The Covid-19 pandemic and impact on breast cancer diagnoses: what happened in England in the first half of 2020

Breast cancer is the most commonly diagnosed cancer in women in England.  Data from the NHS Cancer Waiting Time team was used to examine the impact of the COVID-19 pandemic on breast cancer diagnoses in the first half of 2020.  I will briefly explain the main findings and plans for further work.

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It really has been a year like no other.  The end of March heralded changes to the way the National Health Service operates and delivers care in a way that I suspect many of us never had even imagined possible, and recognise that we are unlikely to see again in our working lives.  Inevitably, the rapid reconfiguration of NHS services to prioritise COVID-19 care, together with the general advice to stay at home had repercussions and concerns  regarding cancer care were rightly raised.  However, the scale of the diagnostic and treatment delay attributed to the pandemic and whether it was equally distributed across all cancer types was unknown.  We knew that real world data from the NHS Cancer Waiting Time team could be interrogated, and would provide useful information as to what was happening specifically to breast cancer diagnoses in the first half of 2020.

This study, published in the British Journal of cancer, analysed data to compare activity for breast cancer in the first six months of 2020 compared to the same time period in 2019 in England.  The number of referrals for suspected breast cancer was 28% lower, but the decrease was much more marked for patients referred in non-urgent referrals for assessment of breast cancer symptoms, where the conversion rate to a cancer diagnosis in 2018/19 was 1.4%, compared to 5.7% for urgent referrals.  The number of patients who received their first treatment for a breast cancer diagnosis was 16% lower.  These data suggested that the number of breast cancers diagnosed during the first half of 2020 was not as low as initially feared, and a substantial proportion of the shortfall can be explained by the suspension of routine screening in March 2020, as screening accounted for approximately four out of ten cancer diagnosed in 2018/19.  

There has been some recovery.  Routine screening resumed in May 2020 and referrals from primary care have been steadily increasing since its lowest point in April, and the state of the recovery achieved by year end needs to be examined and the reasons for any shortfalls understood.  We need to investigate if there have been changes in the patterns of referrals e.g. by age, or on the conversion rates to a cancer diagnosis or the average stage at presentation which in turn will have impact on survival from this treatable disease.  Although we can assess short term impact, it will be many years before we fully understand what the impact of measures to manage the Covid-19 pandemic will be on breast cancer outcomes. 

Toral Gathani

Senior Clinical Research Fellow and Consultant Surgeon, University of Oxford