The Impact of COVID-19 on Breast Cancer Treatment: A Systematic Review Breast cancer treatment during pandemic

Michael Budiarta (1), Meagan Brennan (2)
(1) School of Medicine Sydney, The University of Notre Dame Australia, Oxford St, Darlinghurst, NSW Australia, Australia,
(2) School of Medicine Sydney, The University of Notre Dame Australia, Oxford St, Darlinghurst, NSW Australia, Australia


Background: During the COVID-19 pandemic, health resources were stretched, access was impacted by lockdowns and there were concerns about exposure to the virus during visits to hospitals. The purpose of this study was to examine how breast cancer treatments (presentation, surgery, radiotherapy, chemotherapy and/or endocrine therapy) changed or were adapted during the early phase of the pandemic.

Methods: A systematic review was conducted using PRISMA guidance. Eligible studies presented original data reporting changes to early breast cancer treatment by comparing ‘pandemic’ treatment to a ‘pre-pandemic’ cohort or to ‘ideal’ treatment of individual cases. Data were extracted into evidence tables and narrative synthesis was used to analyse results.  

Results: Fifteen studies with paired design were eligible. These reported outcomes for 6,353 people treated for early breast cancer (January 2020–June 2021). All studies reported some change to treatment due to the pandemic. The nature of reported changes was inconsistent. Changes included: tumours more advanced at presentation compared to pre-pandemic, increase in breast conserving surgery;  increase in simple mastectomy (without breast reconstruction); trend towards increased wait times, delays to start of treatment, shorter post-operative hospital stay and hypofractionation or omission of radiotherapy. Centres used more or less neoadjuvant chemotherapy or endocrine therapy.

Conclusion: In the early stage of the pandemic, fewer early-stage breast cancer cases were treated many centres. Treatment for breast cancer was impacted and various local solutions were developed. These included less complicated breast surgery, increased use of neoadjuvant therapy, and changes to radiotherapy regimens. Surgery was frequently delayed and breast reconstruction was often unavailable. These results have implications for breast cancer services during the pandemic recovery as a ‘catch-up’ increase in cancer diagnoses is expected. Women may wish to access breast reconstruction, unavailable due to COVID-19. The impact of changes to treatment on long-term quality of life should be evaluated.

Full text article

Generated from XML file


Worobey M. Dissecting the early COVID-19 cases in Wuhan. Science. 2021;374(6572):1202-4. doi: 10.1126/science.abm4454.

World Health Organisation. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020 2020 [Available from:

World Health Organization. Weekly epidemiological update on COVID-19 - 22 June 2022 2022 [Edition 97:[Available from:

World Health Organization. Breast cancer 2021 [updated 26 March 2021. Available from:

Maringe C, Spicer J, Morris M, Purushotham A, Nolte E, Sullivan R, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. The Lancet Oncology. 2020;21(8):1023-34. doi: doi:10.1016/S1470-2045(20)30388-0.

Hui JYC, Yuan J, Teoh D, Thomaier L, Jewett P, Beckwith H, et al. Cancer Management During the COVID-19 Pandemic in the United States: Results From a National Physician Cross-sectional Survey. American journal of clinical oncology. 2020;43(10):679-84. doi: 10.1097/COC.0000000000000757.

PROSPERO. International Prospective Register of Systematic Reviews: National Institute for Health Research; 2022 [Available from:

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi: 10.1136/bmj.n71.

Wells G, Shea B, O'Connell D, Peterson J, Welch VA, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. The Ottawa Hospital Research Institute. 2021. doi: Not Available

Acea-Nebril B, García-Novoa A, García-Jiménez L, Escribano-Posada C, Díaz-Carballada C, Bouzón-Alejandro A, et al. Impact of the COVID-19 pandemic on a breast cancer surgery program. Observational case-control study in a COVID-free hospital. Breast J. 2020;26(12):2428-30. doi: 10.1111/tbj.14037.

Cadili L, DeGirolamo K, McKevitt E, Brown CJ, Prabhakar C, Pao JS, et al. COVID-19 and breast cancer at a Regional Breast Centre: our flexible approach during the pandemic. Breast Cancer Res Treat. 2021;186(2):519-25. doi: 10.1007/s10549-020-06008-3.

Dave RV, Kim B, Courtney A, O'Connell R, Rattay T, Taxiarchi VP, et al. Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK 'Alert Level 4' phase of the B-MaP-C study. British Journal of Cancer. 2021;124(11):1785-94. doi: 10.1038/s41416-020-01234-4.

