Impact of the COVID-19 pandemic on diagnosis, stage, and initial treatment of breast cancer in the Netherlands: a population-based study

doi:10.1186/s13045-021-01073-7

Impact of the COVID-19 pandemic on diagnosis, stage, and initial treatment of breast cancer in the Netherlands: a population-based study

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Abstract

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, OR wks9-11: 2.18). Invasive tumors were less likely to be treated initially by mastectomy with immediate reconstruction (OR wks12-13: 0.52) or by breast conserving surgery (OR wks14-17: 0.75). Chemotherapy was less likely for tumors diagnosed in the beginning of the study period (OR wks9-11: 0.59, OR wks12-13: 0.66), but more likely for those diagnosed at the end (OR wks14-17: 1.31). Primary hormonal treatment was more common (OR wks2-8: 1.23, OR wks9-11: 1.92, OR wks12-13: 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.

Original language	English
Article number	64
Pages (from-to)	1-12
Journal	Journal of Hematology and Oncology
Volume	14
Issue number	1
DOIs	https://doi.org/10.1186/s13045-021-01073-7
Publication status	Published - 17 Apr 2021

Keywords

Adult
Aged
Breast Neoplasms/diagnosis
COVID-19/epidemiology
Disease Management
Female
Humans
Incidence
Mass Screening
Middle Aged
Neoplasm Staging
Netherlands/epidemiology

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@article{e8f107e35b7d471d93eb998d9861e46d,

title = "Impact of the COVID-19 pandemic on diagnosis, stage, and initial treatment of breast cancer in the Netherlands: a population-based study",

abstract = "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, OR wks9-11: 2.18). Invasive tumors were less likely to be treated initially by mastectomy with immediate reconstruction (OR wks12-13: 0.52) or by breast conserving surgery (OR wks14-17: 0.75). Chemotherapy was less likely for tumors diagnosed in the beginning of the study period (OR wks9-11: 0.59, OR wks12-13: 0.66), but more likely for those diagnosed at the end (OR wks14-17: 1.31). Primary hormonal treatment was more common (OR wks2-8: 1.23, OR wks9-11: 1.92, OR wks12-13: 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.",

keywords = "Adult, Aged, Breast Neoplasms/diagnosis, COVID-19/epidemiology, Disease Management, Female, Humans, Incidence, Mass Screening, Middle Aged, Neoplasm Staging, Netherlands/epidemiology",

author = "Eijkelboom, {Anouk H.} and {de Munck}, Linda and {Vrancken Peeters}, {Marie Jeanne T.F.D.} and Broeders, {Mireille J.M.} and Strobbe, {Luc J.A.} and Bos, {Monique E.M.M.} and Schmidt, {Marjanka K.} and {Guerrero Paez}, Cristina and Smidt, {Marjolein L.} and Maud Bessems and Janneke Verloop and Sabine Linn and Lobbes, {Marc B.I.} and Honkoop, {Aafke H.} and {van den Bongard}, {Desir{\'e}e H.J.G.} and Westenend, {Pieter J.} and Jelle Wesseling and {Menke-van der Houven van Oordt}, {C. Willemien} and Tjan-Heijnen, {Vivianne C.G.} and Sabine Siesling and {van Hoeve}, {Jolanda C.} and Merkx, {Matthias A.W.} and {de Wit}, {Niek J.} and Irene Dingemans and Nagtegaal, {Iris D.} and A. Wilbrink and {van Gils}, {Carla H.} and {van Weert}, {Henk C.P.M.} and Marcel Verheij and Luiten, {Ernest J.T.} and {van Leeuwen-Stok}, {A. Elise} and Agnes Jager and Koppert, {Linetta B.} and Hooning, {Maartje J.} and Boersma, {Liesbeth J.} and Schr{\"o}der, {Carolien P.} and Verkooijen, {Helena M.} and {van Rossum-Schornagel}, {Quirine C.} and {van der Velde}, Susanne and Eveliene Manten-Horst and {van Ravensteyn}, {Nicolien T.} and Korevaar, {Joke C.} and Siemerink, {Ester J.M.} and {van Dalen}, Thijs and {van der Velden}, {Annette W.G.} and Mureau, {Marc A.M.}",

note = "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: {\textcopyright} 2021, The Author(s).",

year = "2021",

month = apr,

day = "17",

doi = "10.1186/s13045-021-01073-7",

language = "English",

volume = "14",

pages = "1--12",

number = "1",

}

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 - 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 - 2021/4/17

Y1 - 2021/4/17

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, OR wks9-11: 2.18). Invasive tumors were less likely to be treated initially by mastectomy with immediate reconstruction (OR wks12-13: 0.52) or by breast conserving surgery (OR wks14-17: 0.75). Chemotherapy was less likely for tumors diagnosed in the beginning of the study period (OR wks9-11: 0.59, OR wks12-13: 0.66), but more likely for those diagnosed at the end (OR wks14-17: 1.31). Primary hormonal treatment was more common (OR wks2-8: 1.23, OR wks9-11: 1.92, OR wks12-13: 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, OR wks9-11: 2.18). Invasive tumors were less likely to be treated initially by mastectomy with immediate reconstruction (OR wks12-13: 0.52) or by breast conserving surgery (OR wks14-17: 0.75). Chemotherapy was less likely for tumors diagnosed in the beginning of the study period (OR wks9-11: 0.59, OR wks12-13: 0.66), but more likely for those diagnosed at the end (OR wks14-17: 1.31). Primary hormonal treatment was more common (OR wks2-8: 1.23, OR wks9-11: 1.92, OR wks12-13: 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 - Adult

KW - Aged

KW - Breast Neoplasms/diagnosis

KW - COVID-19/epidemiology

KW - Disease Management

KW - Female

KW - Humans

KW - Incidence

KW - Mass Screening

KW - Middle Aged

KW - Neoplasm Staging

KW - Netherlands/epidemiology

UR - http://www.scopus.com/inward/record.url?scp=85104641365&partnerID=8YFLogxK

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

SP - 1

EP - 12

JO - Journal of Hematology and Oncology

JF - Journal of Hematology and Oncology

IS - 1

M1 - 64

ER -

Impact of the COVID-19 pandemic on diagnosis, stage, and initial treatment of breast cancer in the Netherlands: a population-based study

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