Study finds significant decrease in cancer diagnoses in Wales during pandemic

A new study has revealed that during the Covid-19 pandemic there was a significant reduction in breast, bowel and lung cancer diagnoses in Wales.

The main findings, published in the British Journal of Cancer this month, revealed that diagnosis of three common cancers fell by over 15 percent in Wales in 2020 compared to 2019, over a thousand fewer.

The findings also suggest that there may be a ‘large number of patients in the community with undiagnosed cancers’ and that the routes to diagnosis have changed significantly during the pandemic.

This was the first national population-level paper of its kind to use health service cancer data to quantify in detail the effect of the Covid-19 pandemic on cancer diagnosis in 2020 and was carried out by a new research group DATA-CAN Cancer Collaboration Cymru (DATA-CAN CCC).

The largest reductions occurred for breast cancer amongst women aged 50-69 years old (24 percent), and amongst people aged 80 years and older, for whom diagnoses reduced by about a fifth in each of the three cancer types.

Early-stage breast cancer was particularly affected, reducing by 42 percent. Cases of early and late stages of bowel cancer all reduced by about a quarter to a third each.

The study also found that breast cancer cases diagnosed via screening decreased by 48 percent in 2020 compared to 2019, whereas bowel cancer cases detected through screening fell by only 13 percent.

Diagnoses following GP referral for urgent suspected cancer decreased the most for bowel cancer and lung cancer diagnosis while the percentage of cases diagnosed through an emergency hospital attendance during 2020 remained similar to 2019 for lung cancer at around a third of cases, and for bowel cancer at around a quarter of cases each year.

Stay-at-home messages

The study suggested that the results were possibly due to Covid-19 infections and illness, self-isolation and deaths in the community, as well as necessary public health responses to the Covid-19 pandemic including mandated lockdowns, strong stay-at-home messages, and changes to the way of accessing screening, GP and hospital services.

It also observed that the monthly pattern of diagnosis numbers and the healthcare route to diagnosis changed throughout 2020, particularly for cancer diagnoses after GP referrals for urgent suspected cancer, coinciding with varying changes in access to health services and lockdowns.

Although the pandemic, along with public health and healthcare responses to it have abated somewhat, the report still suggests that extensive alterations to healthcare routes to diagnosis, increases in later-stage diagnoses and an increase in the number of undiagnosed patients with new cancers will occur.

Dr Sharon Hillier, Director of the Screening Division at Public Health Wales said: “The decrease in screen-detected breast and bowel cancer over this period was expected as the two screening programmes were paused in March 2020 in line with government recommendations to suspend non-urgent appointments.

“Both programmes were restarted from July 2020 with Covid-safe measures and have continued throughout the rest of the pandemic.

“During the pause, Breast Test Wales provided support to hospital services for women referred with symptoms of breast cancer, and Bowel Screening Wales provided testing support to prioritise suspected cases of bowel cancer referred by GP services for further investigation.”

Research lead, Professor Dyfed Wyn Huws, Director of the Welsh Cancer Intelligence and Surveillance Unit said: “With over a thousand fewer cases diagnosed across three common cancers during 2020, the study suggests there may also be large numbers of patients with other types of undiagnosed cancer.”

The new DATA-CAN CCC research group is led by Public Health Wales’ Welsh Cancer Intelligence and Surveillance Unit and includes the Population Data Science team at Swansea University and their SAIL Databank, Health Data Research UK Wales-Northern Ireland, DATA-CAN – The Health Data Research Hub for Cancer, Queens University Belfast, Swansea Bay University Health Board and the University of Oxford.