Neoadjuvant Endocrine Therapy and Delays in Surgery for Ductal Carcinoma in Situ: Implications for the Coronavirus Pandemic

• Published in: Annals of surgical oncology Vol. 29; no. 3; pp. 1683 - 1691
• Main Authors: Williams, Austin D., Chang, Cecilia, Sigurdson, Elin R., Wang, Chih-Hsiung, Aggon, Allison A., Hill, Maureen V., Porpiglia, Andrea, Bleicher, Richard J.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-03-2022; Springer Nature B.V
• Subjects: Breast cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - epidemiology; Breast Neoplasms - surgery; Breast Oncology; Cancer; Carcinoma, Ductal, Breast - drug therapy; Carcinoma, Ductal, Breast - epidemiology; Carcinoma, Ductal, Breast - surgery; Carcinoma, Intraductal, Noninfiltrating - drug therapy; Carcinoma, Intraductal, Noninfiltrating - epidemiology; Carcinoma, Intraductal, Noninfiltrating - surgery; Coronaviruses; COVID-19; Diagnosis; Endocrine therapy; Female; Humans; Invasiveness; Medicine; Medicine & Public Health; Neoadjuvant Therapy; Oncology; Pandemics; Patients; Prospective Studies; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Surgery; Surgical Oncology
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-021-10883-5

Background
Surgical delays are associated with invasive cancer for patients with ductal carcinoma
in situ
(DCIS). During the Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) pandemic, neoadjuvant endocrine therapy (NET) was used as a bridge until postponed surgeries resumed. This study sought to determine the impact of NET on the rate of invasive cancer for patients with a diagnosis of DCIS who have a surgical delay compared with those not treated with NET.
Methods
Using the National Cancer Database, the study identified women with hormone receptor-positive (HR+) DCIS. The presence of invasion on final pathology was evaluated after stratifying by receipt of NET and by intervals based on time from diagnosis to surgery (≤30, 31–60, 61–90, 91–120, or 121–365 days).
Results
Of 109,990 women identified with HR+ DCIS, 276 (0.3%) underwent NET. The mean duration of NET was 74.4 days. The overall unadjusted rate of invasive cancer was similar between those who received NET ((15.6%) and those who did not (12.3%) (
p
= 0.10). In the multivariable analysis, neither the use nor the duration of NET were independently associated with invasion, but the trend across time-to-surgery categories demonstrated a higher rate of upgrade to invasive cancer in the no-NET group (
p
< 0.001), but not in the NET group (
p
= 0.97).
Conclusions
This analysis of a pre-COVID cohort showed evidence for a protective effect of NET in HR+ DCIS against the development of invasive cancer as the preoperative delay increased, although an appropriately powered prospective trial is needed for a definitive answer.