Clinical Course, Behaviour and Staging of Breast Cancer at the Time of Presentation During the Era of COVID-19 Pandemic

Breast cancer presentation in the covid-19 era

  • Muhammad Ahmad Mukhtar Nishtar Medical University, Multan, Pakistan
  • Rubina Mukhtar Head of Breast Imaging Department, MINAR Cancer Hospital, Multan, Pakistan
  • Aeimen Khalid Nishtar Medical University, Multan, Pakistan
  • Naila Tariq Nishtar Medical University, Multan, Pakistan
  • Syed Raza Haider MINAR Cancer Hospital, Multan, Pakistan
Keywords: Breast cancer, early detection, Pandemic, Covid 19, Delay in diagnosis


Objective: To explore the repercussions of COVID-19 pandemic on clinical course, behaviour, and staging
of breast cancer
Methodology: This observational study, during the span of COVID-19, included all patients reported as breast
cancer on histopathology in breast care clinic of MINAR Cancer Hospital, Pakistan. Clinical behaviour, details
of histopathology including tumor type, Estrogen Receptors (ER), HER 2 Neu, and stage of disease at the
time of presentation were recorded and analyzed for frequency and percentages.
Results: Mean age of diagnosis was 45.6 years with STD of ±10.75 with parity range of 0 to 8. Lesion was
most frequent on left side. Only 37% patients were diagnosed at early stage. Total 63% patients presented
with advanced disease with 13% patients having distant metastasis with bones being the commonest site. As
many as 79% patients reported positive for ER and 74% for HER 2 Neu, while 84% patients breastfed children.
Hormone intake history was positive in 32% patients.
Conclusion: COVID 19 pandemic has had a drastic effect on the outcome of breast cancer by hindering early
diagnosis in our population. Adding to the preexisting paucity of screening programmes and deficit in
infrastructure for early diagnosis, COVID 19 pandemic led to an increase in the preexisting high mortality


Mukhtar R, Hussain M, Mukhtar MA, Ali SM. Breast metastasis from medullary carcinoma of thyroid: a case report with literature view. JPMA J Pak Med Assoc. 2020; 70(11):2051-3.

2. Caplan L. Delay in breast cancer: implications for stage at diagnosis and survival. Front Public Health. 2014:2:87. doi: 10.3389/fpubh.2014.00087

3. Getachew S, Tesfaw A, Kaba M, Wienke A, Taylor L, Kantelhardt EJ, et al. Perceived barriers to early diagnosis of breast Cancer in south and southwestern Ethiopia: a qualitative study. BMC Womens Health. 2020;20(1): 38. doi: 10.1186/s12905-020-00909-7.

Mukhtar R, Hussain M, Mukhtar MA, Haider SR. Prevalence of different breast lesions in women of southern Punjab, Pakistan, characterized on highresolution ultrasound and mammography. Egyp Jf Radiol Nuclear Med.2021;52(1):633-638. DOI:10.1186/s43055- 021-00633-8

Gulzar F, Akhtar MS, Sadiq R, Bashir S, Jamil S, Baig SM. Identifying the reasons for delayed presentation of Pakistani breast cancer patients at a tertiary care hospital. Cancer Manag Res. 2019:11:1087-1096. doi: 10.2147/CMAR.S180388.

Muhammad AM, Hussain M, Mukhtar MO, Sajid M. Impact of COVID 19 on Anxiety level of Medical Students In Pakistan. NETSOL. 2021;6(1):34-36. /10.24819/netsol2021.03

Shabnam N, Ameer W, Aurangzeb N, Ashraf MA, Shah SH. Estimation of poverty bounds for Pakistan using synthetic panel data PLoS One. 2023;18(3):e0276673. doi: 10.1371/journal.pone.0276673.

Akhtar M, Khan HMA, Muhammad S. A Non-Formal Experimental Study to Accelerate the Literacy among the Workshop Workers through" Workshop Workers' Literacy School". Pak J Distance and Online Learn. 2021;7(2):105-18.

Hawkes N. Cancer survival data emphasise importance of early diagnosis. Br Med J (BMJ). 2019:364:l408. doi: 10.1136/bmj.l408.

Kalli S, Semine A, Cohen S, Naber SP, Makim SS, Bahl M. American joint committee on cancer’s staging system for breast cancer: what the radiologist needs to know. Radiographics. 2018;38(7):1921-1933. doi: 10.1148/rg. 2018180056.

