Delay In Diagnosis Of Cancer Research Articles

Delayed Cancer Diagnosis in Thyroid Nodules Initially Treated as Benign With Radiofrequency Ablation: Ultrasound Characteristics and Predictors for Cancer.

Regrowth after radiofrequency ablation (RFA) of symptomatic large thyroid nodules, initially treated as benign, sometimes turns out to be malignancies. This study aimed to assess the ultrasound (US) characteristics of thyroid nodules initially treated as benign with RFA and later diagnosed as cancers, predictive factors for cancers masquerading as benign, and methods to avoid RFA in these cancers. We reviewed the medical records of 134 consecutive patients with 148 nodules who underwent RFA between February 2008 and November 2016 for the debulking of symptomatic thyroid nodules diagnosed as benign using US-guided biopsy. We investigated the pre-RFA characteristics of the thyroid nodules, changes at follow-up after RFA, and the final surgical pathology. Nodule regrowth after RFA was observed in 36 (24.3%) of the 148 benign nodules. Twenty-two of the 36 nodules were surgically removed, and malignancies were confirmed in seven (19.4% of 36). Of the 22 nodules removed surgically, pre-RFA median volume (range) was significantly larger for malignant nodules than for benign nodules: 22.4 (13.9-84.5) vs. 13.4 (7.3-16.8) mL (P = 0.04). There was no significant difference in the regrowth interval between benign and malignant nodules (P = 0.49). The median volume reduction rate (range) at 12 months was significantly lower for malignant nodules than for benign nodules (51.4% [0-57.8] vs. 83.8% [47.9-89.6]) (P = 0.01). The pre-RFA benignity of all seven malignant nodules was confirmed using two US-guided fine-needle aspirations (FNAs), except for one nodule, which was confirmed using US-guided core-needle biopsy (CNB). Regrown malignant nodules were diagnosed as suspicious follicular neoplasms by CNB. Histological examination of the malignant nodules revealed follicular thyroid carcinomas, except for one follicular variant, a papillary thyroid carcinoma. Symptomatic large benign thyroid nodules showing regrowth or suboptimal reduction after RFA may have malignant potential. The confirmation of these nodules is better with CNB than with FNA.

What Has Changed During the COVID-19 Pandemic? - The Effect on an Academic Breast Department in Portugal.

One year ago, Portugal entered its first lockdown because of the coronavirus disease-2019 (COVID-19) pandemic. The impact of this on delays in cancer diagnosis and treatment is a major concern, which may negatively affect the outcomes of these patients. This retrospective, single-center analysis compared the clinical and pathological characteristics of breast cancer (BC) patients referred to a medical oncology first appointment between March 2020 and 2021, with the same period in the previous year. Strikingly, there was a 40% reduction in the number of BC patients during lockdown. However, there was a statistically significant increase in the proportion of metastatic BC patients admitted for the first time for systemic therapy (13.6% vs. 28.9%, p = 0.003). Additionally, a statistically significant increase in the number of patients with bilateral early BC at diagnosis after March 2020 was found (7.2% vs. 1.9%, p = 0.043). These findings support international recommendations for an accelerated restoration of BC screening, to reduce incidence of advanced breast cancer at diagnosis and mitigate the expected impact of the COVID-19 pandemic on patients with cancer. Further work is needed to examine in detail the impact of measures to manage the COVID-19 pandemic on breast cancer outcomes.

Improving equity in access to early diagnosis of cancer in different healthcare systems of Latin America: protocol for the EquityCancer-LA implementation-effectiveness hybrid study

IntroductionHealthcare fragmentation, a main cause for delay in cancer diagnosis and treatment, contributes to high mortality in Latin America (LA), particularly among disadvantaged populations. This research focuses on integrated care...

Being sick to a cancer patient: pathways of delay in help seeking and diagnosis of cancer in India.

