COVID-19 in Breast Cancer Patients

A Cohort at the Institut Curie Hospitals in the Paris Area

Perrine Vuagnat; Maxime Frelaut; Toulsie Ramtohul; Clémence Basse; Sarah Diakite; Aurélien Noret; Audrey Bellesoeur; Vincent Servois; Delphine Hequet; Enora Laas; Youlia Kirova; Luc Cabel; Jean-Yves Pierga; Institut Curie Breast Cancer and COVID Group; Laurence Bozec; Xavier Paoletti; Paul Cottu; François-Clément Bidard

Disclosures

Breast Cancer Res. 2020;22(55) 

In This Article

Discussion

The SARS-CoV-2 outbreak is the first viral pandemic affecting cancer patients and oncology teams. To the best of our knowledge, this is the first report on COVID-19 diagnosis, signs, and outcome in breast cancer patients.

While 15,600 patients were actively treated for breast cancer at Institut Curie hospitals over the 4 months prior to the pandemic, only 59 were diagnosed with COVID-19 by either RNA test or CT scan. A recent study estimated that more than 10% of inhabitants of the greater Paris area have been infected by the SARS-CoV-2 virus (https://hal-pasteur.archives-ouvertes.fr/pasteur-02548181). While our study cannot determine the incidence of COVID-19 infection among breast cancer patients, the small number of diagnosed cases suggests that breast cancer patients do not appear to be at higher risk than the general population. This apparent low incidence could possibly be attributed to much stricter application of social distancing procedures by cancer patients, who had been informed that they may be at higher risk of severe COVID-19 infection. Prophylactic changes implemented in breast cancer care (e.g., postponement of all non-mandatory visits to ICH, changes in medical treatments) may also have contributed to further reduce the risk of SARS-CoV-2 infection. A limitation of our study is that some patients may have been treated by their family physicians or referred to local hospitals, without any notification to ICH. Although no data was available to compare COVID-19 patients to the other breast cancer patients seen at ICH, rates of high BMI and hypertension in our COVID-19 patient cohort were very similar to those reported in a recent prospective large-scale report on French breast cancer patients,[11] suggesting that these comorbidities do not increase the risk of COVID-19. Our analyses showed that breast cancer patients have similar clinical and radiologic features of COVID-19 to those previously described in other reports on non-cancer COVID-19 patients. Importantly, we found no trend in favor of a relationship between a history of breast and lymph node radiation therapy, radiation therapy sequela, and radiologic extent of disease or outcome. Thrombotic, cardiovascular, microvascular, and dermatological events were not recorded, as their association with COVID-19 was not fully recognized when the registry was set up.

In terms of COVID-19 outcome, we observed a non-negligible mortality rate of 6.7% (4/59) among breast cancer patients diagnosed with COVID-19, with a higher mortality rate of 9.7% (4/41) in the RNA-positive subgroup. As of April 26, the reported mortality rate among RNA-positive patients in the general population ranges from 18.2% in France to 5.6% in the USA and 3.7% in Germany (https://www.who.int/docs/default-source/coronaviruse/situation-reports). However, these percentages reflect more testing policy more than true differences in mortality rates. As in the general population, the true infection and mortality rates could subsequently be determined by serology tests detecting an immune response to SARS-CoV-2. Nevertheless, on univariate analysis, age and hypertension were associated with disease severity rather than the extent of disease or ongoing cancer therapy. More specifically, we found no statistical relationship between ongoing chemotherapy and outcome. Overall, our data suggest that breast cancer patients share the same risk factors for severe COVID-19 as the general population. Strikingly, the only early breast cancer patient who died was concomitantly treated for a systemic disease by a CTLA-4 signaling modulator, suggesting that breast cancer per se is not a major contributor to COVID-19 mortality. Limitations of this analysis include the limited number of patients, a potential under-declaration due to the difficulty in identifying COVID-19 cases in outpatients who may have been referred to other hospitals. A longer follow-up of this registry may help defining more precisely the outcome of breast cancer patients with COVID-19.

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