Introduction: Initial chaos to breast service provision from Covid-19 pandemic prompted this prospective audit. In our hospital, the first Lockdown period was challenging in terms of assessing patients on the 2WW pathway. Patients detected with cancer requiring surgery as part of their cancer pathway in a timely manner, was also challenging. This prospective audit, highlights our cancer detection rates during Lockdown (March 2020 - May 2020) in comparison to pre-Covid cancer detection rates (Dec-2019 - Feb 2020)
Aims:
• To prospectively audit referral rates during Lockdown to our Breast Unit compared with referral rates pre-Lockdown.
• Assess Total cancers detected during Lockdown (1st March '20 -31st May '20) in comparison to cancer detection rates pre Covid-19 Lockdown (1st December '19- 28th February '20)
• To audit re-excision rates after primary cancer surgery.
Objective: To audit impact of lockdown on breast cancer detection rates and service delivery
Methods:
• Prospective data collection from Somerset records - Total cancers detected from 2ww breast referrals prior to Covid19 (Dec '19-Feb '20) as guideline for workload compared with data collected prospectively during Lockdown (March'20 to May'20.)
• Prospective GIRFT data for outcomes of surgery to ascertain re-operation rates.
• Trust policy, Regional & ABS guidelines adhered to during pandemic.
Results: GP referrals Dec'19 - May'20
| MONTH | TOTAL GP REFERRALS | BENIGN DIAGNOSES | CANCERS DETECTED | CANCER INCIDENCE RATE % |
|---|---|---|---|---|
| DECEMBER | 265 | 14 | 14 | 5.3% |
| JANUARY | 281 | 35 | 14 | 5% |
| FEBRUARY | 261 | 15 | 14 | 5.4% |
| MARCH | 239 | 12 | 12 | 5% |
| APRIL | 89 | 25 | 9 | 10.1% |
| MAY | 145 | 6 | 11 | 7.4% |
RE-OPERATIONS:
| TOTAL PATIENTS | MONTH | MARGINS | SLNB+ | ANC |
|---|---|---|---|---|
| 28 | DECEMBER | 3(10.7%) | 0 | 0 |
| 40 | JANUARY | 2(5%) | 1(2.5%) | 1 |
| 24 | FEBRUARY | 2(5%) | 3(8.3%) | 3 |
| 26 | MARCH | 2(7.6%) | 5(13.8%) | 3 |
| 41 | APRIL | 2(4.8%) | 4(9.7%) | 2 |
| 23 | MAY | 3(13%) | 1(4.3%) | 1 |
Discussion: Referrals dropped during lockdown but cancer diagnosis rates almost doubled-? discerning GP referral.
Conclusion: Referral quality appears improved - although fewer referrals, cancer detection rate doubled from 5% pre-Covid19 to 7.5-10% during lockdown. Service quality maintained with minimal re-operations within social distancing restrictions.