There is evidence that cancer mortality and morbidity could be reduced when the disease is diagnosed and treated at an early stage. The paper examines the pathways of delay of cancer diagnosis in an Indian setting. It draws on a qualitative study conducted among cancer survivors and family members of cancer patients in the city of Bengaluru, South India. The results show that a substantial part of the delay occurred at the stage of initial formal help seeking wherein patient and family-led, disease-related and systemic factors together played a major role. Patient-led factors included trivialisation and normalisation of symptoms as part of general fatigue and aging; unrealistic risk perceptions that linked causality of cancer merely to heredity and behavioural risk factors; fear of being diagnosed as cancer patient; gender related reasons including family's gender performance expectation, lower agency of women to seek help and lower prioratisation of women's health in the household and access related issues including financial constraints and unavailability of specialised hospitals nearby. Disease-related factors included the presence of comorbidity, cancer's mimicking of symptoms of other diseases and absence of distinguishable symptoms at the initial stage for certain types of cancers. The practitioner-led and system-led factors such as trivialisation of symptoms by general practitioners, non cancer-specific referrals, and lack of cancer screening facilities accounted for a major part of delay after the formal help seeking. The paper argues that the mere knowledge of cancer symptoms did not always lead to early diagnosis due to the interplay of these factors. The ongoing cancer prevention and control interventions in India need to be informed of these micro level factors while developing strategies to prevent avoidable delays in cancer diagnosis.

Delineating the SARS-CoV-2 Induced Interplay between the Host Immune System and the DNA Damage Response Network.

COVID-19 is an infectious disease caused by the SARS-CoV-2 coronavirus and characterized by an extremely variable disease course, ranging from asymptomatic cases to severe illness. Although all individuals may be infected by SARS-CoV-2, some people, including those of older age and/or with certain health conditions, including cardiovascular disease, diabetes, cancer, and chronic respiratory disease, are at higher risk of getting seriously ill. For cancer patients, there are both direct consequences of the COVID-19 pandemic, including that they are more likely to be infected by SARS-CoV-2 and more prone to develop severe complications, as well as indirect effects, such as delayed cancer diagnosis or treatment and deferred tests. Accumulating data suggest that aberrant SARS-CoV-2 immune response can be attributed to impaired interferon signaling, hyper-inflammation, and delayed adaptive immune responses. Interestingly, the SARS-CoV-2-induced immunological abnormalities, DNA damage induction, generation of micronuclei, and the virus-induced telomere shortening can abnormally activate the DNA damage response (DDR) network that plays a critical role in genome diversity and stability. We present a review of the current literature regarding the molecular mechanisms that are implicated in the abnormal interplay of the immune system and the DDR network, possibly contributing to some of the COVID-19 complications.

One-Step and Real-Time Detection of microRNA-21 in Human Samples for Lung Cancer Biosensing Diagnosis.

The rapid diagnosis of cancer, especially in its early stages, is crucial for on-time medical treatment and for increasing the patient survival rate. Lung cancer shows the highest mortality rate and the lowest 5-year survival rate due to the late diagnosis in advanced cancer stages. Providing rapid and reliable diagnostic tools is a top priority to address the problem of a delayed cancer diagnosis. We introduce a nanophotonic biosensor for the direct and real-time detection in human plasma of the microRNA-21-5p biomarker related to lung cancer. The biosensor employs a silicon photonic bimodal interferometric waveguide that provides a highly sensitive detection in a label-free format. We demonstrate a very competitive detectability for direct microRNA-21-5p biomarker assays in human plasma samples (estimated LOD: 25 pM). The diagnostic capability of our biosensor was validated by analyzing 40 clinical samples from healthy individuals and lung cancer patients, previously analyzed by reverse-transcription quantitative polymerase chain reaction (qRT-PCR). We could successfully identify and quantify the levels of microRNA in a one-step assay, without the need for DNA extraction or amplification steps. The study confirmed the significance of implementing this biosensor technique compared to the benchmarking molecular analysis and showed excellent agreement with previous results employing the traditional qRT-PCR. This work opens new possibilities for the true implementation of point-of-care biosensors that enable fast, simple, and efficient early diagnosis of cancer diseases.

