Study finds significant reductions in cancer diagnoses in Wales during the Covid-19 pandemic

The study, published in the British Journal of Cancer this month, found that over a thousand fewer new cases of three common cancers were diagnosed in Wales in 2020 compared to 2019, equivalent to a reduction of 15 percent. The largest reduction in new cases of almost a fifth occurred for breast (19 percent) and bowel (17 percent) cancers, although by the end of 2020, lung cancer cases had reduced by only 8 percent, in contrast.

To help understand what happened to cancer diagnoses in Wales during the first full year of the pandemic in 2020, a new research group: DATA-CAN Cancer Collaboration Cymru (DATA-CAN CCC) analysed NHS Wales cancer data on breast, bowel and lung cancer diagnoses.

This was the first national population-level study 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.

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. In contrast, bowel cancer cases detected through screening fell by only 13 percent.

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.”

Diagnoses after GP referral for urgent suspected cancer decreased the most for bowel cancer and lung cancer diagnosis. 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.

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.

The study 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.

Study 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.”

Although the pandemic, along with public health and healthcare responses to it have abated somewhat, the study 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.

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.