Although the presented data comes from only one centre of oncology, yet it may be treated as representative for the whole Poland. It reflects the situation at the centre treating the largest number of patients with newly diagnosed breast cancer every year. Furthermore, the Kujawsko-Pomorskie Voivodeship, in which the Centre of Oncology in Bydgoszcz operates, is a typical industrial and agricultural region of the country, with a number of inhabitants (2.07 million), a population density (116 people/km²) and a percentage of urban areas (61.1%) at an average level.
Contrary to data indicating a decreasing number of cancer patients coming to oncology centres [3–5], the situation found at our centre was different. When compared to the situation before the pandemic, 15.6% more patients qualified for surgical treatment were hospitalised at the second stage of the study (when comparing 12-month periods: April 2019–March 2020 and April 2020–March 2021, 1092 and 1262 patients, respectively). At the same time, the number of patients receiving the conservative treatment did not change (110 and 111 patients, respectively, in the same 12-month periods). However, in that case the number of patients receiving the palliative treatment increased.
Different data was presented by Gathani et al. [13], who found that the number of patients starting treatment for breast cancer in the first six months of 2020 was lower by 16% versus the corresponding period in 2019. A similar decreasing trend was observed by Baxter et al., who described a nearly 20% reduction in the number of patients receiving the systemic treatment, observed during first 4 months of the pandemic [4]. The changes described above also apply to the number of patients with other cancers [4, 14–16]. So, did we manage to achieve something impossible in our case?
Despite many hazards associated with the new epidemiological situation, we maintained the continuous operation of our centre. This was possible due to introduction of a number of restrictions (for example, an access to inpatient wards was completely forbidden to any third persons, significant restrictions in that respect were also implemented at outpatient clinics, hospitalised people were required to remain in their room at all times, and our personnel had restricted possibilities of working outside our centre) and additional requirements (e.g., all patients were tested for the SARS-CoV-2 infection before starting each hospitalisation, a change in a system for meals distribution - meals were again delivered to hospital rooms, replacing the generally accessible hospital restaurant, duration of patient hospitalisation was reduced to a necessary minimum), as well as a fast restart of the programme for early breast cancer diagnosis (mammographic screening). The listed actions were definitely also used in other health care centres. However, in our case they proved to be highly effective.
In the studied group of patients, the most important consequence of the COVID-19 pandemic is a higher clinical staging of newly diagnosed neoplasms. The resulting differences (highly statistically significant: stage I – p = 0.003, stage II – p = 0.001) are a consequence of a progress in the primary tumour size observed during the pandemic (in a clinical: p = 0.033 and pathological: p = 0.048 evaluation). At the same time, they did not result from a change of the most important prognostic factor in breast cancer patients - the axillary lymph node status [17] (no significant difference in that respect was found in both compared groups).
The increase in the percentage of mastectomies (by 5.5% – p = 0.004) during the pandemic stage did not result from a change in a way in which patients were qualified for this surgery. It also did not result from a reduction in the use of auxiliary radiotherapy (associated with the breast-conserving therapy) by the patients or by the therapeutic team. However, it was closely related to the said change in the primary tumour size.
An increase in the overall number of breast cancer cases treated at our centre during the pandemic stage did not result from the introduction of any changes in the distribution of cancer patients at a national level. However, it was possible due to implementation of strict management protocols concerning organisation of diagnostics and patient treatment. However, in our opinion, we cannot stop only at initiatives undertaken at a bottom level, even those most proven and effective. We believe that a systemic intensification of all efforts that may prevent delays in diagnosing and treatment of cancer patients is necessary. From our national perspective, such actions were not undertaken in the greatest extent. We should never again leave cancer patients on their own, even if for a short time.
The currently continuing COVID-19 pandemic has clearly changed the health situation of societies all over the world. With the improvement in the pandemic situation (mainly, due to widespread vaccinations against SARS-CoV-2), the actions aiming at restoring all solutions for organisation and treatment of neoplastic diseases in force before the pandemic should be undertaken as soon as possible. However, the questions about the length of a period required to return to the initial situation, as well as about the pandemic influence on delayed treatment outcomes still remain open [18].