Metadata about: BACKGROUND: During the COVID-19 pandemic, surgical delays have been common for patients with ductal carcinoma in situ (DCIS) and early-stage estrogen receptor-positive (ER+) breast cancer, often in favor of neoadjuvant endocrine therapy (NET). To understand possible ramifications of these delays, we examined the association between time to surgery (TTS), pathological staging and overall survival (OS). STUDY DESIGN: Patients with DCIS or ER+ cT1-2N0 breast cancer treated 2010-2016 were identified in the National Cancer Database. TTS was recorded. Factors associated with pathological upstaging were examined using logistic regression analyses. Cox proportional hazard models were used to analyze OS. Analyses were stratified by disease stage and initial treatment strategy. RESULTS: 378,839 patients were identified. Among those undergoing primary surgery, TTS was within 120 days in >98% in all groups. Among cT1-2N0 patients selected for NET, surgery was performed within 120 days in 59.6% of cT1N0 and 30.9% of cT2N0 patients. Increased TTS was associated with increased odds of pathological upstaging in DCIS patients (ER+: 60-120 days: OR:1.15, 95% CI:1.08-1.22; >120 days: OR:1.44, 95% CI:1.24-1.68; ER-: 60-120 days: NS; >120 days: OR:1.36, 95% CI:1.01-1.82; <60 days: reference), but not in patients with invasive cancer irrespective of initial treatment strategy. No difference in OS was seen by TTS in DCIS or NET patients. CONCLUSION: Increased TTS was associated with a small increase in pathological upstaging in DCIS patients, but did not impact OS. In patients with cT1-2N0 disease, NET use did not impact stage or OS, supporting the safety of delay strategies in ER+ breast cancer patients during the pandemic.

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