Breast Cancer Surgery Wait Times and COVID-19: A Canadian Population-Based Analysis

Abstract Background During the COVID-19 pandemic, operating room restrictions led to triaging of breast cancer (BC) surgery. This study assessed the impact of the pandemic on wait times for BC surgery at a population level. Methods Patients diagnosed with BC between January 2018 and December 2021 in Ontario, Canada, were categorized as pre-pandemic (January 1, 2018, to March 14, 2020), immediate (March 15, 2020, to June 13, 2020), and peri-pandemic (June 14, 2020, to December 31, 2021). Time-to-event analysis evaluated the time to first BC surgery, with subgroup analyses for patients receiving neoadjuvant chemotherapy (NAC) and neoadjuvant endocrine therapy (NET). Results Among 37,520 patients with newly diagnosed BC, the probability of undergoing surgery each month from their diagnosis date was significantly lower during the immediate and peri-pandemic period than during the pre-pandemic period (log-rank p < 0.01). However, the use of NAC and NET increased during the immediate pandemic compared with the pre-pandemic (NAC: 24.3% vs. 14.4%; NET 12.4% vs. 6.6%; p < 0.01). Among patients who had surgery as first treatment, the median wait time was shortest during the immediate pandemic (1.0 mo) compared with the pre- and peri-pandemic periods (1.2 mo, p < 0.01). Conclusion This population-based study found longer diagnosis-to-surgery times during the immediate pandemic, with increased use of neoadjuvant therapy. However, surgical wait times (e.g. post NAC) were shorter in the immediate pandemic, highlighting the triaging of BC care during this unprecedented event.