Interrupting radiation therapy for breast cancer due the COVID-19 coronavirus

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UPDATED March 24, 2020.

For everyone going through radiation treatment for breast cancer during this coronavirus pandemic, I am sorry you have to go through this at this time. It is bad enough to go through it when life is “regular”, let alone when so many fears and concerns are added to your already full plate.

Many breast (invasive breast cancer or DCIS) patients are wondering whether to pause or interrupt their radiation therapy course during the coronavirus pandemic, trying to balance the risk of continuing treatment to decrease the chance of recurrence of DCIS versus the risk of acquiring the coronavirus infection with their daily excursions to the radiation center.

On March 24, 2020, the American Society of Breast Surgeons together with several of the national societies involved in breast cancer care released the first iteration of their recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic. Of note, these are general guidelines, and nothing is a substitute for the doctor/patient relationship and assessment of the individual patient risk factors in the local context of each breast center.

The guidelines propose that patients over age 65-70 years old with lower risk Stage I hormone receptor positive and HER2-negative cancers and taking adjuvant endocrine therapy can be encouraged to defer or omit radiation without affecting overall survival. If patients cannot tolerate endocrine therapy, re-evaluation for radiation depending on individual patient and pathologic factors and current severity of pandemic is recommended.

For patients with DCIS, these guidelines state that women with DCIS may omit radiation therapy, especially those with estrogen receptor positive lesions taking adjuvant endocrine therapy, without affecting overall survival.

Importantly, the guidelines prioritized patients who have already started a course of radiation as Priority A. In general, once a treatment is started, it should be completed with minimal interruption to achieve the best reduction of risk of recurrence of breast cancer or DCIS. Every situation is different and should be discussed with your own radiation oncologist and breast cancer team.

Rest assured that your radiation oncology facility is taking strong measures to decrease risk of infection in patients in your situation. Needless to say, be diligent about washing your hands and not touching your face to minimize your risk of infection. It’s also OK to ask healthcare providers and caregivers at the center to wash their hands before touching you. It’s a good idea to talk to your radiation oncologist about any other protective measures that may be recommended for your unique situation.

Before making any hasty decisions, please discuss the option of pausing radiation with your radiation oncologist. Your breast surgeon and medical oncologist will also offer valid input.

This article has been edited to reflect the position of the American Society of Breast Surgeons together with several of the national societies involved in breast cancer care in the release of v1.0 of their recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients During the COVID-19 Pandemic. on March 24, 2020.