the COVID and Cancer-NL Consortium: Jolanda C. van Hoeve, Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht; Matthias A.W. Merkx, Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht; Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen; Niek J. de Wit, Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht University, Utrecht; Irene Dingemans, Dutch Federation of Cancer Patient Organisations (NFK), Utrecht; Iris D. Nagtegaal, Department of Pathology, Radboud University Nijmegen Medical Centre, Nijmegen; A. Wilbrink, Dutch Hospital Data (DHD), Utrecht; Carla H. van Gils, Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht; Henk C. P. M. van Weert, department of General Practice, Amsterdam Public Health, Amsterdam UMC location AMC, Amsterdam; Marcel Verheij, Department of Radiation Oncology, Radboud University Medical Center, Nijmegen. Collaborating authors of the NABON-COVID-19 consortium: Ernest J. T. Luiten, Department of Surgery, Amphia Ziekenhuis, Breda; A. Elise van Leeuwen-Stok, Dutch Breast Cancer Research Group, Amsterdam; Agnes Jager, Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam; Linetta B. Koppert, Department of Surgery, Erasmus University Medical Center, Rotterdam; Maartje J. Hooning, Department of Medical Oncology, Erasmus University Medical Center, Rotterdam; Liesbeth J. Boersma, Department of Radiation Oncology (Maastro), GROW, School for Oncology and Developmental Biology, Maastricht University Medical Centre+, Maastricht; Carolien P. Schr?der, Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen; Helena M. Verkooijen, Division of Imaging and Oncology, University Medical Centre Utrecht, Utrecht; Quirine C. van Rossum-Schornagel, Department of Internal Medicine, Franciscus Gasthuis & Vlietland, Rotterdam; Susanne van der Velde, Department of Surgery, Amsterdam UMC/VU University Medical Center, Amsterdam; Eveliene Manten-Horst, Dutch AYA ?Young & Cancer? Carenetwork, Regional AYA Carenetwork Radboudumc, Radboud University Medical Center, Nijmegen; IKNL, Utrecht; Nicolien T. van Ravensteyn, Department of Public Health, Erasmus MC University Medical Center, Rotterdam; Joke C. Korevaar, Netherlands Institute for Health Services Research (NIVEL), Utrecht; Ester J. M. Siemerink, Department of Internal Medicine, Ziekenhuis Groep Twente, Hengelo/Almelo; Thijs van Dalen, Department of Surgery, Diakonessenhuis Utrecht, Utrecht; Annette W. G. van der Velden, Department of Internal Medicine, Martini Hospital, Groningen; Marc A.M. Mureau, Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam; all the Netherlands.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - Background: The onset of the COVID-19 pandemic forced the Dutch national screening program to a halt and increased the burden on health care services, necessitating the introduction of specific breast cancer treatment recommendations from week 12 of 2020. We aimed to investigate the impact of COVID-19 on the diagnosis, stage and initial treatment of breast cancer. Methods: Women included in the Netherlands Cancer Registry and diagnosed during four periods in weeks 2–17 of 2020 were compared with reference data from 2018/2019 (averaged). Weekly incidence was calculated by age group and tumor stage. The number of women receiving initial treatment within 3 months of diagnosis was calculated by period, initial treatment, age, and stage. Initial treatment, stratified by tumor behavior (ductal carcinoma in situ [DCIS] or invasive), was analyzed by logistic regression and adjusted for age, socioeconomic status, stage, subtype, and region. Factors influencing time to treatment were analyzed by Cox regression. Results: Incidence declined across all age groups and tumor stages (except stage IV) from 2018/2019 to 2020, particularly for DCIS and stage I disease (p < 0.05). DCIS was less likely to be treated within 3 months (odds ratio [OR]wks2–8: 2.04, ORwks9–11: 2.18). Invasive tumors were less likely to be treated initially by mastectomy with immediate reconstruction (ORwks12–13: 0.52) or by breast conserving surgery (ORwks14–17: 0.75). Chemotherapy was less likely for tumors diagnosed in the beginning of the study period (ORwks9–11: 0.59, ORwks12–13: 0.66), but more likely for those diagnosed at the end (ORwks14–17: 1.31). Primary hormonal treatment was more common (ORwks2–8: 1.23, ORwks9–11: 1.92, ORwks12–13: 3.01). Only women diagnosed in weeks 2–8 of 2020 experienced treatment delays. Conclusion: The incidence of breast cancer fell in early 2020, and treatment approaches adapted rapidly. Clarification is needed on how this has affected stage migration and outcomes.
AB - Background: The onset of the COVID-19 pandemic forced the Dutch national screening program to a halt and increased the burden on health care services, necessitating the introduction of specific breast cancer treatment recommendations from week 12 of 2020. We aimed to investigate the impact of COVID-19 on the diagnosis, stage and initial treatment of breast cancer. Methods: Women included in the Netherlands Cancer Registry and diagnosed during four periods in weeks 2–17 of 2020 were compared with reference data from 2018/2019 (averaged). Weekly incidence was calculated by age group and tumor stage. The number of women receiving initial treatment within 3 months of diagnosis was calculated by period, initial treatment, age, and stage. Initial treatment, stratified by tumor behavior (ductal carcinoma in situ [DCIS] or invasive), was analyzed by logistic regression and adjusted for age, socioeconomic status, stage, subtype, and region. Factors influencing time to treatment were analyzed by Cox regression. Results: Incidence declined across all age groups and tumor stages (except stage IV) from 2018/2019 to 2020, particularly for DCIS and stage I disease (p < 0.05). DCIS was less likely to be treated within 3 months (odds ratio [OR]wks2–8: 2.04, ORwks9–11: 2.18). Invasive tumors were less likely to be treated initially by mastectomy with immediate reconstruction (ORwks12–13: 0.52) or by breast conserving surgery (ORwks14–17: 0.75). Chemotherapy was less likely for tumors diagnosed in the beginning of the study period (ORwks9–11: 0.59, ORwks12–13: 0.66), but more likely for those diagnosed at the end (ORwks14–17: 1.31). Primary hormonal treatment was more common (ORwks2–8: 1.23, ORwks9–11: 1.92, ORwks12–13: 3.01). Only women diagnosed in weeks 2–8 of 2020 experienced treatment delays. Conclusion: The incidence of breast cancer fell in early 2020, and treatment approaches adapted rapidly. Clarification is needed on how this has affected stage migration and outcomes.
KW - Breast cancer
KW - COVID-19
KW - Incidence
KW - Population-based
KW - Screening
KW - Stage
KW - Treatment
U2 - 10.1186/s13045-021-01073-7
DO - 10.1186/s13045-021-01073-7
M3 - Article
C2 - 33865430
AN - SCOPUS:85104641365
SN - 1756-8722
VL - 14
JO - Journal of Hematology and Oncology
JF - Journal of Hematology and Oncology
IS - 1
M1 - 64
ER -