Patient delay to diagnosis and its predictors among colorectal cancer patients: A cross-sectional study based on the Theory of Planned Behavior.

The prognosis for colorectal cancer is closely related to the time of diagnosis. However, patient delay is common and become a major contributor to delays in cancer diagnosis. We aimed to investigate patient delay and its predictors based on the Theory of Planned Behavior among colorectal cancer patients. In total, 303 colorectal cancer patients were recruited from a Grade-A tertiary cancer center in southern China by convenience sampling. The participants' general information, stigma, self-efficacy, and knowledge about colorectal cancer were assessed by a self-designed general information questionnaire, the Social Impact Scale, the General Self-Efficacy Scale, and the section of the Bowel Cancer Awareness Measure on total knowledge of colorectal cancer. Descriptive statistics, univariate analysis, and binary logistic regression were applied for data analysis. The median patient delay was four months (range: 1 day-10 years). The prevalence of prolonged patient delay (≥3 months) was 57.8%. Identified by binary logistic regression, prolonged patient delay was associated with having no close family members/friends in medical professionals, unwillingness to accept colonoscopy, blood in stools, dyspepsia, insufficient support from family members, more measures taken to control symptoms, lower perceived severity of symptoms, knowledge shortage, negative help-seeking attitudes, lower self-efficacy, and higher stigma. Patient delay was considerable in individuals with colorectal cancer in China. Factors associated with patient delay are complex in Chinese culture. To shorten patient delay, culturally sensitive interventions may be required to improve knowledge, alleviate cancer stigma, enhance self-efficacy to seek medical attention, and promote positive help-seeking behaviors.

Prevalence and consequences of non-adherence to an evidence-based approach for incidental pulmonary nodules.

Distinguishing benign from malignant pulmonary nodules is challenging. Evidence-based guidelines exist, but their impact on patient-centered outcomes is unknown. To understand if the evaluation of incidental pulmonary nodules that follows an evidence-based management strategy is associated with fewer invasive procedures for benign lesions and/or fewer delays in cancer diagnosis. Retrospective cohort study. Large academic medical center. Adults (≥18 years age) with an incidental pulmonary nodule discovered between January 2012 and December 2014. Patients with calcified nodules, prior nodules, prior diagnosis of cancer, high suspicion for pulmonary metastasis, or limited life expectancy were excluded. Nodule management strategy (pre-specified based on evidence-based practices). Composite of any invasive procedure for a benign nodule or delay in diagnosis in patients with cancer (>3 month delay once probability of cancer was >15%). Of 314 patients that met inclusion criteria, median age was 61, 46.5% were men, and 66.5% had current or former tobacco use. The mean nodule size was 10.3 mm, mean probability of cancer was 11.8%, and 14.3% of nodules were malignant. Evaluation followed an evidence-based strategy in 245 patients (78.0%), and deviated in 69 patients (22%). The composite outcome occurred in 26 (8.3%) patients. Among patients whose nodule evaluation was concordant with an evidence-based evaluation, 6.1% (15/245) experienced the composite outcome versus 15.9% (11/69) of patients with an evaluation that deviated from evidence-based recommendations (P<0.01). At a large academic medical center, more than 1 in 5 patients with an incidental pulmonary nodule underwent evaluation that deviated from evidence-based practice recommendations. Nodule evaluation that deviated from an evidence-based strategy was associated with biopsy of benign lesions and delays in cancer diagnosis, suggesting a need to improve guideline uptake.

Health Disparity and Breast Cancer Outcomes in Asian Women.

