Breast cancer in the time of COVID

Like just about everyone else, health care providers and medical facilities have felt the impact of COVID-19 ever since the pandemic’s implications first became clear. This is as true for the diagnosis and treatment of breast cancer as it is for other types of surgeries, services and procedures.

Xpress checked in with providers at several local institutions, most of whom told a similar tale: implementing enhanced measures aimed at keeping everybody safe while ensuring that essential procedures are performed as needed.

“Breast cancer surgery is not considered elective,” and thus has not been “canceled or delayed,” Dr. Jennifer McAlister, a surgeon at Pardee UNC Health Care, explained via email. And while Pardee did pause elective surgeries for a period of time, routine mammography has been performed at the patient’s discretion, and diagnostic studies (for those with a problem or as follow-up for cancer patients) have continued as scheduled.

Over at AdventHealth, Jennifer Sorensen-Taiwo, administrative director of operations for physician services, said: “I am not aware if any surgeries were canceled. … We asked each provider involved in care to review and make the decision based on the patient’s need.”

Patients receiving chemotherapy or radiation treatments, she continued, “cannot postpone care, and we maintained their schedules as usual. We provided deep cleaning in between each patient, maintained social distancing in clinics, all clinical staff wore PPE, and we screened all patients prior to their visits. We also began offering telehealth options, as appropriate, for some traditional office visits.”

Remote delivery has also loomed large at Mission Health’s Fullerton Genetics Center, which has remained open, counselor Carolyn Wilson noted. “We have transitioned to seeing as many patients as possible by telemedicine,” she wrote in an email. “Patients who proceed with testing are then sent saliva collection kits directly to their homes, and they return them by mail or FedEx. Genetic counseling is particularly well suited for remote visits, and we are working diligently to see as many patients as possible in this way.”

Dr. Blair Harkness, a gynecological oncologist at Hope Women’s Cancer Centers, said, “Surgeries for invasive breast cancer were not delayed due to COVID; breast reconstruction was delayed in most but not all cases.” Some other surgeries and radiation treatments may have been delayed, he explained, but only if “those delays would not be expected to affect outcomes.”

McAlister, meanwhile, said Pardee has followed breast cancer “recommendations made by a multidisciplinary task force of medical oncologists, surgeons and radiation oncologists. These guidelines allowed for ‘low risk’ cancers (small and hormone receptor positive) to be placed on hormone blocking therapy until surgery could be done. This would be without any detriment to the patient, since these medications are used for therapy.” Decisions, she noted, “were made on a case-by-case basis. Some patients chose to proceed with surgery as their first step, others chose hormone blockade as their first step.”

To ensure the safety of everyone involved, she continued, Pardee has “asked screening questions and monitored temperatures of staff and patients; required use of masks for all staff and all patients; and not allowed visitors. With these precautions in place, we’re able to continue ‘normal’ operations of the cancer center and safely serve our patients.”