Strong decline of newly diagnosedgynecologic and breast cancers during the COVID-19pandemic: A retrospective analysis from Innsbruck, Austria
Authors: Irina Tsibulak, Elisabeth Reiser, Christoph Ebner, Katharina Knoll, Katharina Leitner, Verena Wieser, Justina Angerer, Christian Marth
Journal: Clinical Cancer Research (2020)

A nationwide lockdown was declared on March 16 in Austria due to coronavirus disease 2019 (COVID-19) outbreak, requiring citizens to remain in their homes except for necessary reasons  The lockdown resulted not only in socialdistancing and reduction of commercial activity, but also in severe restrictions in the health care system  Regularmedical services and outpatient care were nearly shut down to prevent the spread of the virus and to increase thetotal hospital capacities  Thus, patients faced barriers to attend preventive checkups, such as mammography, screening for cervical cancer, or to consult the general practitioner  As a gynecologic department with a largeoncologic subunit, we noticed significantly fewer tumor diagnoses presenting at our department since the lockdown This phenomenon forced us to perform this retrospective study on newly diagnosed gynecologic and breast cancersbefore and during the COVID-19 pandemic  A retrospective analysis of newly diagnosed gynecologic and breastcancers presented at the University Hospital Innsbruck from January to May 2019 and from January to May 2020was performed  Descriptive statistics and analysis of the clinical data stratified by the year of diagnosis wereperformed using SPSS software and Mann-Whitney U test  Our results showed a slight increase of newly diagnosedcancers in January and February 2020 as compared to 2019 (+13%) and a strong decline in newly diagnosedtumors since the lockdown: -45% in March 2020 vs  March 2019, -63% in April 2020 vs  April 2019, and -44% in May 2020 vs  May 2019  Around two third of patients diagnosed during the pandemic consulted the specialist due totumor symptoms, while before the pandemic less than 50% of patients presented with symptoms  The ratio of breastand vulvar cancer was significantly higher during the pandemic (71 vs  61% and 3 vs  1 9%, respectively;p=0 043), but significantly fewer cervical cancers were diagnosed (4 4 vs  8 9%;p=0 043)  Patients with other malignant, rheumatic, or metabolic disease were rarely diagnosed with a new cancer in 2020 as compared to 2019 (7 5 vs 12%;0 7 vs  3 7% and 6 7 vs  12%, respectively;p=0 014)  A better performance status was observed in patientspresented in 2020 as compared to 2019 (p=0 011)  In a country with maximum intensive care bed occupancy of26% during the COVID-19 pandemic, the accessibility of the health care services was severely impaired andpreventive care and early cancer detection was restricted, leading to an increase in undetected or postponed tumordiagnoses  The aim of our work is to raise awareness of this issue  It is not clear whether these undetected caseswill lead to potential months of life lost;however, decreased accessibility of the medical services and postponeddiagnosis of potentially curable cancers are clearly a step backwards in our health care system and will probablyimpair cancer treatment outcomes  Thus, new strategies to manage early cancer detection are needed to optimizecancer care in a time of pandemic in the future