Health disparities in Asian women are complex and multifactorial. Screening attendance is low among Asian women, regardless of nativity or acculturation, and breast cancer detection has decreased by more than half in this population during the COVID-19 pandemic. The follow-up rate after abnormal screening results is similarly poor among Asian women compared with that among other groups, often resulting in a delay of cancer diagnosis. Yet the incidence of breast cancer in Asian women is increasing in the United States, with no such increase observed in other racial and ethnic groups in recent years. The age distribution of breast cancer in Asian women is distinct and peaks in younger women, underscoring the importance of early screening. The predilection for human epidermal growth factor receptor 2 (HER2)-enriched tumors may reflect the unique biologic characteristics of breast cancer among Asian subgroups, which are not well understood. Known biomarkers for breast cancer risk such as body mass index and mammographic density do not perform the same way in Asian women, as compared with other groups, owing to a lack of Asian population-specific data. Within that limitation, the association between body mass index and breast cancer is strongest in older Asian women, and the association between breast density and breast cancer is strongest in younger Asian women. There is an unmet need to improve breast cancer care in Asian women, a heterogeneous and growing population that is facing an increasing burden of breast cancer. An invited commentary by Leung is available online. ©RSNA, 2022.

Cancer Evaluations During the COVID-19 Pandemic: An Observational Study Using National Veterans Affairs Data

IntroductionFewer cancer diagnoses have been made during the COVID-19 pandemic. Pandemic-related delays in cancer diagnosis could occur from limited access to care or patient evaluation delays (e.g., delayed testing after abnormal results). Follow-up of abnormal test results warranting evaluation for cancer was examined before and during the pandemic.MethodsElectronic trigger algorithms were applied to the Department of Veterans Affairs electronic health record data to assess follow-up of abnormal test results before (March 10, 2019–March 7, 2020) and during (March 8, 2020–March 6, 2021) the pandemic.ResultsElectronic triggers were applied to 8,021,406 veterans’ electronic health records to identify follow-up delays for abnormal results warranting evaluation for 5 cancers: bladder (urinalysis with high-grade hematuria), breast (abnormal mammograms), colorectal (positive fecal occult blood tests/fecal immunochemical tests or results consistent with iron deficiency anemia), liver (elevated alpha-fetoprotein), and lung (chest imaging suggestive of malignancy) cancers. Between prepandemic and pandemic periods, test quantities decreased by 12.6%–27.8%, and proportions of abnormal results lacking follow-up decreased for urinalyses (−0.8%), increased for fecal occult blood tests/fecal immunochemical test (+2.3%) and chest imaging (+1.8%), and remained constant for others. Follow-up times decreased for most tests; however, control charts suggested increased delays at 2 stages: early (pandemic beginning) for urinalyses, mammograms, fecal occult blood tests/fecal immunochemical test, iron deficiency anemia, and chest imaging and late (30–45 weeks into pandemic) for mammograms, fecal occult blood tests/fecal immunochemical test, and iron deficiency anemia.ConclusionsAlthough early pandemic delays in follow-up may have led to reduced cancer rates, the significant decrease in tests performed is likely a large driver of these reductions. Future emergency preparedness efforts should bolster essential follow-up and testing procedures to facilitate timely cancer diagnosis.

Trends in breast and prostate cancer screening and diagnostic procedures during the COVID-19 pandemic in central Massachusetts

PurposeWe calculated rates of breast and prostate cancer screening and diagnostic procedures performed during the COVID-19 pandemic through December 2021 compared to the same months in 2019 in a large healthcare provider group in central Massachusetts.MethodsWe included active patients of the provider group between January 2019 and December 2021 aged 30–85 years. Monthly rates of screening mammography and digital breast tomosynthesis, breast MRI, total prostate specific antigen (PSA), and breast or prostate biopsy per 1,000 people were compared by year overall, by age, and race/ethnicity. Completed procedures were identified by relevant codes in electronic health record data.ResultsRates of screening mammography, tomosynthesis, and PSA testing reached the lowest levels in April–May 2020. Breast cancer screening rates decreased 43% in March and 99% in April and May 2020, compared to 2019. Breast cancer screening rates increased gradually beginning in June 2020 through 2021, although more slowly in Black and Hispanic women and in women aged 75–85. PSA testing rates decreased 34% in March, 78% in April, and 53% in May 2020, but rebounded to pre-pandemic levels by June 2020; trends were similar across groups defined by age and race/ethnicity.ConclusionThe observed decline in two common screening procedures during the COVID-19 pandemic reflects the impact of the pandemic on cancer early detection and signals potential downstream effects on the prognosis of delayed cancer diagnoses. The slower rate of return for breast cancer screening procedures in certain subgroups should be investigated to ensure all women return for routine screenings.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10552-022-01616-4.