Cadiz F, Gormaz JG, Burotto M. Breast cancer staging: is TNM ready to evolve? J Glob Oncol. 2018:4:1-3. doi: 10.1200/JGO.17.00004.

Fujimoto RHP, Koifman RJ, Silva IFd. Survival rates of breast cancer and predictive factors: a hospital-based study from western Amazon area in Brazil. Cien Saude Colet. 2019;24(1):261-273. doi: 10.1590/1413- 81232018241.35422016.

Brierley JD, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours: John Wiley and Sons 8th Edition; 2016.

Saadatmand S, Bretveld R, Siesling S, Tilanus-Linthorst MM. Influence of tumour stage at breast cancer detection on survival in modern times: population based study in 173 797 patients. BMJ. 2015:351:h4901. doi: 10.1136/ bmj.h4901.

Zielonke N, Gini A, Jansen EE, Anttila A, Segnan N, Ponti A, et al. Evidence for reducing cancer-specific mortality due to screening for breast cancer in Europe: A systematic review. Eur J Cancer. 2020:127:191-206. doi: 10.1016/j.ejca.2019.12.010

Christiansen SR, Autier P, Støvring H. Change in effectiveness of mammography screening with decreasing breast cancer mortality: a population-based study. Eur J Public Health. 2022;(4):630-635. doi: 10.1093/eurpub/ckac047.

Mukhtar Hussain MAM, Amna Mukhtar, Tariq N, Khalid A, Mukhtar R. Online Teaching, a Big Challenge for Developing Countries during the Era of Covid 19, A Survey Conducted in Medical Students of Southern Punjab, Pakistan. Med Forum. 2022;33(3):132-136.

Hussain M, Mukhtar MA, Mukhtar, Tariq N, R. Evaluation and comparison of Awareness and practice of protective measures for COVID-19 between preclinical and clinical Medical students in developing country: Pakistan. Technium Soc Sci J. 2021;17(1):104- 110.

Mukhtar Hussain MAM, Amna Mukhtar, Tariq N, Khalid A, Mukhtar R. Knowledge and awareness of Medical Students for protective measures against COVID 19. Med Forum. 2022; 2022;33(6):46-50.

Anders CK, Zagar TM, Carey LA. The management of early-stage and metastatic triple-negative breast cancer: a review. Hematol Oncol Clin North Am. 2013;27(4):737-49, viii. doi: 10.1016/j.hoc.2013.05.003

Reeves C. San antonio breast cancer symposium 2021. Lancet Oncol. 2022;23(1):e18. doi: 10.1016/S1470- 2045(21)00727-0.

Kumar S, Shaikh A, Rashid Y, Masood N, Mohammed A, Malik U, et al. Presenting features, treatment patterns and outcomes of patients with breast cancer in Pakistan: Experience at a university hospital. Indian J Cancer. 2016;53(2):230-234. doi: 10.4103/0019-509X.197728.

Majeed I, Ammanuallah R, Anwar AW, Rafique HM, Imran F. Diagnostic and treatment delays in breast cancer in association with multiple factors in Pakistan. East Mediterr Health J. 2021n 23;27(1):23-32. doi: 10.26719/emhj.20.051.

Liu L, Hao X, Song Z, Zhi X, Zhang S, Zhang J. Correlation between family history and characteristics of breast cancer. Sci Rep. 2021;11(1):6360. doi: 10.1038/s41598-021-85899-8.

Tazzite A, Jouhadi H, Saiss K, Benider A, Nadifi S. Relationship between family history of breast cancer and clinicopathological features in Moroccan patients. Ethiop J Health Sci. 2013;23(2):150-7.

Jassem J, Ozmen V, Bacanu F, Drobniene M, Eglitis J, Lakshmaiah KC, et al. Delays in diagnosis and treatment of breast cancer: a multinational analysis. Eur J Public Health. 2014;24(5):761-7. doi: 10.1093/eurpub/ckt131.

How to Cite
Mukhtar, M. A., Mukhtar, R., Khalid, A., Tariq, N., & Haider, S. (2024). Clinical Course, Behaviour and Staging of Breast Cancer at the Time of Presentation During the Era of COVID-19 Pandemic. Annals of Jinnah Sindh Medical University, 10(1), 24-29.
Original Articles