[BREAST CANCER COMPLICATIONS DURING THE COVID-19 PANDEMIC - LESSONS LEARNT]

In their article published in this issue of Harefuah, Greenhouse et al. describe a complicated case of a woman with delayed diagnosis of breast cancer, presenting with spinal cord compression due to spin metastases and a locally advanced breast lesion. The patient had concurrent symptomatic infection with COVID-19, and was successfully diagnosed and treated, resulting in neurologic recovery. This case raises several issues, relevant to the care of patients with breast cancer. Late diagnosis of breast cancer is not uncommon, but little is known regarding the reasons why some women forego breast cancer screening or delay diagnosis of symptomatic breast lesions. Available information points at fear of breast cancer and fear of surgery as common causes, and it seems that interventions aimed to increase screening rates should take these findings into account. The patient described by Greenhouse et al. complained of back ache and was treated by telemedicine for a month preceding hospitalization, during the initial stages of the COVID-19 outbreak. As the implementation of telemedicine increases, organizations should issue guidelines for its use. It seems prudent to avoid using telemedicine in patients with new symptoms or recurring symptoms without a definite diagnosis. There is currently sufficient data showing that breast cancer patients are not at higher risk for COVID-19 complications compared with the general population, even while treated for their cancer. Serologic studies performed in Israel following COVID-19 vaccination found that 85-90% of patients with solid tumors have positive serologic tests after the 2nd dose of the vaccine. Studies have estimated that delaying breast cancer screening during the pandemic would result in increased breast cancer mortality. Thus, efforts should be made to continue breast cancer screening, diagnostic workup of suspicious findings and treatment of confirmed breast cancer in the event of additional outbreaks of COVID-19.