Background The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown.

Breast-conserving surgery is the treatment of choice for all benign lesions. For borderline and malignant lesions, excision with a wide margin reduces the rate of recurrence. If a diagnostic local excision biopsy or enucleation is performed, it should be followed by a definitive wider excision.

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Metaplastic breast cancers (MPBCs) represent <1% of breast cancers. Reports of MPBC in men are limited to case reports. We report a case of MPBC with pulmonary metastasis occurring in a 59-year-old man who initially presented with a presumed breast abscess. Histology from the breast lesion revealed a poorly differentiated carcinoma and a computed tomography scan showed an ulcerative right-sided breast mass and an area of scarring in the apex of the left lung. The breast lesion and the lung lesion were resected separately and the histology from the lung showed a poorly differentiated carcinoma with sarcomatous features in keeping with metastasis from a primary breast cancer. Our patient then proceeded to chemotherapy with FEC 100 regimen (5-fluorouracil, epirubicin and cyclophosphamide). MPBC is an aggressive breast cancer that has a propensity to metastasis to the lungs. Prognosis is poor.