Ko Gary, Li Qing, Liu Ning, Amir Eitan, Covelli Andrea, Eskander Antoine, Freitas Vivianne, Anne Koch C, Ramruthan Jenine, Reel Emma, Roberts Amanda, Zhong Toni, Cil Tulin D
Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
ICES, Toronto, ON, Canada.
Breast Cancer Res Treat. 2025 Feb;210(1):147-156. doi: 10.1007/s10549-024-07547-9. Epub 2024 Nov 15.
The COVID-19 pandemic significantly impacted breast cancer (BC) surgeries. Most studies showing reduced BC surgical volumes during the pandemic are from single institutions, few have described volume changes in different types of surgical procedures. This study aimed to assess the impact of the pandemic on BC surgery volumes and types at a population level.
Patients diagnosed with BC between January 1, 2018, and June 25, 2022, in Ontario, Canada, were analysed from population-based datasets. Time periods were defined as pre-pandemic (Jan 2018-Mar 2020), immediate pandemic (Mar-Jun 2020), and peri-pandemic (Jun 2020-Jun 2022). Weekly BC surgery volume and type (lumpectomy, mastectomy, or mastectomy with immediate reconstruction) were evaluated using segmented negative binomial regression models.
Among 44 226 patients, 50 440 surgeries were performed. Weekly BC surgeries decreased by 16.9% during the immediate pandemic compared to pre-pandemic levels (180.5 vs. 217.1; p = 0.03). Surgical volumes recovered to pre-pandemic levels by June 2021. Mastectomies represented a higher proportion of BC surgeries during the pandemic (31.1% pre, 36.3% immediate, 32.4% peri-pandemic; p < 0.01). The proportion of mastectomies with immediate reconstruction remained stable during the immediate pandemic but increased in the peri-pandemic (20.1% vs. 17%; p < 0.01).
There was a significant reduction in all BC surgeries during the pandemic. Mastectomies accounted for a higher proportion of BC surgeries in the pandemic period however access to reconstruction was maintained. Surgical volumes recovered within a year despite ongoing pandemic hospitalizations. Future studies are needed to explore the pandemic's long-term impact on BC care.
新冠疫情对乳腺癌（BC）手术产生了重大影响。大多数显示疫情期间BC手术量减少的研究来自单一机构，很少有研究描述不同类型手术程序的量的变化。本研究旨在在人群水平上评估疫情对BC手术量和类型的影响。
从基于人群的数据集分析2018年1月1日至2022年6月25日期间在加拿大安大略省被诊断为BC的患者。时间段定义为疫情前（2018年1月 - 2020年3月）、疫情初期（2020年3月 - 6月）和疫情期间（2020年6月 - 2022年6月）。使用分段负二项回归模型评估每周BC手术量和类型（保乳手术、乳房切除术或即刻重建乳房切除术）。
在44226例患者中，共进行了50440例手术。与疫情前水平相比，疫情初期每周BC手术量下降了16.9%（180.5对217.1；p = 0.03）。到2021年6月手术量恢复到疫情前水平。乳房切除术在疫情期间占BC手术的比例更高（疫情前31.1%，疫情初期36.3%，疫情期间32.4%；p < 0.01）。即刻重建乳房切除术的比例在疫情初期保持稳定，但在疫情期间有所增加（20.1%对17%；p < 0.01）。
疫情期间所有BC手术量显著减少。乳房切除术在疫情期间占BC手术的比例更高，然而重建手术的可及性得以维持。尽管疫情期间仍有住院情况，但手术量在一年内恢复。未来需要开展研究以探索疫情对BC护理的长期影响。
