Covid-19 precautions, however necessary, have created a ticking time-bomb of undiagnosed cancers and delayed treatment. Before the pandemic, across the UK, we were already failing to hit targets for the number of people starting cancer treatment within two months. In some areas we had not hit targets for several years. Now, in lockdown, there are reports of patients having treatment delayed for up to three months and possibly longer. depending on how management of the pandemic progresses. According to Cancer Research UK, the number of cancer-related surgeries has dropped to around 60% of expected levels and 6,000 fewer people are receiving chemotherapy than would have been expected.
Some of these recent delays are due to cancer patients being more vulnerable and susceptible to severe illness if they contract coronavirus and, understandably, wanting to limit their exposure to infection. Whilst far more is needed in terms of regular testing of staff and patients to maintain and expand safe accessible services across the country, some progress has been made. Doctors are making more use of non-invasive and therefore less risky to infection treatments such as hormone therapies and radical radiotherapy. Trusts are creating ’Covid-free cancer hubs’ as well as employing innovative ideas such as mobile ’chemo buses’ to help patients get access to treatment. But what if you don’t even know you have cancer yet?
For as long as I can remember, the message around cancer has been that early diagnosis is absolutely key to curative treatment. I was one of the fraction of women whose breast cancer is diagnosed at a late stage having not been able to be identified by the diagnostic testing regimes. I know from that experience that once you know you have a large cancer, the delay in diagnosis and its potential impact on the success or otherwise of your treatment is terrifying.
When cancers spread from their primary site to other parts of the body they generally become incurable. The crucial element here is time. When a cancer is diagnosed early, it’s often possible for treatment to begin before the cancer has time to grow and spread and the chance of being cured is massively increased. The development of screening tests for breast, bowel and cervical cancers has been a game changer in reducing cancer mortality rates. These tests can detect cancers before there are any symptoms and treatment can begin when cancers are very small and unlikely to have spread to other parts of the body. Since the UK introduced breast screening in the 1980s the mortality rate for breast cancer has reduced by nearly 40%. [1]
But since the Covid-19 pandemic began there has been a dramatic drop in people being diagnosed with cancer. This is happening because screening programmes are paused, fewer people are going to their GP when they develop symptoms and some diagnostic tests with a higher risk of spreading Covid-19, such as endoscopies, are on hold. Whilst the impact of lockdown is starting to abate, the drop in diagnoses is storing up a tsunami of cancer diagnoses later on and potentially significantly impacting on cancer mortality rates.
NHS England figures show that in April 2020 urgent referrals for all cancers had dropped by 60% compared to April 2019 levels. The drop in urgent breast cancer referrals was even greater, down 78%. Cancer Research UK states these figures are improving but they remain at around 50% of usual levels. As longs as these figures remain below 100%, cancers are going undiagnosed. The figures for screening are also worrying. Screening is officially paused in Scotland, Northern Ireland and Wales and invitations to screening in England have been suspended. More than 200,000 screenings a week for breast, bowel and cervical cancers are not taking place and that means more cancers going undetected for longer. Cancer Research UK estimates that so far there are 2.4 million people waiting for screening, tests or treatment and each week that goes by increases that number. Tens of thousands of cancers are going undetected and untreated, some potentially to the point of becoming incurable.
Covid-19 is of course a global emergency and must be taken seriously. NHS trusts are doing everything possible to continue cancer treatments and to protect staff and patients from Covid-19. But more must be done to improve the levels of testing. Only a comprehensive programme of regular testing for Covid-19 of both staff and patients will make it possible for trusts to provide screening and treatments that patients can access with confidence.
Whilst we are all focusing on Covid-19, the UK’s biggest killer is still at work. Cancer kills someone in the UK every four minutes. The loss of screening programmes and reduction in referrals risks that figure rocketing in future. We must make sure that the NHS has the resources it needs to continue to detect, treat and cure cancers otherwise we face a deadly backlog. With early detection and treatment we can save thousands of lives and so whatever else is happening we have to maintain vigilance, because cancer remains one disease where being alert can actually make a difference.
Ashley Dalton
Ashley is a breast cancer survivor, volunteer Macmillan cancer voice and was Labour’s Parliamentary candidate in Rochford and Southend East in 2017 and 2019.
[1]Impact of Screening on Breast Cancer Mortality: The UK Program 20 Years On
Nathalie J. Massat, Amanda Dibden, Dharmishta Parmar, Jack Cuzick, Peter D. Sasieni and Stephen W. Duffy