Delay in diagnosis remains a common problem in newly diagnosed cervical cancer patients (580)

Delay in diagnosis remains a common problem in newly diagnosed cervical cancer patients (580)

Malignant mesothelioma diagnosis and survival in the time of COVID-19 in Northeastern Italy

Early data suggest a decrease in the diagnosis of new cancers and, consequently, an increase in avoidable deaths during the COVID-19 pandemic. To assess the impact of the pandemic on new diagnoses of malignant mesothelioma and survival in a population-based setting, we analysed 109 patients records from the Friuli Venezia Giulia Register during the period 2019-2020. Clinical data and information on COVID-19 diagnosis were retrieved and the number of mesothelioma diagnoses recorded in 2020 was compared to those recorded in 2019. A 2019-2020 comparison was also performed for survival time. Compared to 2019, in 2020 the total number of mesothelioma diagnoses and pleural cases increased by 9.2% and 16.7%, respectively, whereas peritoneal cases decreased by 45.2%. Mesothelioma distribution by period of diagnosis in 2020 showed no significant changes during the lockdown period, compared to the same period of the previous year, with an increase (+36.36%) in June-September and a decrease (-60%) in the second wave of the pandemic. Only six patients developed COVID-19. For the period 2019-2020, median survival was 11.5 and 7 months for pleural and peritoneal mesothelioma, respectively. Younger age (p&lt;0.01) and epithelioid histology improved survival. Compared to 2019, in 2020 median survival was worse for peritoneal mesotheliomas (6 versus 12.5 months) and females (6 versus 9 months). Overall, the pandemic did not affect mesothelioma diagnosis, but survival is still poor. Our data evidence the indirect impact of the pandemic control measures on delays in cancer diagnosis and treatment, which in turn may have had a major effect on survival time. This means that early diagnosis is essential to ensure the clinical management of mesothelioma patients and provide adequate support and compensation.

Abstract 433: Colorectal and gastric cancer screening rates in Korea during the COVID-19 pandemic

Abstract Background: The COVID-19 pandemic has disrupted healthcare delivery, which is widely discussed as the distraction effect. This study aimed to estimate the distraction effect of the COVID-19 pandemic in Korea by analyzing colorectal and gastric cancer screening rates in the years 2019 and 2020. Methods: Information of eligible population who had colorectal and gastric cancer screening provided by the National Cancer Screening Program in the years 2019 and 2020 was collected. Participation rates were analyzed by age group, sex, geographic region, and calendar month. Percentage change was calculated by dividing the percentage point difference by the screening rate of the reference period (2019). Results: Overall, the colorectal and gastric cancer screening rates had decreased in 2020, compared to the reference period. For colorectal cancer, the screening rate decreased from 68.3% in 2019 (5,886,319 participants/14,526,424 eligible population) to 54.6% in 2020 (5,135,218/9,410,525) For gastric cancer, the screening rates decreased from 61.9% in 2019 (7,194,489/11,625,627) to 54.6% in 2020 (6,244,491/11,439,246). In March, during the first wave, the screening rates declined sharply (percentage change: colorectal, 56.6%; gastric, 57.3%). Although the screening rates had rebounded aftermath, they declined again in December, during the third wave (percentage change: colorectal, 17.0%; gastric, 13.8%). According to specific-age group, we found a substantial decline in screening rates for older adults aged 80~84, and those over 85 (percentage change: colorectal, 19.0% &amp; 23.0%; gastric, 17.4% &amp; 25.1% respectively). Conclusion: During the COVID-19 pandemic, the screening rates for both colorectal and gastric cancer decreased. There was a substantial decline during the first and the third waves of the epidemic, in March and in December. The older adults group showed the highest reduction in screening rates. However, comparing the screening rate by region and sex, we did not find a significant difference. Delayed cancer diagnosis or excess death due to distraction effect of the COVID-19 pandemic has not yet been detected in Korea, therefore, further studies are needed. Citation Format: Seung Hee Seo, Hyeree Park, Jong Heon Park, Bhumsuk Keam, Shin Hye Yoo, Aesun Shin. Colorectal and gastric cancer screening rates in Korea during the COVID-19 pandemic [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 433.

