Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study
Authors: Dave Rajiv V. , Kim Baek , Courtney Alona , O’Connell Rachel , Rattay Tim , Taxiarchi Vicky P. , Kirkham Jamie J. , Camacho Elizabeth M. , Fairbrother Patricia , Sharma Nisha , Cartlidge Christopher W. J. , Horgan Kieran , McIntosh Stuart A. , Leff Daniel R. , Vidya Raghavan , Potter Shelley , Holcombe Chris , Copson Ellen , Coles Charlotte E. , Cutress Ramsey I. , Gandhi Ashu , Kirwan Cliona C. ,   on behalf of the B-MaP-C study collaborative, Agrawal Amit , Benson John , Forouhi Parto , Wignarajah Primeera , Shrotri Anu , Kattakayam Arjun , Noronha Jarin Louis , Martin Lee , Lafi Mohamed , Hardy Rob , Amin Khalid , AL-Zawi Abdalla Saad Abdalla , Elamass Mohamed , Salih Ali , Alkistawi Firas Eddin Bachir , Heeney Anna , Hill Arnold D. K. , Power Colm , Allen Michael J. , Chouhan Ashok , Rathinaezhil Rathi , Shaheed Samy , Zammit Charles , Clayton Gillian , Dua Sascha , Smith Simon , Gandamihardja Tasha , Williams Chloe , Egbeare Donna , Davies Eleri , Sweetland Helen M. , Chopra Sharat , Goyal Sumit , Elfadl Dalia , Rana Dheer Singh , Kalakouti Eliana , Barkeji Musa , Vashisht Rajiv , Bunza Ralia , Phyu Saung Hnin , Hollywood Ciaran , Azmy Iman , Massey Julia , Hargreaves Anita , Harding-Mackean Claudia , Ooi Jane , Seward Joanna , Mathers Helen , Scally Norah , Salman Reem , Shin Hyunjin , Turner Jane , Noor Lubna , Joshi Sanjay , Horne Sarah , Sarakbi Wail Al , Liptay-Wagner Peter , Jacklin Rosamond , Chandrasekharan Sankaran , Marsh Simon , Saha Sunita , Wilson Christopher , Rutherford Claire Louise , Doughty Julie , Romics Laszlo , Stallard Sheila , Chaudhry Anushka , Peck Jennifer , Coombs Nathan , Williams Samantha K. , Hawkins Simon , Kothari Ashutosh , Hamed Hisham , Jain Urvashi , Daltrey Ian , Abbott Nick , Mullen Russell , Dumitru Dorin , Khalifa Eiman , Sarker Masuma , Elahi M. Bilal , Bichoo Raouef Ahmed , Gvaramadze Anzors , Thekkinkattil Dinesh , Jibril Jibril , Hadjiminas Demetrios , St John Edward R. C. , Robb Henry Douglas , Hogben Katy , Bakri Nur Amalina Che , Thiruchelvam Paul , Exarchos Georgios , Al-Mufti Ragheed , Mortimer Caroline , Mallidis Evangelos , Karagiannidis Georgios , Tuffaha Hussein , Peerlink Inga , Nair Rajive , Thekkinkattil Dinesh , Prusty Lydia , Gvaramadze Anzors , Jibril Jibril , Sami Amtul , Knight Alex , Ravichandran Duraisamy , Kirkpatrick Katharine , James Ruth , Akolekar Deepika , Mehta Disha , Barua Ellora , Knowles Hannah , Devalia Haresh , Cox Karina , Dani Mohsin , Chalmers Ritchie , Satpathy Anjana , Quinn Edel , Byrne Gerard , Harvey James , Murphy John , Highton Lyndsey , Sharif Mohammad Amir , Barnes Nicola , Dimopoulos Nikitas , Johnson Richard , Chatterjee Sumohan , Fatayer Hiba , Mathen Vinod , Taylor Amanda , Soulsby Rachel , Walsh Adam , Thorne Amanda , Gill Jasper , Merker Louise , Critchley Adam , Pieri Andrew , Cain Henry , Ralph Jane , Kalra Loraine , Thomas Robert , Young Ian , Khan Lucy R. , Elsberger Beatrix , Smyth Elizabeth , Urquhart Gordon , Fuller Mairi , Masannat Yazan , Chrysafi Ada , Salman Muhammad , Abdalla El-Rasheed , Zechmeister Katalin , Hussien Maged , Youssef Mina M. G. , Tanhueco Angeline , Salvador Reginald , Wallace Sharon , Pain Simon , Sahu Ajay , Chambers Alice , Moody Alice , Dash Isabella , Cook James , Batt Jeremy , Mullan Michelle , Shere Mike , Gallegos Nicholas , Ainsworth Rachel , Govindarajulu Sasi , Potter Shelley , Rayter Zenon , Williams Kate E. , Bramley Maria , Absar Mohammed , Nasir Nabila , Tabbakh Rami , Pereira Bernadette , Gahir Jasdeep , Bosch Karen , Fafemi Oladapo , Touqan Nader , Oni Georgette , Khout Hazem , Asgeirsson Kristjan , Whisker Lisa , Lee Rachel Xue Ning , Macmillan Robert , McCulley Stephen , Rasheed Tuabin , Adwani Asha , Segaran Ashvina , Dodwell David , Remoundos Dennis , MacLean Gael , Cuffolo Giulio , Douek Michael , Roy Pankaj , Gathani Toral , Absar Mohammed , Najeeb Erum , Simonca Claudiu , Verroiotou Maria , Ramzi Sa’ed , Jenkins Stephanie C. , Gopalan Vallipuran , Barker Sarah , McGoldrick Ciara , Irwin Gareth W. , Mallon Peter , Sloan Samantha A. , Imran Abbas , Mondani Giuseppina , Brown Iain , Abbas Imran , Sulieman Mona , Drew Philip , King Polly , English Rachel Elizabeth , Sharma Anita , Ives Charlotte , Ferguson Douglas , Boundouki George , Bentley James , Banks Jenny , Dunn Julie , Tillett Rachel , Olsen Sisse , Tansley Anne , Sousa Emma de , Mitchell Geraldine , Whitehead Ian , Henderson Julia , Rowland Matthew , Chandrashekar Mysore , Eid Raja , Clayton Elizabeth , Pakzad Farrokh , Horsnell Jonathan D. , Hague Matthew , Partlett Polly , Irvine Tracey , Kallaway Charlotte , Fairhurst Katherine , Laban Christiana , McIntosh Jamie , Laurence Nicola , Sutton Richard , Sharma Anup , Banerjee Dibyesh , Betambeau Nadine , Bezzaa Sabrina , Bathla Sonia , Ray Atanu , Chagla Leena , Kiernan Tamara , Hogan Brian , Navin Channegowda , Macinnes Emma , Turton Philip , Achuthan Raj , Kantola Venla , Mckenzie Shireen , Dent Helen , Pogson Caroline , Waheed Shamaela , de Silva Tania S. , Suleiman Usama , Jones Lucie , Athwal Ruvinder , Harries Simon , Krzyzanowska Catherine , Abbas Abeera , Hurley Anna R. , Gui Gerald , Rusby Jennifer E. , Krupa Katherine , Harborough Kathryn E. , Roche Nicola , Barry Peter A. , Law Rebekah , Allum William H. , Lobo Cheryl , Ntakomyti Eleni , Franks Joanna , Cariati Massimiliano , Patani Neill , Stanilov Noyko , Charalampoudis Petros , Taraki Zarghuna , McEvoy Kat , Sait Mohamed Razick , Robertson Stuart , Zeidan Bashar , Rew David , Mazari Fayyaz , Alder Louise , Sakellariou Vasileios , Hamad Ahmed , Goyal Amit , Carmichael Amtul , Courtney Carol-Ann , Sibbering David Mark , Garreffa Emanuele , Cheung Kwok-Leung , Williams-Jones Susan , Wahedna Yasmin , Ansari Aonghus , Kenny Frances , Valassiadou Kalliope , Lambert Kelly , Krupa Jaroslaw , Sardar Mini V. , Kaushik Monika , Shokuhi Sheila , Pilgrm Simon , Sasi Walid , McManus Penelope , Parmeshwar Rishikesh , Somasundaram Santosh , Gowda Manoj , Jafferbhoy Sadaf , Narayanan Sankaran , Marla Sekhar , Soumian Soni , Goh Ngee-Ming , Vatish Jamie , Sein Tin Aung , Agabiti Ennio , Maalo Joseph , Chong Kelvin , Lai Lee-Min , Elkorety Mohamed , Monib Sherif , Thomson Simon , Mikhael Youhana , Mirshekar-Syahkal Bahar , Aitken Jane , Girgis Mina , Betal Dibendu , Rapisarda Fabio , Cook Lorna , Odofin Olubunmi , Bonomi Riccardo , Wardle Stacy , Sotheran Wendy , Athanasiou Irene , Lund Jonathan , Callaghan Maria , Burrah Rajaram , Vinayagam Raman , James Karen , Poonawala Shabbir , Isgar Brian , Matey Pilar , Mylvaganam Senthurun , Podesta Carl , Sircar Tapan , Salem Fathi , Al-Ishaq Zaid 
Published: March 2021

Abstract
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.