Stage migration of breast cancer patients during Covid-19 pandemic

Abstract

Background: COVID-19 pandemic had enormous impact on health care delivery worldwide. In response to evolving COVID-19 pandemic first wave, national lockdown was introduced across UK in March 2020. The national breast cancer screening programme was halted temporarily. This posed significant challenges to the routine delivery of oncological and supportive care to patients with breast cancer. In this study, we determined the impact of COVID-19 on stage migration of breast cancer patients. Materials and Methods: A retrospective study was conducted at Breast surgery unit, Royal Free hospital London. It includes all breast cancer patients diagnosed in pandemic period from March 2020 till June 2020. We also obtained patients data from pre-pandemic of similar time period from March 2019 to June 2019. The outcome studied were route of referral either national screening programme or GP and TNM stage in pandemic vs pre-pandemic period. Results: A total of 124 breast cancer patients were included in this study. Of these 47.5% (n=59) from pandemic and 60.8% (n= 65) from pre-pandemic. We found a decline in the number of referrals from the national screening program 5% (n=3) in pandemic as compared to pre-pandemic 56%(n=37). Patients with T3-T4 tumours represent 20.3% (n=12) in pandemic period versus 6% (n=4) in pre-pandemic period. In pandemic period there was 3.4% (n=2)of patients with N3 and 6.7%(n=4) had metastasis while none of the patients had N3 or metastasis in pre-pandemic period. Conclusions: Breast cancer treatment is time sensitive; the prognosis and life expectancy depend on early diagnosis and timely intervention. However, delay in diagnosis and treatment will increase the likelihood of metastatic disease. Stage migration is a feared complication of delayed treatment of breast cancer patients, urgent policy interventions are necessary to mitigate the impact of COVID-19 pandemic.