Treatment Recommendations and Prioritization Planning for Breast Cancer Patients During COVID-19 Pandemic. Part 1: High Risk Lesions, DCIS And Hormonal Positive Breast Cancer. A Caribbean Breast Surgeon’s Perspective.

Abstract

The ongoing COVID-19 pandemic has presented a challenging approach to breast surgical oncology both internationally and locally. Triage and prioritization are the cornerstones of international recommendations for cancer management during this pandemic. This formidable and unique set of challenges influences the delivery of oncological and supportive care to breast cancer patients. Preservation of hospital resources, reduction in patients’ hospital visits and health care provider exposure to infection, result in non-urgent cases being deferred or cancelled. Delay of treatment, both medical or surgical, may influence patients’ outcome if not strategically planned and discussed with a multidisciplinary approach. As physicians, we need to weigh the risk-to-benefit ratio on a case-by-case scenario. Several expert oncology bodies have collaboration in the triaging, prioritizing and treatment processes of breast cancer management. The adaptation and utilization of neoadjuvant therapy is one bridging and mitigating technique heavily implemented during the pandemic. The existing recommendations will be presented in two articles for ease of interpretation. In this article, the current recommendations for the pandemic response to high-risk lesions, Ductal Carcinoma In-Situ (DCIS) and Hormone Receptor Positive Breast Cancer management are highlighted. Suggestions for regional and national implementation of these guidelines in accordance with local resources and conditions will be outlined.