The symptomatic breast services in a university hospital: pandemic peak compared to the pre-pandemic year and future implications

Abstract

Background COVID-19 infection led to a substantial overhaul of the symptomatic breast services within the UK. Aim The purpose of this study was to evaluate the pattern of primary care referrals to the symptomatic one-stop clinic during the pandemic. This study also provides a snapshot of the workings of symptomatic breast services and the scope for improvements. Methods The data points were collected for 1 month during the peak of the pandemic (April 2020) and compared to corresponding data points for the same month in the previous year (April 2019). This was compared to the monthly data from Wales Cancer Network (WCN) data source. A hundred patients from each month over 2 years were evaluated to get a snapshot into the working of the breast clinic. Results A total of 516 patients were referred from primary care or General Practitioners (GPs), and were seen in the Hospital ‘one-stop breast clinic’ in April 2019. This number dropped to 330 patients during the peak of the pandemic in April 2020. Ninety percent of referrals from the GP were urgent suspected cancers or urgent referrals. This trend of referrals did not change over 2 years. There was a 5% and 7% cancer diagnosis rate in 2020 and 2019, respectively. Conclusions Most patients were referred from GP as ‘urgent’ or ‘urgent suspected cancer’. The cancer diagnosis rate reduced from 7 to 5% during the pandemic peak but the number of ‘worried well’ patients did not reduce. The total number of referrals reduced, which is predictive of increased demand in the future. The authors have suggested ways to meet this demand.

A Single-Center Audit of Symptomatic Breast Cancer Patient Referrals During COVID-19 Pandemic Restrictions

“…The referral rate fall is linked to several factors, including the GPs more stringent referral approach, health facility avoidance by patients prone to nosocomial infection, and government and media campaign against hospital visits. Our study shows an increased 2ww target and cancer diagnosis rate in the pandemic era, similar to previous findings [ 15 , 16 ]. The increased 2ww target is partly due to the diversion of facilities and clinicians to the one-stop clinic following the suspension of benign and reconstructive procedures and family history clinics.…”

“…Overall, the 2ww referrals reduced by 28.3% in 2020 compared with those in 2019. Other studies have recorded fewer urgent and symptomatic referrals during the pandemic [ 15 - 18 ]. We note that there is no difference in the referral rates of patients aged younger and older than 50 years, in contrast to the finding of Bansal et al [ 15 ], which showed reduced referral rates in patients aged more than 50 years.…”

“…Other studies have recorded fewer urgent and symptomatic referrals during the pandemic [ 15 - 18 ]. We note that there is no difference in the referral rates of patients aged younger and older than 50 years, in contrast to the finding of Bansal et al [ 15 ], which showed reduced referral rates in patients aged more than 50 years. The tie in the referral rates between the two age groups in this study might be due to a relative decrease in the referral rates among the older population.…”

A systematic review of the impact of the COVID-19 pandemic on breast cancer screening and diagnosis

“…An initial 2451 citations were identified for title and abstract screening, of which 77 were eligible for inclusion ( Fig. 1 ) [ [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] ,…”

“…For 3 studies with multiple publications reporting different or complementary outcomes, we selected the most recently published for inclusion [ 34 , 57 , 59 ], and extracted relevant data (where available) from the other superseded publications [ [85] , [86] , [87] ] but did not include them as separate papers. Therefore, a total of 74 studies were included in this review [ [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , ...…”