Cancer staging data using 2018 to 2020 DCE data - the impact of COVID-19

About this release

This release by Public Health Scotland is a planned revision presenting data examining the impact of COVID-19 on the cancer staging distributions, with the focus of the report being 2020 Q2- Q4 data in comparison with the expected numbers using the most recent pre-pandemic Detect Cancer Early (DCE) data (2018 and 2019). Charts and tables from the DCE audit dataset for patients diagnosed with cancer during the full two-year period 1 January 2019 to 31 December 2020 have already been published and are available.

Main points

• During the nine months of the pandemic in 2020 (April-December), there were 2,681 patients diagnosed with breast cancer, 1,958 patients diagnosed with colorectal cancer and 3,287 patients diagnosed with lung cancer. These numbers are 19% (breast), 25% (colorectal) and 9% (lung) lower than would have been expected in this period had COVID-19 not happened.
• The fall in numbers in 2020 Q2 is due to the initial lockdown. In the remaining months of 2020, numbers of people diagnosed with breast and lung cancer started to return to pre-pandemic levels, although colorectal figures remain well below previous years.

• For breast cancer, there were large falls numbers in stages 1 and 2 (35% and 15% respectively). In contrast, there were small increases in stages 3 and 4 (5% and 7%), with the biggest increase seen for those of unknown stage (34%).
• For Colorectal Cancer, there were substantial drops (30% and more) in the numbers diagnosed with stages 1, 2 or 3 colorectal cancer; whereas there was only a 4% drop for metastatic colorectal cancer.
• For Lung Cancer, there were falls 11%-13% for stages 1, 2 and 3; but only a fall of 4% for stage 4 diagnoses, which was only lower than expected in April 2020.

Background

When the first national lockdown due to COVID-19 was imposed in March 2020, clinical services within primary, secondary and tertiary care were severely affected in numerous ways.  These included:

• The public being asked to 'stay at home' and 'protect the NHS';
• Many patients were put on a 'shielding' list due to their pre-existing medical conditions, with tougher restrictions around and beyond lockdown to help minimise their risk of contracting COVID-19;
• GPs switched mainly from face-to-face to telephone appointments, possibly making it more difficult to elicit signs and symptoms of some cancers;
• There was confusion caused by the overlapping 'persistent cough', breathlessness and fatigue symptoms between COVID-19 and stage 2-4 lung cancer; this may have led to some referrals for lung cancer being delayed;
• Aerosol-generating procedures (AGPs) were identified as a high risk to staff and patients in regards to spreading and contracting COVID-19. These AGPs included key cancer diagnostics, such as endoscopy. As such, many of these were initially suspended due to lack of knowledge around the extent of the risks of COVID-19 to patients and staff, and then had to resume with reduced capacity, due to necessary increased health protection measures, which continue today. These include:
  • socially distanced lower capacity waiting rooms and recovery areas,
  • increased down-time between procedures to allow deep cleaning and aid ventilation of rooms between patients,
  • reduced availability of operating lists;
• Many staff and facilities (eg operating theatres, ICU beds) were redeployed to treat and care for COVID-19 patients;
• There was a temporary pause of all adult National Screening Programmes on 30th March 2020: no new invites were sent out during the pause; breast screening restarted on 3 August 2020; colorectal screening restarted on 12 October 2020.

These measures will have all contributed differently to the observed effects seen for the early and late stages for the three different cancer sites.

Further information

The next release of this publication is scheduled for October 2022.