Impact of the COVID-19 Pandemic on Breast Cancer Stage at Diagnosis in a Tertiary Referral Cancer Center in Egypt

Background: The COVID-19 pandemic caused cessation of breast screening 
programs in many cancer centers worldwide, and seeking medical care was 
delayed for many patients with suspected breast cancer. This study compared 
breast cancer stage at diagnosis and type of surgery performed in patients who 
presented to our institution before, during, and after the COVID-19 lockdown.
Methods: This retrospective study included medical records of all newly 
diagnosed breast cancer patients between January 2019 and December 2021 
from the Beni-Suef University Registry. We compared patient characteristics 
between 3 cohorts: the pre-COVID-19 group (March 2019 – December 2019), 
the COVID-19 group (March 2020 – December 2020), and the post-COVID-19 
group (March 2021 – December 2021). 
Results: A total of 517 patients were identified among which 515 had complete 
staging data; 171 in pre-COVID-19 group, 145 in COVID-19 group, and 201 in 
post-COVID-19 group. The proportion of patients with stage 4 was higher 
during the COVID-19 pandemic (20.0%) compared with 10.5% pre-COVID-19 
and 10.1% post-COVID-19 (p=0.003). Early-stage breast cancer (stage 0–IIB) 
was diagnosed more frequently in the pre-COVID-19 (55.0%) and post-
COVID-19 (50.3%) groups compared with the COVID-19 (33.1%) group 
(p<0.001). Visceral metastases at diagnosis were present more frequently during 
the COVID-19 pandemic (10.3%) compared with pre-COVID-19 (6.4%) and 
post-COVID-19 (4.0%) (p=0.037). The median age, number of male patients, 
and proportion of patients who had mastectomy during COVID-19 pandemic 
did not differ from those in the pre-COVID-19 and post-COVID-19 periods.
Conclusions: More breast cancer patients presented with advanced stages and 
visceral metastases during the COVID-19 lockdown compared with the pre-
lockdown period. Subsequently, these rates returned to pre-COVID-19 levels, 
most probably as a result of a successful vaccination campaign.