Public Health Wales report details impact of Covid pandemic on cancer diagnosis

New figures published by Public Health Wales (PHW) have confirmed the dramatic impact of the Covid pandemic on the diagnosis of some of the most common cancers diagnosed in Wales.

As healthcare services focused on dealing with the impact of the pandemic in 2020, according to PHW’s data, the number of new cases of five common cancers diagnosed declined significantly compared to the year before.

The largest decrease in diagnosis was in prostate cancer, with a fall of 26.5 per cent.  Prostate cancer diagnosis relies on patients attending their GP and hospital referral.

There were also decreases in cases of breast cancer in women, and bowel cancer, at 17.2 per cent and 16.7 per cent, respectively. The decrease in lung cancer was smaller at 10.7 per cent, another cancer diagnosed on symptoms.

There was very little change in the ovarian cancer rate with just a 1.6 per cent decrease.

Lockdown

The largest fall in the diagnosis of new cases coincided with the first lockdown, in March 2020, when NHS services were largely focused on managing COVID-19 patients and people were asked to stay at home.

Across the five cancers analysed, there were 2,214 fewer new cases diagnosed between April and December 2020 compared to the pre-pandemic average.

Following the partial lifting of restrictions and the re-starting of non-Covid healthcare services, the incidence in new diagnoses of bowel, lung, female breast and ovarian cancers varied over the rest of the year, as the services began recovery to pre-pandemic levels.

The pandemic had an impact on the number of cases of bowel and female breast cancers detected in certain age groups, as well as on the stage of cancer at diagnosis.

For female breast cancer, the number of new cases diagnosed at stage 1 between April and December 2020 dropped by almost 40 per cent compared to the pre-pandemic average.

Professor Dyfed Wyn Huws, Director of the Welsh Cancer Intelligence & Surveillance Unit (WCISU) at Public Health Wales, said: “The impact of the COVID-19 pandemic and lockdowns, on cancer diagnosis is shown for the first time today using high quality whole-population cancer registry data.

“The focus of large areas of NHS services to concentrate on dealing with the COVID-19 pandemic, the pause in screening services for some cancers, along with an understandable reluctance by many people to seek NHS help after ‘Stay at Home’ messaging, resulted in a drop in cancer diagnoses, especially at the early stages – which is when treatment options are greater, less onerous for the patient, and more effective.

“The recovery to pre-pandemic levels of diagnosis varied between the cancers, with female breast recovering by September 2020.  By contrast, lung and bowel cancer diagnoses recovered to pre-pandemic levels by July 2020, but then decreased below the pre-pandemic average in the final months of 2020.

“It will be important to monitor trends in incidence and stage at diagnoses with cancer registry data over the next few years, in order to fully understand the impact of the pandemic on people with cancer who were not diagnosed during 2020, or who were diagnosed but at a later stage than usual.”

Screening programmes

Dr Sharon Hillier, Director of Screening for Public Health Wales, added: “As with the rest of the UK and in many other parts of the world, Public Health Wales’s screening programmes were paused for a period while pandemic restrictions were in place from March 2020.  This has inevitably resulted in a decrease in the early-stage diagnosis of cancers for which screening programmes are in place.

“During the pause in screening programmes, Breast Test Wales (BTW) staff, worked with several health board’s symptomatic breast screening services, supporting symptomatic assessment appointments in BTW premises.

“All of the cancer screening programmes restarted in Summer of 2020, our teams have worked extremely hard throughout the pandemic to continue to offer our programmes, to recover their timeliness, to maintain safe environments in which screening can take place, and to encourage people to attend their appointments.

“We are also implementing an equity strategy within Public Health Wales’s Screening Division, which is to ensure that everyone who is eligible for screening has equitable access and opportunity to take up their screening offer using reliable information to make a personal informed choice.”

Surveillance dashboard

This set of official statistics based on whole population accurate cancer registry data is the first that has been added to WCISU’s new cancer surveillance dashboard. In addition to the gold standard cancer registration data used today, in the near future, monthly numbers of new diagnoses of cancer based on pathology samples alone will be included to provide users with nearer real time information.

The dashboard brings together the incidence, survival and mortality statistics for all cancers except for non-melanoma skin cancer, which will be included in future updates.

The five leading cancer sites – lung, breast, colorectal, ovary and prostate – have their own section of the dashboard which have official statistics included between 2002 and 2020.  There is also a section which looks at the impact of the pandemic on these five types of cancer.

The dashboard can be viewed here………..