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The emergence of the COVID pandemic has heavily impacted the healthcare systems of most infected countries and has required the prioritization of hospital resources to care for the patients critically affected by the disease. This prioritization has at times required the suspension of oncologic surgery programs for women with breast cancer, causing delays in the first treatment after diagnosing the disease. Although the pandemic has affected all hospitals throughout the country, there are 2 circumstances that can facilitate the organization of priority programs for oncologic surgery. First, the pandemic has had an uneven effect among cities, and there are therefore geographical areas with a low incidence of the disease, which allows for greater availability of healthcare resources for oncological programs. Secondly, Covid-free hospitals facilitate the maintenance of cancer programs, as long as screening for the infection is guaranteed in the treated patients. Various European studies have provided their initial experience with patients with breast cancer during the COVID-19 pandemic but have not reported the impact on hospital resources or on the delay in treating these patients.

Our hospital is located in a geographical area with a low incidence rate of COVID-19, with a mortality of 23 deaths per 100,000 inhabitants, lower than the national mean (60 deaths per 100,000 inhabitants) and the large major cities such as Madrid (127 deaths per 100,000 inhabitants). Moreover, the presence of COVID-free hospitals facilitated the maintenance of oncologic programs, provided screening for the disease was ensured in the patients who underwent surgery. Our breast unit is located in a COVID-free hospital in a city with a low incidence for the pandemic, which has allowed us to maintain 70% of the surgical activity compared with the same period last year. This situation also facilitated the implementation of symmetrization in the oncoplastic surgery and immediate reconstruction after mastectomy, thereby ensuring the same opportunities for the study patients compared with the control patients. This fact was important because the national recommendations for breast cancer surgery programs during the COVID pandemic recommended the suppression of these procedures, which, in our opinion, causes an ethical conflict related to the loss of opportunity. We also have to remember that, unlike other oncologic operations (pancreas, liver, esophagus), patients undergoing breast surgery do not require an intensive care room and therefore do not compete with patients affected by the pandemic over this healthcare resource and only require a ventilator in the operating room.