Clinical Report: Impact of COVID-19 on Breast Surgery Practices in Italy
Overview
This multi-center retrospective study evaluated the impact of the COVID-19 pandemic on breast cancer surgical procedures across 14 Italian Breast Care Units. The study found a significant 9% overall reduction in breast oncologic surgeries in 2020 compared to 2019, with a notable increase in the mastectomy to breast-conserving surgery (BCS) ratio and shifts in reconstructive surgery trends.
Background
The COVID-19 pandemic severely challenged healthcare systems worldwide, with Italy being the first European country heavily affected in early 2020. To manage resources for COVID-19 patients, hospitals reduced elective surgeries and routine screenings, impacting breast cancer care. This study aimed to quantify changes in breast cancer surgical volume and practices during the pandemic year 2020 compared to 2019, focusing on mastectomy versus BCS rates and reconstructive procedures across different Italian regions.
Data Highlights
Parameter
2019
2020
Change (%)
p-value
Total breast oncologic surgeries
9,383
8,509
-9%
<0.01
Mastectomies (% of surgeries)
39%
42%
+3%
<0.05
Breast-conserving surgeries (BCS) (% of surgeries)
61%
58%
-3%
<0.01
1st level oncoplastic breast surgery (OBS)
4,917
4,238
-13.8%
Not specified
2nd level OBS
783
718
-8.3%
Not specified
Immediate direct-to-implant reconstructions
1,105
1,271
+15%
<0.01
Expander reconstructions
1,489
1,192
-20%
<0.01
Key Findings
The overall number of breast oncologic surgeries decreased by 9% in 2020 compared to 2019 (p < 0.01).
The mastectomy rate increased significantly from 39% to 42% of all breast surgeries (p < 0.05), while BCS decreased from 61% to 58% (p < 0.01).
First-level oncoplastic breast surgeries decreased by 13.8% and second-level by 8.3% between 2019 and 2020.
Immediate direct-to-implant breast reconstructions increased by 15% (p < 0.01), whereas expander reconstructions decreased by 20% (p < 0.01).
Geographically, Lombardy and Northern Italy experienced significant reductions in surgical volume, while Central and Southern Italy did not.
All regions showed an increase in the mastectomy to BCS ratio during the pandemic year.
Clinical Implications
The COVID-19 pandemic led to a measurable reduction in breast cancer surgeries and altered surgical practice patterns in Italy, with a shift towards more mastectomies and immediate direct-to-implant reconstructions. Clinicians should be aware of these trends when planning breast cancer care during healthcare crises, ensuring that oncologic safety and reconstructive options are balanced against resource constraints. Regional differences highlight the need for tailored strategies based on local pandemic impact.
Conclusion
The COVID-19 pandemic significantly impacted breast cancer surgical practices in Italy, reducing overall surgical volume and shifting treatment patterns towards increased mastectomy rates and immediate implant reconstructions. These findings underscore the importance of adaptable breast cancer care pathways during public health emergencies.
References
Italian Government and Health Data 2020 -- COVID-19 Pandemic Impact on Healthcare
by R. Sgarzani, G. Macrì, A. Gurrado, A. Curcio, F. De Lorenzi, V. Galimberti, C. Garusi, M. Bocchiotti, M. Roncella, F. Rovera, G. Caputo, A. Sgarella, L. Barone Adesi, D. Terribile, R. Nonnis, P. Frittelli, B. Cagli, S. Tenna, I. Baldelli, A. Cordova, R. Elia, M. Salgarello
