Modifications in Breast Cancer Guidelines in COVID-19 Pandemic; An Iranian Consensus

Main Article Content

Farhad Shahi
Mehrzad Mirzania
Mahdi Aghili
Mohammadreza Dabiri
Sharareh Seifi
Alireza Bary
Nafiseh Ansarinejad
Alireza Rezvani
Soroush Rad
Amirali Shahi
Ahmad Elahi
Ahmad Kaviani


Coronavirus, Breast cancer guidelines, COVID-19


Background: In March 2020, the World Health Organization declared the novel COVID-19 infection a pandemic. Among high-risk patients infected by the virus, breast cancer patients are vulnerable to present more severe infections. Iran is among the countries with a high incidence of COVID-19 , and most of the routine activities of medical centers are affected by the epidemic disease. Thus, there is a need to make some modifications to international protocols for dealing with breast cancer in the affected countries.

Methods: The headings of breast cancer management protocols have been discussed among the university-affiliated professors in different disciplines involved in breast cancer management. The discussions were done through a “WhatsApp” group considering the tiles and the latest news about COVID-19. Under each title, we provide the consensus of all members in the related disciplines.

Recommendations and Conclusion: In each specialty, all members agreed to choose minimal intervention. The modifications aim to reduce the workload of the medical centers as well as to provide the least interface of the patients with the medical centers. The members know that some recommendations may interfere with the routine best-practice recommendations and decrease the quality measures in the patient's outcome. Therefore, these recommendations are valid just in epidemic COVID-19 situation in the country.


1. Branswell H, Joseph A. WHO declares the coronavirus outbreak a pandemic 2020 [Available from:]
2. Liang W, Guan W, Chen R, Wang W, Li J, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335-7.
3. Wang H, Zhang L. Risk of COVID-19 for patients with cancer. Lancet Oncol. 2020.
4. Xia Y, Jin R, Zhao J, Li W, Shen H. Risk of COVID-19 for cancer patients. Lancet Oncol. 2020.
5. Zhou F, Yu T, Du R, Fan G, Liu Y, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020.
6. Lindesy H. Preventing infection in immunocompromised cancer patients: Latest recommendations. Oncology Times. 2008;30(18): 25-6.
7. Kamboj M, Sepkowitz KA. Nosocomial infections in patients with cancer. Lancet Oncol. 2009;10(6):589-97.
8. Li JY, Duan XF, Wang LP, Xu YJ, Huang L, et al. Selective depletion of regulatory T cell subsets by docetaxel treatment in patients with nonsmall cell lung cancer. J Immunol Res. 2014;2014:286170.
9. Iranian Ministry of Health and Medical Education medical guidelines, Infographic / Existing Statistics of COVID-19 Patients - 20 March 2020 to 21 March 2020 [Available from:]
10. Care of Individuals with Cancer During COVID-19. 2020 [Available from:]
11. National Center for Immunization and Respiratory Diseases (NCIRD) DoVD. Coronavirus Disease 2019 (COVID-19), Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19). 2020. [Available from:]
12. NCCN. Guideline v3.2020 BINV-1 2020 [Available from:]
13. American College of Surgens, COVID-19: Guidance for Triage of Non-Emergent Surgical Procedures 2020 [Available from:]
14. American College of Surgens, COVID-19: Recommendations for Management of Elective Surgical Procedures 2020 [Available from:]
15. Caponio R, Ciliberti MP, Graziano G, Necchia R, Scognamillo G, et al. Waiting time for radiation therapy after breast-conserving surgery in early breast cancer: a retrospective analysis of local relapse and distant metastases in 615 patients. Eur J Med Res. 2016;21(1):32.
16. Salner AL, Smith S, Yu PP. Timing of adjuvant chemotherapy administration for early breast cancer. American Society of Clinical Oncology; 2018.
17. Gagliato Dde M, Gonzalez-Angulo AM, Lei X, Theriault RL, Giordano SH, et al. Clinical impact of delaying initiation of adjuvant chemotherapy in patients with breast cancer. J Clin Oncol. 2014;32(8):735-44.
18. Chavez-MacGregor M, Clarke CA, Lichtensztajn DY, Giordano SH. Delayed initiation of adjuvant chemotherapy among patients with breast cancer. JAMA oncology. 2016;2(3):322-9.
19. Shannon C, Ashley S, Smith I. Does timing of adjuvant chemotherapy for early breast cancer influence survival? Journal of clinical oncology. 2003;21(20):3792-7.
20. Lohrisch C, Paltiel C, Gelmon K, Speers C, Taylor S, et al. Impact on survival of time from definitive surgery to initiation of adjuvant chemotherapy for early-stage breast cancer. J Clin Oncol. 2006;24(30):4888-94.
21. Kupstas AR, Hoskin TL, Day CN, Habermann EB, Boughey JC. Effect of Surgery Type on Time to Adjuvant Chemotherapy and Impact of Delay on Breast Cancer Survival: A National Cancer Database Analysis. Ann Surg Oncol. 2019;26(10): 3240-9.
22. Online PREDICT Tool, Version 1.2. [Available from:]
23. Nitz U, Gluz O, Clemens M, Malter W, Reimer T, et al. West German Study PlanB Trial: adjuvant four cycles of epirubicin and cyclophosphamide plus docetaxel versus six cycles of docetaxel and cyclophosphamide in HER2-negative early breast cancer. Journal of Clinical Oncology. 2019;37(10):799-808.
24. What should medical oncologists know about COVID-19? 2020 [Available from:]
25. Kindts I, Laenen A, Depuydt T, Weltens C. Tumour bed boost radiotherapy for women after breast-conserving surgery. Cochrane Database Syst Rev. 2017;11:CD011987.
26. Kim K, Chie EK, Han W, Noh D-Y, Ha SW. Impact of delayed radiotherapy on local control in node-negative breast cancer patients treated with breast-conserving surgery and adjuvant radiotherapy without chemotherapy. Tumori Journal. 2011;97(3):341-4.
27. Livi L, Borghesi S, Saieva C, Meattini I, Rampini A, et al. Radiotherapy timing in 4,820 patients with breast cancer: university of florence experience. International Journal of Radiation Oncology* Biology* Physics. 2009;73(2):365-9.
28. Associazione Italiana di Radioterapia Oncologica-La Radioterapia dei tumori della mammella: indicazioni e criteri guidada. Ed. 2013. 2016 [Available from:]
29. van Maaren MC, Bretveld RW, Jobsen JJ, Veenstra RK, Groothuis-Oudshoorn CG, et al. The influence of timing of radiation therapy following breast-conserving surgery on 10-year disease-free survival. Br J Cancer. 2017;117(2):179-88.
30. Instructions for taking vitamin D to combat corona 2020 [Available from:]
31. National Center for Immunization and Respiratory Diseases (NCIRD) DoVD. About Coronavirus Disease 2019 (COVID-19), 2020 [Available from:]
32. National Center for Immunization and Respiratory Diseases (NCIRD) DoVD. Coronavirus Disease 2019 (COVID-19), Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19). 2020. [Available from:]
33. National Center for Immunization and Respiratory Diseases (NCIRD) DoVD. Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States 2020. [Available from:]
34. Iranian Ministry of Health and Medical Education medical guidelines for COVID-19 2020 [Available from:]
35. NHS Clinical guide for the management of cancer patients during the coronavirus pandemic 2020 [Available from:]

Article Statistics :Views : 1942 | Downloads : 1071

Most read articles by the same author(s)

1 2 3 4 5 6 > >>