People with breast or gynecologic cancer may be at increased risk for COVID-19. This may be because of the cancer itself or due to cancer treatment weakening the immune system and making them more susceptible, or because they have more encounters with the healthcare system. Elisa R. Port, MD, Director of the Dubin Breast Center and Chief of Breast Surgery for The Mount Sinai Hospital, and Stephanie V. Blank, MD, Director of Gynecologic Oncology for the Mount Sinai Health Stem and Director of Women’s Health at the Blavatnik Family- Chelsea Medical Center at Mount Sinai, discuss what you need to know about breast and gynecologic cancer and COVID-19.

Is it safe to go to my oncology appointment?

Dr. Blank: Whether you should keep your appointment depends on the purpose of the visit. If you are having a routine mammogram or an annual check-up, you may be able to reschedule your appointment for later. It is a matter of weighing the risks and benefits of going to the appointment with possibly exposing yourself to the virus. Talk with your doctor to see what he or she recommends.

The Centers for Disease Control and Prevention has recommended that people do not go to the doctor for non-essential appointments. They want to protect you from people who might have or be carrying COVID-19. While we do our best to keep our offices as safe as possible, we cannot guarantee that someone who is asymptomatic has not been in the waiting or exam room. That said, we do limit the number of people entering the facility, so waiting rooms are empty and very few patients are on site.

The other question is how to get to the appointment. I would try to avoid public transportation if possible. If you do not have another option, I would encourage you to wear a face mask, carry hand sanitizer, wash your hands frequently, and be careful about what you touch. You would also want to distance yourself from people. Luckily, public transportation is a lot less crowded than usual, so it should be easier than usual to keep your distance from others.

Why did my doctor cancel my appointment?

Dr. Blank: If your doctor cancelled your appointment, chances are your doctor considered the reason for the appointment and the risk of exposure to COVID-19 and determined that the benefits of the appointment did not outweigh the risks. But, if you are concerned, contact your doctor and ask. The first question is whether the appointment was cancelled altogether or delayed for a period.

If you really want to talk to your doctor sooner rather than later, telehealth is an option in most health care systems. This allows you to discuss your concerns with your doctor without physically being in the same space. If your doctor does not have telehealth capabilities, try setting up a telephone conversation.

I think I might have COVID-19. What do I do?

Dr. Port: If you develop symptoms that suggest COVID-19, such as cough, fever or difficulty breathing, you should call your doctor. Discuss these symptoms with your doctor and get his or her advice. Availability of COVID-19 testing varies across the county, so your ability to be tested will depend on where you are. In addition to talking to your doctor, you should isolate yourself in your home to avoid possibly spreading the virus. Keep away from others in your home to protect them as well. Your doctor should be able to provide additional advice.

The business world may be on pause due to the COVID-19 pandemic, but that does not mean medical conditions have taken a reprieve. If you are worried that you might have breast or gynecologic cancer, you need expert advice. Elisa R. Port, MD, Director of the Dubin Breast Center and Chief of Breast Surgery for the Mount Sinai Hospital, and Stephanie V. Blank, MD, Director of Gynecologic Oncology for the Mount Sinai Health System and Director of Women’s Health at the Blavatnik Family- Chelsea Medical Center at Mount Sinai, discuss what you need to know about breast and gynecologic cancer and COVID-19.

I have symptoms that make me worried I might have cancer. Should I see a doctor or wait until the pandemic subsides?

Dr. Port: If you feel a lump in your breast, have unexplained weight loss, unusual bleeding or bloating, changes to the color or texture of the skin on the outside of your genitals, or other concerning signs, you should definitely get checked out. Do not delay seeing medical attention due to the pandemic.

Most doctors, including those in the Mount Sinai Health System, are open for business to evaluate potential patients. We encourage patients to reschedule non-essential visits such as routine annual mammograms and check-ins. This helps us keep the office (and waiting room) mostly empty so we can see new or potential patients while maintaining and allowing you to maintain social distancing. When you come into the office, we take you immediately into a private exam room to limit the risk of exposure. We continue to perform imaging tests, biopsies, and other key diagnostic examinations.

If I am diagnosed with breast cancer, will I receive treatment now, or will I need to wait until after COVID-19 has subsided?

Dr. Port: The short answer is: It depends.

It’s important to remember there are dozens of types and subtypes of breast cancer. There are also a variety of treatment options; there’s no one-size-fits-all approach. We can safely delay treatment for some types of very early breast cancers. Others respond to medication that can prevent growth of the cancer until the threat of COVID-19 has decreased and we can more safely proceed with treatment. But the first step is to get an accurate diagnosis.

Fortunately, there are very few emergency situations where you need surgery or treatment within a day or two to prevent a bad or worse outcome. In most cases, we have the luxury of being able to delay treatment without affecting your overall prognosis and survival rate. It is all about balancing the risks and benefits in your individual case.

Some cancers grow very slowly, so we can safely delay care for one to three months. Others may respond to a medication, such as an anti-hormonal drug, that can allow us to hold off on care for a while. If you have a more aggressive type of cancer, we may decide to do surgery or start chemotherapy.

Of course, receiving these treatments in the setting of a pandemic carries certain risks of immunosuppression and we don’t take those risks lightly. Even just coming to the hospital carries some risk. So, we will talk with you about the risks and benefits of each care option and decide together on the most appropriate approach for your individual situation.

Is it safe to have chemotherapy now?

Dr. Blank: Again, there is no blanket answer to this question. You and your doctor need to consider your individual situation. First, it depends on the purpose of chemotherapy. Is it going to cure you? If so, you may not want to interrupt it. If it is controlling your symptoms, that may be a different conversation. You may be able to increase the time between treatments, or there may be another way to help with your symptoms.

At Mount Sinai, we test women for COVID-19 before we start chemotherapy because we know that women who have the virus and are in treatment may get significantly sicker than others. We also take measures to boost patients’ blood counts during this time to help patients fight the disease should they contract it.

Is it safe to have surgery now?

Dr. Blank: Here, too, the answer is not simple. In general, we are trying to delay all the surgeries that we believe can be safely postponed. The reason is that you really don’t want to be in a hospital right now. There are a lot of COVID-19-positive patients there and you may well be exposed to the virus. We look at the risks and benefits and discuss the issues with our patients. We are not delaying the procedures permanently, just until we have a safe environment for our patients so we can perform procedures again. This is not unusual. We often delay surgery when it is safe to do so. Sometimes a patient wants to delay so she can attend a daughter’s wedding or a grandson’s graduation.

Sometimes we can change our treatment approach to avoid or delay surgery. We can change the order of treatment. For instance, if someone was recently diagnosed with ovarian cancer, we may start with chemotherapy instead of surgery. Then we can perform the surgery later, when it is safer. We know that’s safe cancer-wise; we have a lot of data that show this.  Sometimes we can use a different treatment approach. For example, we can treat certain endometrial cancers with hormones. Talk with your cancer doctors; they can tell you what the options are in your individual situation.