Eijkelboom AH, de Munck L, Vrancken Peeters M, Broeders MJM, Strobbe LJA, Bos M, et al. Impact of the COVID-19 pandemic on diagnosis, stage, and initial treatment of breast cancer in the Netherlands: a population-based study. J Hematol Oncol. 2021;14(1):64. doi: 10.1186/s13045-021-01073-7.

Fancellu A, Sanna V, Piredda C, Ariu L, Piana GQ, Deiana G, et al. The COVID-19 outbreak may be associated to a reduced level of care for breast cancer. A comparative study with the pre-COVID era in an Italian Breast Unit...12th European Breast Cancer Conference (EBCC-12), October 2-3, 2020 (Virtual Conference). European Journal of Cancer. 2020;138:S16-S7. doi: 10.1016/S0959-8049(20)30562-1.

Hawrot K, Shulman LN, Bleiweiss IJ, Wilkie EJ, Frosch ZAK, Jankowitz RC, et al. Time to Treatment Initiation for Breast Cancer During the 2020 COVID-19 Pandemic. JCO Oncol Pract. 2021:Op2000807. doi: 10.1200/op.20.00807.

Kennard K, Williams AD, Goldblatt LG, Buckley ME, Bruce L, Larson S, et al. COVID-19 Pandemic: Changes in Care for a Community Academic Breast Center and Patient Perception of Those Changes. Ann Surg Oncol. 2021:1-11. doi: 10.1245/s10434-020-09583-3.

Koch CA, Lee G, Liu ZA, Liu FF, Fyles A, Han K, et al. Rapid Adaptation of Breast Radiation Therapy Use During the Coronavirus Disease 2019 Pandemic at a Large Academic Cancer Center in Canada. Adv Radiat Oncol. 2020;5(4):749-56. doi: 10.1016/j.adro.2020.06.002.

Lee J, Jung JH, Kim WW, Park CS, Park HY. Patterns of Delaying Surgery for Breast Cancer During the COVID-19 Outbreak in Daegu, South Korea. Front Surg. 2020;7:576196. doi: 10.3389/fsurg.2020.576196.

Montagna E, Bellerba F, Sangalli C, Gandini S, Cancello G, Aliaga PT, et al. Management of breast cancer patients during the peak of the COVID 19 pandemic. Eur J Surg Oncol. 2021. doi: 10.1016/j.ejso.2021.05.037.

Ngaserin S, Chua HW, Chew MH, Tan BK. A tripartite approach can seek to optimize breast cancer management during a pandemic - Real-Time experience of a developing breast oncology unit in Singapore. Breast J. 2020;26(8):1593-6. doi: 10.1111/tbj.13961.

Romics L, Doughty J, Stallard S, Mansell J, Blackhall V, Lannigan A, et al. A prospective cohort study of the safety of breast cancer surgery during COVID-19 pandemic in the West of Scotland. Breast. 2021;55:1-6. doi: 10.1016/j.breast.2020.11.015.

Satish T, Raghunathan R, Prigoff JG, Wright JD, Hillyer GA, Trivedi MS, et al. Care Delivery Impact of the COVID-19 Pandemic on Breast Cancer Care. JCO Oncol Pract. 2021:Op2001062. doi: 10.1200/op.20.01062.

Vanni G, Pellicciaro M, Materazzo M, Pedini D, Portarena I, Buonomo C, et al. Advanced Stages and Increased Need for Adjuvant Treatments in Breast Cancer Patients: The Effect of the One-year COVID-19 Pandemic. Anticancer Res. 2021;41(5):2689-96. doi: 10.21873/anticanres.15050.

Vanni G, Tazzioli G, Pellicciaro M, Materazzo M, Paolo O, Cattadori F, et al. Delay in Breast Cancer Treatments During the First COVID-19 Lockdown. A Multicentric Analysis of 432 Patients. Anticancer Res. 2020;40(12):7119-25. doi: 10.21873/anticanres.14741.

Zhang EJ, Stuart K, Hui R, Mellor R, Wang W, Ahern V, et al. Management of Early Breast Cancer at an Australian Cancer Centre During the Early Phase of COVID-19 Pandemic. Available at: SSRN 3829713. 2021.


Michael Budiarta
Meagan Brennan (Primary Contact)
Author Biography

Michael Budiarta, School of Medicine Sydney, The University of Notre Dame Australia, Oxford St, Darlinghurst, NSW Australia

MD student, University of Notre Dame Australia

Budiarta M, Brennan M. The Impact of COVID-19 on Breast Cancer Treatment: A Systematic Review: Breast cancer treatment during pandemic. Arch Breast Cancer [Internet]. 2022 Jul. 30 [cited 2024 Jun. 16];9(4):421-38. Available from:

Article Details