The Covid-19 pandemic has had a significant impact on the diagnosis and treatment of some of the most common cancers in Wales, according to a new report by Public Health Wales (PHW). The report, published on June 25, 2023, analysed the data from the Welsh Cancer Intelligence & Surveillance Unit (WCISU) and found that there were 2,214 fewer new cases of five common cancers diagnosed between April and December 2020 compared to the pre-pandemic average.
The decline in cancer diagnosis during the first lockdown
The report focused on five common cancers: prostate, breast, bowel, lung and ovarian. It found that 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.
The report attributed the decline in cancer diagnosis to several factors, such as:
- 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
- The reluctance by many people to seek NHS help after ‘Stay at Home’ messaging
- The fear of catching Covid-19 in healthcare settings
The largest fall in the diagnosis of new cases coincided with the first lockdown, in March 2020, when these factors were most prominent. The report warned that the drop in cancer diagnoses, especially at the early stages, could have serious consequences for patient outcomes and survival rates.
The recovery of cancer services after the first lockdown
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 report noted that some cancers recovered faster than others, depending on the mode of detection and referral.
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. This was mainly due to the suspension of breast screening programmes during the first lockdown. However, the report found that female breast cancer diagnoses recovered by September 2020, as screening resumed and more women attended their appointments.
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. The report suggested that this could be due to seasonal variations or changes in patient behaviour. Lung and bowel cancers are usually diagnosed based on symptoms, which require patients to seek help from their GP or hospital.
The report also found that 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 example:
- There was a larger decrease in bowel cancer diagnoses among people aged 60-69 years than among other age groups. This could be related to the temporary suspension of bowel screening kits for this age group during the first lockdown.
- There was a larger decrease in female breast cancer diagnoses among women aged 50-69 years than among other age groups. This could be related to the suspension of breast screening programmes for this age group during the first lockdown.
- There was a larger decrease in stage 1 diagnoses for both bowel and female breast cancers than for other stages. This could indicate that fewer cancers were detected at an early stage when treatment options are greater, less onerous for the patient, and more effective.
The challenges and opportunities for cancer care in Wales
The report concluded that the Covid-19 pandemic has posed unprecedented challenges for cancer care in Wales, but also highlighted some opportunities for improvement and innovation. Some of the challenges identified by the report include:
- The backlog of patients waiting for diagnosis or treatment
- The increased demand for cancer services as more people present with symptoms or attend screening
- The potential increase in late-stage or advanced cancers due to delayed diagnosis
- The need to ensure adequate staffing and resources for cancer care
- The need to protect cancer patients and staff from Covid-19 infection
Some of the opportunities identified by the report include:
- The use of digital technology to enhance communication and information sharing between patients and healthcare professionals
- The adoption of new models of care such as rapid diagnostic centres or virtual clinics
- The collaboration and coordination between different sectors and organisations involved in cancer care
- The involvement of patients and the public in the design and delivery of cancer services
- The evaluation and learning from the changes and innovations implemented during the pandemic
Professor Dyfed Wyn Huws, Director of the WCISU at PHW, 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 report provides valuable insights into the effects of the pandemic on cancer care in Wales, as well as the challenges and opportunities for the future. We hope that this report will inform and support the planning and delivery of cancer services in Wales, as well as the research and evaluation of new initiatives and interventions.”
