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

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.