Analysis of Factors Affecting Delayed Diagnosis of Women with Breast Cancer at Anugrah Medika Oncology Clinic in Kendari

The goal of this research is to determine the variables that contribute to breast cancer detection delays in women at Anugrah Medika Kendari Oncology Clinic. This is a cross sectional study using an analytic observational research approach. The data were examined univariately, bivariately, and multivariately using the multiple logistic regression approach. The findings indicated that, among the nine factors hypothesized to have an impact on breast cancer diagnosis delay, the variables (fear p=0.000; shyness p=0.001; alternative medicine p=0.000) were shown to have an influence on breast cancer diagnostic delay. Fear of exp (B1) = 24,621 &gt; 1 was a risk factor in multivariate analysis, and the 95 percent CI value was more than 1 (4,635 – 130,790), indicating that the OR was significant. The study's conclusion is that fear, shame, and alternative medicine were all found to be influential factors on the delay in diagnosis of breast cancer patients at the Anugrah Medika Kendari Oncology Clinic. Fear was found to be the most concurrently influential variable on the delay in diagnosis of breast cancer patients at the Anugrah Medika Kendari Oncology Clinic. Due to the importance of cooperation between clinics and psychologists supporting patients in overcoming psychological challenges, the government should prioritize upgrading facilities, access, and human resources, particularly in the area of cancer.

Mitigating COVID-19's impact on missed and delayed cancer diagnoses.

The COVID-19 pandemic has brought unparalleled changes to our lives and health care system. The need to increase hospital capacity and redirect health care resources led to the unprecedented suspension of cancer screening during the first wave of the pandemic, decreased screening in subsequent waves

Retrospective study of factors associated with late detection of oral cancer in alberta: A qualitative study.

Oral cancer continues to be diagnosed in advanced stages, giving patients lower chances of survival. The objective of this study was to explore reasons for delayed diagnosis of oral cancer in Alberta. A retrospective qualitative design was implemented through seven steps suggested for conducting a narrative clinical document. Data was retrieved from the Alberta Cancer Registry database between 2005 and 2017. A sample of initial consultation notes (ICN) of oral and oropharyngeal cancer patients were identified through a purposeful sampling method and added to the study until saturation was achieved. A deductive analysis approach inspired by the model pathways to treatment health care provider (HCP) was employed. From the 34 ICN included in our analysis, five main categories were identified: appraisal interval, help-seeking interval, diagnosis interval, pre-treatment interval, and other contributing factors such as health-related behaviours, system delay, and tumor characteristics. These factors negatively contributed to early detection of oral and oropharyngeal cancers and affect treatment wait time with patients, providers, and the healthcare system. Patient’s lack of awareness, provider’s oversight and prolonged access to care were the main reasons of delay in cancer diagnosis and management in our study. A sustainable plan for public awareness interventions and implementation of a solid curriculum for medical and dental students is needed to enhance their related knowledge, competence in clinical judgement, and treatment managements.

