Background: Our breast unit in a district general hospital serves a population of 500,000, and treats around 500 new breast cancers in a typical year. We aim to assess the impact of COVID-19 on clinical practice and workload during the height of the pandemic.
Materials and Methods: Retrospective audit on data collected prospectively between April and June 2020. Outpatient attendance and surgical procedures were compared to data from the same interval in 2019.
Results: As expected, the number of patients treated was lower.
However, the breast unit managed to maintain an essential cancer service, with the following modification to the standard operating procedures: Additional operating theatres were commissioned at a local private hospital. Oncoplastic and reconstructive procedures were stopped. Oncological surgeries were limited to breast conservation and mastectomy. Criteria for adjuvant radiotherapy were modified. Hormone receptor positive cancer patients were started on neo-adjuvant endocrine therapy. The number of new symptomatic referrals dropped, and the breast screening service was temporarily suspended. We also halted our mammogram surveillance programme. Our mastectomy rate increased from 28% to 43%, and breast conservation procedures dropped from 72% to 57%.
Conclusions: These changes brought on by the pandemic have long term impact for our patients. There will be a number of undetected new cancers due to failure to seek help or to attend for diagnosis for fear of catching the infection. The halt of reconstructive procedures means that patients will be returning for delayed breast reconstructions. Patients with known genetic mutations who would have qualified for bilateral mastectomy and reconstruction found themselves having essential unilateral surgery only. Adjusted referral criteria for adjuvant treatment meant few patients did not receive radiotherapy, and others have had a reduced therapeutic dose. The potential longer term repercussions of these changes are yet to be seen. Further studies will be needed to evaluate true impact of the pandemic.
ESSO20V-0033