Table 1.

Clinical triage in breast cancer

Priority level	(A) High-priority Urgent treatment is required as usual strategy when possible	(B) Medium priority Treatment delay may cause inferior outcome	(C) Low priority Immediate treatment is not required and can be deferred until the pandemic is over
Outpatient	Confirmation of diagnosis for clinically malignant cases Severe inflammatory diseases including infectious mastitis	Confirmation of diagnosis for suspected malignant cases (category 3) Decision of adjuvant treatment for cases with completing operation Immediate change of treatment for metastatic breast cancer is required Biopsy of cases with suspected ductal carcinoma in situ	Screening of breast cancer including high-risk population Benign diseases and follow-up of breast cancer Biopsy of cases with a suspected benign tumor
Diagnostic imaging	Imaging examination of outpatients categorized 1	Imaging examination of outpatients categorized 1 Suspected case of metastasis without urgency	Imaging examination of outpatients categorized 1) Follow-up of early breast cancers Follow-up of metastatic breast cancers without symptom
Surgical procedure	Operative drainage of abscesses Salvage operation for surgical complications including hematoma and ischemic autologous tissue flap Revision of ischemic autologous flap or repair Rapidly growing phyllodes tumor	Operation for stages I and II hormone receptor-positive cases can be extended with endocrine therapy *Safety and efficacy of neoadjuvant endocrine therapy during 6–12 months for luminal or lobular breast cancer are reported Altered treatment strategy of patients with neoadjuvant chemotherapy Switch to endocrine therapy in patients with T2 or N1 hormone receptor-positive HER2-negative breast cancer Switch to operation in cases with triple-negative or HER2-positive breast cancer is possible considering the local context Excision of local recurrence Avoid autologous reconstruction and use implant or tissue expanders in breast cancer operation accompanied by immediate reconstruction	Benign diseases Prophylactic surgery Confirmed as ductal carcinoma in situ Re-excision of a positive margin Effective cases of neoadjuvant endocrine therapy (see medium priority)
Radiation therapy (RT)	Palliative RT when no other effective therapy for the control of symptoms is available (inoperable bleeding/painful breast masses, spinal cord compression, symptomatic brain metastases, or life-threatening metastases) Patients already on treatment	Postoperative RT for patients with high-risk features such as inflammatory breast cancer, triple-negative breast cancer, HER2-positive breast cancer, residual disease after neoadjuvant chemotherapy or young age (< 40 years) with additional high-risk features. RT is required to be started within 8–12 weeks from the completion of operation or chemotherapy Postoperative RT for patients with low or intermediate-risk features such as aged < 70 years and Stage I/II ER-positive. RT is required to be started within 20 weeks from the completion of operation or chemotherapy	Postoperative RT for elderly patients (≥ 70) with low-risk Stage I ER-positive/HER2-negative breast cancer and taking endocrine therapy may be omitted Postoperative RT for patients with ductal carcinoma in situ may be omitted, particularly for those with ER-positive tumor and taking endocrine therapy
Medication therapy	Neoadjuvant and adjuvant chemotherapies for triple-negative or HER2-positive breast cancer Continuation of ongoing neoadjuvant and adjuvant chemotherapies Initiate chemotherapy for metastatic breast cancer in a case, in which improved prognosis is expected Consideration points:  Consider interruption or cessation of neoadjuvant and adjuvant endocrine therapies for old patients or those treated for more than 5 years  Consider dosages and administration, or modification of dosing interval for reduced visit to hospital  Consider use of PEGylated granulocyte colony-stimulating factor to prevent febrile neutropenia  Consider limited use of dexamethasone appropriately avoiding immune suppression  Anti-HER2 antibody therapy and endocrine therapy should not affect immune function  Select long-acting luteinizing hormone-releasing hormone agonist	Palliative chemotherapy Consideration points:  Duration of adjuvant trastuzumab can be shortened to 7 months instead of 12 months  The interval of anti-HER2 therapy can be extended to 4 weeks  Consider stopping anti-HER2 therapy in cases responding for more than 2 years without disease progression  Addition of CDK4/6 or mTOR inhibitors for breast cancers can be delayed when endocrine monotherapy is acceptable or when responding to endocrine monotherapy	Bone-modifying agents for bone metastases Venous access device (port) flush