DELAYED DIAGNOSIS OF METASTATIC INVASIVE DUCTAL CARCINOMA DUE TO THE COVID-19 PANDEMIC

Abstract

TOPIC: Imaging TYPE: Medical Student/Resident Case Reports INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has drastically changed access to medical care. In an attempt to decrease the breakout of COVID-19, quarantine protocols and strict restrictions led to brief closures of primary care offices leading to delays in preventative care. The combination of primary care closures and public fear led to an interruption in the continuity of care. The consequences can be dire and include delays in serious and time sensitive diagnoses, like cancer. CASE PRESENTATION: Our patient is a 59-year-old woman with a history of heart failure with reduced ejection fraction, hypertension, and type-2 diabetes mellitus, who presented to the emergency room with acute-onset dyspnea and a right-sided breast mass. She first noticed a golf ball sized breast lump in March of 2020. She was not able to see her primary care physician due to the lockdown and her own fear of exposure to COVID-19. By June of 2020, the patient stated the mass had grown to be the size of a baseball.She decided to come to the hospital in March of 2021 when her symptoms progressed to include dyspnea with minimal exertion. She described increasing shortness of breath over a few days and denied orthopnea, fever, chills, chest pain, nausea, and vomiting. CT angiogram was negative for a pulmonary embolism; however, it revealed numerous bilateral lung nodules, a moderate-sized left pleural effusion, and a 11.5 x 9.7 cm low-density focus in the right breast with enhancing rim and septa. She was admitted to the hospital and subsequent thoracentesis revealed exudative fluid without malignant cells. A bedside breast biopsy would later reveal triple-negative, aggressive metastatic invasive ductal carcinoma of the right breast. The patient died two weeks after admission to the hospital. DISCUSSION: Breast cancer is the most common cancer in women in the United States and the second most common cause of mortality secondary to cancer. Triple-negative breast cancer is an aggressive malignancy that is defined by the absence of estrogen receptor, tyrosine kinase human epidermal growth factor receptor 2, and progesterone receptor. This cancer has a high mortality rate, but early intervention can lead to better outcomes including prolonged life and improved quality of life. Early intervention may have led to a better outcome for our patient. CONCLUSIONS: COVID-19 pandemic protocols overshadowed and briefly suspended routine screening. The impact of this delay in the diagnosis and treatment of invasive or preventative cancer will be evident in the coming years. REFERENCE #1: Mitchell EP. Declines in Cancer Screening During COVID-19 Pandemic. J Natl Med Assoc. 2020;112(6):563-564. doi:10.1016/j.jnma.2020.12.004 REFERENCE #2: Chen Y, Susick L, Davis M, et al. Evaluation of Triple-Negative Breast Cancer Early Detection via Mammography Screening and Outcomes in African American and White American Patients. JAMA Surg. 2020;155(5):440–442. doi:10.1001/jamasurg.2019.6032 REFERENCE #3: Chen Y, Susick L, Davis M, et al. Evaluation of Triple-Negative Breast Cancer Early Detection via Mammography Screening and Outcomes in African American and White American Patients. JAMA Surgery. 2020;155(5):440. doi:10.1001/jamasurg.2019.6032? DISCLOSURES: No relevant relationships by Kendall Creed, source=Web Response No relevant relationships by Kenneth Nugent, source=Web Response No relevant relationships by Navkiran Randhawa, source=Web Response No relevant relationships by Sukhbir Randhawa, source=Web Response