Pausing screening in Scotland saw cancer under-diagnosed in 2020 – report

Pausing screening services as coronavirus ripped through Scotland saw cases of early-stage breast, colorectal and cervical cancers missed, a new report has said.

Nearly 2,800 fewer cancer diagnoses were made in 2020 compared to the previous year, a fall of 8%, Public Health Scotland said in its annual cancer incidence statistics on Tuesday.

And the report said even larger decreases were recorded in specific cancers, with diagnoses for bowel cancer falling by a fifth and for cervical cancer by a quarter.

Professor David Morrison, director of the Scottish Cancer Registry, said: “Usually, a fall in new cancer diagnoses suggests that we are getting better at preventing it.

“But in 2020, the drop in expected cases suggests that people still had cancer but were not being diagnosed.”

Outcomes from cancer are better when diagnosed at the earliest stage, but the report said it appeared that the pandemic had a greater effect on those more treatable cancers.

Diagnosis of early-stage cancer fell more than for late-stage disease, and early breast, bowel, and cervical cancer diagnoses probably fell most because of pauses in cancer screening programmes.

Researchers found that in 2020 there was a 20% under-diagnosis of breast cancer, one of 33% for colorectal, and one of 45% in cervical cancers compared with the number of early-detected cancers the year before.

The 63-page report said that Covid has a “huge impact on all aspects of cancer control in Scotland, causing widespread disruption from the end of March 2020”.

“All cancer-screening programmes were paused for several months and urgent referrals for suspected cancer fell substantially as patients followed the ‘Stay at home; protect the NHS’ message,” it said.

“Patients being less likely to seek help, and delays in investigations may have led to patients not being diagnosed in 2020 when they could have been.

“Also, some will have died of Covid-19 before they were diagnosed with cancer in 2020.”

Professor Morrison said: “The pandemic has affected cancer care in many ways. Public Health Scotland is working with a range of clinical, management and policy colleagues to inform the recovery of cancer and screening services, and to diagnose cancer in Scotland at the earliest stage.

“I would encourage anyone who gets an invitation for cancer screening to take it. If you are worried about an unusual symptom, don’t put it off – get in touch with your GP.”

And decreases in cancer diagnoses were seen to a greater extent in poorer areas. But, rather than this meaning fewer people had cancer, the report said people from more deprived areas were not getting their cancers diagnosed.

MSP Maree Todd, the public health minister, said: “The NHS remains under sustained pressure as a result of Covid-19, with the number of people awaiting diagnostic tests now at the highest level since 2018, and we are working tirelessly with health boards to provide vital services.

“Early cancer diagnosis has never been more important which is why we’ve committed a further £20 million over the parliamentary term – on top of the £44 million previous investment – to our Detect Cancer Early Programme, which aims to provide greater public awareness of signs and symptoms of cancer to improve earlier diagnosis rates.

“Patients continue to be seen based on their clinical urgency, for example those referred with an urgent suspicion of cancer continue to be prioritised for key diagnostic tests. Significant funding has also been targeted at increasing diagnostic capacity across NHS Scotland.”