April 20, 2020
Some Recommendations for Managing Breast Disease During the Pandemic
During this truly unprecedented time, the world swoons from not only the COVID-19 pandemic, but also from the secondary viral impact of the internet and social media. We’re witnessing the metastases of information; some good, some unfounded, some bad that has resulted in the near-paralysis of the world economy, human socialization, and routine institutional operations like schools. Amongst those hit the hardest are the country’s sick from causes other than the COVID-19 virus, although as of April 2020, all illness currently needs to be viewed in light of the Coronavirus pandemic.
If you’re like me, you’ve heard every theory ranging from the pandemic being a major medical threat, a secret government plot, to aliens planting the virus on Earth. With all of that information to distill, how can we move forward and continue to take care of patients who have other very real, serious health problems, most of whom have unintentionally been placed on the back burner? How can we, as practitioners, help reduce the fear associated with a breast cancer diagnosis that we don’t necessarily have the resources to treat currently as a result of the pandemic?
Breast cancer and other breast diseases present a unique challenge against the backdrop of the SARS-Cov-2 (the virus associated with the COVID-19 pandemic). With this in mind, a task force, the COVID-19 Breast Cancer Consortium, was assembled to provide clinicians and patients with a set of guidelines, a mammoth undertaking given the uncertainty of the Coronavirus’s course in all-comers and the overwhelming amount of information that has been bombarding the airwaves.
While the COVID-19 Breast Cancer Consortium has initiated an ongoing discussion on how to proceed with breast cancer treatment and management in light of the pandemic, the experts have suggested some preliminary guidelines which place patients into three priority categories:
Priority A Category:
“Priority A patients have a condition that is immediately life threatening, clinically unstable, or completely intolerable and for whom even a short delay would significantly alter the patient’s prognosis. Assuming efficacious treatment, these patients are given top priority even if resources become scarce, requiring urgent treatment for preservation of life or control of progressing disease or symptomatic relief.”
1) patients presenting with an abscess, pain, and fever
2) underlying lung disease with shortness of breath
Priority B Category:
“Patients in the Priority B category are patients who do not have immediately life-threatening conditions but for whom treatment or services should not be indefinitely delayed until the end of the pandemic. Most breast cancer patients will fall under Priority B. If conditions in a geographic location only allow for Priority A patients to receive treatment, then treatment for Priority B patients can be delayed for a defined period of time during the pandemic. A short delay (e.g. 6-12 weeks) would not impact overall outcomes for these patients. Longer delays could impact outcomes in some Priority B patients and triage may become necessary to justify which patients should undergo treatment versus further delay. Patients within the Priority B category will be sub-stratified as B1 (higher priority), B2 (mid-level priority), and B3 (lower priority) as defined by each breast cancer subspecialty.”
Example: patients requiring lumpectomy for breast cancer who are not in the middle of a neoadjuvant treatment
Priority C Category:
“Patients in Priority C category are patients for whom certain treatment or services can be indefinitely deferred until the pandemic is over without adversely impacting outcomes.”
Example: excision of benign disease
While much of our relief efforts are going towards acute treatment of those patients suffering from COVID-19, we want you to know that we are still working hard to make sure those who are COVID-19 negative with chronic medical conditions still receive the treatment they need. We hope you understand that the prioritization is meant to ensure that the entire medical system can continue to run smoothly. Please note that this will be an ongoing discussion as more information becomes available.
Thank you for your understanding during this difficult time.
Rachel B. Wellner, MD MPH FACS
Jonathan Vaynberg, MD
Medically-Necessary, Time-Sensitive Procedures: A Scoring System to Ethically and Efficiently Manage Resource Scarcity and Provider Risk During the COVID-19 Pandemic. Vivek N. Prachand, MD FACSa,∗,Correspondence information about the author MD FACS Vivek N. Prachand
Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic.
The COVID-19 Pandemic Breast Cancer Consortium: Representatives from the American Society of Breast Surgeons (ASBrS), the National Accreditation Program for Breast Centers (NAPBC), the National Comprehensive Care Network (NCCN), the Commission on Cancer (CoC), and American College of Radiology (ACR).
Jill R. Dietz, MD; Meena S. Moran, MD; Steven J. Isakoff, MD, PhD; Scott H. Kurtzman, MD; Shawna C. Willey, MD; Harold J. Burstein, MD, PhD; Richard J. Bleicher, MD; Janice A. Lyons, MD; Terry Sarantou, MD; Paul L. Baron, MD; Randy E. Stevens, MD; Susan K. Boolbol, MD; Benjamin O. Anderson, MD; Lawrence N. Shulman, MD; William J. Gradishar, MD; Debra L. Monticciolo, MD; Donna M. Plecha, MD; Heidi Nelson, MD; Katharine A. Yao, MD