Auswirkungen der COVID-19-Pandemie auf die Inzidenz und Therapie von Krebserkrankungen

Die COVID-19-Pandemie hat weltweit gravierende Auswirkungen auf die Gesundheitsversorgung. Vorerkrankte Personen, insbesondere Krebspatient*innen, stellen dabei eine besonders vulnerable Gruppe dar. Die COVID-19-Pandemie hatte und hat sowohl national als auch international erhebliche Auswirkungen auf die Diagnostik und Therapie bei Krebspatient*innen. Bereits zu Beginn der Pandemie wurde über gravierende Einschränkungen bei der Abklärung von Krebserkrankungen sowie den Früherkennungsuntersuchungen berichtet. Es zeigten sich Verzögerungen bei der Krebsdiagnostik sowie ein erheblicher Rückgang der Zahl der diagnostizierten Krebsfälle. Patient*innen vermieden aus Sorge vor einer Ansteckung, medizinische Versorgung in Anspruch zu nehmen. Diese Faktoren können zu einer erhöhten Rate von Diagnosestellungen in fortgeschrittenen Tumorstadien führen. Eingeschränkte Versorgungskapazitäten haben Verzögerungen von Krebstherapien zur Folge. Therapiemodifikationen können den Verlauf und das Überleben von Patient*innen mit Tumorerkrankungen beeinflussen.

Unilateral axillary lymphadenopathy following Covid-19 vaccination: case report and considerations for patient management of regional lymphadenopathy in the era of Covid-19

Introduction: The coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), has caused effects on cancer patients including cancer screening process, risk factor records, cancer diagnoses, cancer treatment and follow-up. Nowadays, the COVID-19 vaccine has been used around the world and it has resulted axillary lymphadenopathy reaction. Unilateral axial lymphadenopathy which located near the vaccine injection site following COVID-19 vaccination is common of expecting adverse reaction especially happened in mRNA vaccine (Pfizer-BioTech and Moderna). In this COVID-19 pandemic, physicians should be aware of this follow-up process to avoid false positive cancer diagnosis and inform patient of unnecessary investigation, or delayed cancer diagnosis because suspected COVID-19 vaccination reaction instead of cancer diagnosis. Case report: We present two cases of a 47-year-old female and 34-year-old with no medical history, admitted to Department of Breast and Gynecologic cancer, Danang Oncology Hospital because of axillary lymphadenopathy that occurred after COVID-19 vaccination. Conclusion: After reviewing the literature, ipsilateral injection side axillary lymphadenopathy has been reported. Therefore, physician as well as oncologist working in the era of COVID-19 should be obtained information regarding COVID-19 vaccination including injected time, injected arm, and the symptoms after vaccinating to ensure the accuracy diagnosis and to avoid unnecessary biopsy and the possibility of a misdiagnosis. We recommend to perform cancer screening before vaccination or consider delay breast cancer screening exams until 4-6 weeks after vaccination, and the patient can undergo short term follow-up in the three months to ensure resolution. Key words: COVID-19 vaccination, ipsilateral axillary lymphadenopathy, breast cancer screening

Conflict of COVID-19 pandemic restrictions in the first diagnoses of skin cancer in 2020: a single-centre study

The data results of the skin cancer treatment institute aim to approach the affect of COVID-19 pandemic in the first detection of new skin cancer cases in 2020. Materials and Methods The study is retrospective and compares the data between 2020 and the expected incidence of the same year (mean of the years 2016-2019) of the new diagnosed cases of skin cancer which concerns squamous cell carcinomas (SCC), basal cell carcinomas (BCC), and melanomas. Results The results of the institutional data disclose the expected concern related to COVID-19 pandemic, with a reduction of 30.1% new skin cancer cases. The decrease of first-diagnosed SCC, BCC, and melanomas compared to expected incidence is respectively 44.8%, 22.3% and 36.3%. The mean age of the patients’ skin cancer first diagnosis is impressively lower and similarly the diagnosis at stages 0 and IA shows a same course. On the contrary, skin cancer at stages IIC, III and IV that were first detected, confirmed to be much higher. Conclusions The study data revealed that the COVID-19 pandemic effluent led to skin cancer diagnosis delay. It is highly recommended to the authorities and the national health system support the early skin cancer diagnosis of the population.