This guidance for Breast Surgeons should be considered in the context of your local resources and guidance provided by local Departments of Health and Individual Institutions, and on a case by case basis based on your knowledge of your patient, institution and available treatment options.
Based on The American College of Breast Surgeons ‘Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic: Executive Summary v1.0’, The COVID-19 Pandemic Breast Cancer Consortium 24/3/2020 – see link
Case status (i.e. risk of death time frame) determination should be made by a multidisciplinary team, ideally in a multidisciplinary meeting, which is documented in the medical record.
Guidance for treatment of breast cancer patients in Australia and New Zealand during the COVID-19 Pandemic is provided for two categories of semi-urgent (Stage 1) and urgent (Stage 2) settings, based on patient condition, prevalence of COVID-19 pandemic in your region and resource availability. These recommendations require update with changing severity of the COVID-19 pandemic.
Definition: Few COVID 19 patients, hospital resources not exhausted and COVID trajectory not in rapid escalation phase
Surgery restricted to patients likely to have survival compromised if surgery not performed within next 3 months.
Cases that need to be done as soon as feasible (recognizing status of hospital likely to progress over next few weeks):
*In some cases, institutions may decide to proceed with surgery versus subjecting a patient to an immunocompromised state with neoadjuvant chemotherapy. These decisions will depend on institutional resources.
Encourage use of breast conserving surgery whenever possible, defer definitive mastectomy and/or reconstruction until after the COVID 19 pandemic resolves provided radiation oncology services are available.
Cases that should be deferred
Cases that may be deferred
Alternative treatment approaches to be considered (assuming resources permit):
# Many women with early stage, ER pos breast cancers do not benefit substantially from chemotherapy. In general, these include women with stage 1 or limited stage 2 cancers, particularly those with low-intermediate grade tumours, lobular breast cancers, or “luminal A” signatures. High level evidence supports the safety and efficacy of 6 to 12 months of primary endocrine therapy before surgery in such women, which may enable the deferral of surgery.
Definition:Many COVID 19 patients, ICU and ventilator capacity limited, OR supplies limited or COVID trajectory within hospital in rapidly escalating phase
Surgery restricted to patients likely to have survival compromised if surgery not performed within next few days
Cases that need to be done as soon as feasible (recognizing status of hospital likely to progress over next few days):
Cases that should be deferred:
Alternative treatment approaches RECOMMENDED (assuming resources permit):