Public Health Scotland has released new cancer diagnoses figures for 2020, with comparisons to previous years providing insight into the effects of the pandemic across Scotland, including that fewer cases were being spotted during the pandemic.

Looking at all cancers, there has been a total decrease of nearly 3,000 in the number of cases reported in 2020 from the 33,156 in 2019 according to the report published today.

Unfortunately, Public Health Scotland (PHS) says, this isn’t the result of innovative preventative action across Scotland, but instead mostly reflects “under-diagnosis caused by the pandemic.”

Missed diagnoses can lead to people going untreated until their cancer has advanced to a worse state, leading many to emergency departments in hospitals. We reported earlier this month that over 1 in 3 cancer diagnoses in Scotland were via emergency care even before the pandemic.

More diagnoses at advances stages of cancers have been reported compared to earlier years, where a greater number of early-stage detections were recorded. For example, the number of Stage I & II cervical cancer registrations has more than halved from 2019 to 2020.

At the same time, a 70% increase in Stage III cervical cancer was recorded from 2019 to 2020, meaning cervical cancer is increasingly being detected in its more advanced stage.

Public Health Scotland said:

“It seems likely that disruption of cervical screening would explain some of the reductions in diagnosis of early-stage cervical cancer.”

Cancer Research UK say that 96% of people with cervical cancer will survive for one or more years when diagnosed at Stage I, but the rate of survival decreases as the cancer progresses.

Breast cancer detection was also impacted by the pandemic. Where around 50% of females aged 50-69 years old previously had their breast cancer detected by screening in the decade prior to the pandemic, this fell to only 39% of breast cancers in this age group in 2020.

Professor Ghulam Nabi, NHS Research Scotland Clinical Lead in Cancer for the East of Scotland, told healthandcare.scot:

“Unfortunately, everything at the moment has taken a back-seat while we focus our attention on covid-19. Some cancers don't have early symptoms and by the time patients have symptoms, it can sometimes be too late.”

Audit Scotland’s report on the NHS in Scotland echoes this, noting that PHS is monitoring the undiagnosed cancers, but delayed referrals will lead to long-term health problems.

Considering all services across Scotland, the Auditor General’s report said:

“A cohesive strategy is needed to better understand what the wider health impact of covid-19 will be on NHS services and inform future service provision.”

Public Health Scotland previously recorded an increase from 26% in 2015 to 35% 2019 for bowel cancers in 50–74-year-old people. In 2020, detection via screening reached a five-year low, with only 20% of colorectal cancers in this age group reported.

Socio-economic inequalities in terms of cancer incidence do not appear to have been greatly impacted by the pandemic.

Overall, there appears to be a small short-term narrowing from 33% higher cancer incidence in the most deprived areas 2019 to 30% higher in 2020. Separate research cited by PHS suggests this is due to greater strain placed on NHS services in more deprived areas, causing under-diagnoses rather than disease prevention.

Lung cancer, the most common in Scotland, accounted for 16% of all cancers in 2020 but still saw diagnoses fall by 7% from 2019 levels. Previously reported as three times more likely among the most deprived areas than the least deprived areas, in 2020, the risk of lung cancer was twice as likely in the most deprived areas. Public Health Scotland said:

“This may reflect that people from deprived areas were more likely to catch covid-19 and more likely to die from it, potentially before any diagnosis of lung cancer was made.”

Public Health Scotland cite the pausing of screening services among the key reasons for the decrease in cancer diagnoses across Scotland during the pandemic. Professor Nabi said: “I think with the pandemic hitting us very hard, we need to go back to the table and re-design strategies.”

Other NHS staff and Cancer Research UK Scotland have called for the government to address staff shortages and support the workforce.

Scotland’s NHS recovery plan committed £130m to the Detect Cancer Early Programme and a consultation on the new ten year cancer strategy was launched yesterday.

 

Read more: Seven-day results promised in cancer check shake-up; High cancer diagnoses rate via emergency care; "Staggering" fall in cancer diagnoses over lockdown

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