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. 2022 Aug;127(3):558-568.
doi: 10.1038/s41416-022-01830-6. Epub 2022 May 2.

Impact of the SARS-CoV-2 pandemic on female breast, colorectal and non-small cell lung cancer incidence, stage and healthcare pathway to diagnosis during 2020 in Wales, UK, using a national cancer clinical record system

Giles Greene  1 , Rowena Griffiths  2 , Jun Han  2 , Ashley Akbari  2 , Monica Jones  3 , Jane Lyons  2 , Ronan A Lyons  2 , Martin Rolles  4 , Fatemeh Torabi  2 , Janet Warlow  1 , Eva R A Morris  5 , Mark Lawler  6 , Dyfed Wyn Huws  7
Affiliations

Impact of the SARS-CoV-2 pandemic on female breast, colorectal and non-small cell lung cancer incidence, stage and healthcare pathway to diagnosis during 2020 in Wales, UK, using a national cancer clinical record system

Giles Greene et al. Br J Cancer. 2022 Aug.

Abstract

Background: COVID-19 pandemic responses impacted behaviour and health services. We estimated the impact on incidence, stage and healthcare pathway to diagnosis for female breast, colorectal and non-small cell lung cancers at population level in Wales.

Methods: Cancer e-record and hospital admission data linkage identified adult cases, stage and healthcare pathway to diagnosis (population ~2.5 million). Using multivariate Poisson regressions, we compared 2019 and 2020 counts and estimated incidence rate ratios (IRR).

Results: Cases decreased 15.2% (n = -1011) overall. Female breast annual IRR was 0.81 (95% CI: 0.76-0.86, p < 0.001), colorectal 0.80 (95% CI: 0.79-0.81, p < 0.001) and non-small cell lung 0.91 (95% CI: 0.90-0.92, p < 0.001). Decreases were largest in 50-69 year olds for female breast and 80+ year olds for all cancers. Stage I female breast cancer declined 41.6%, but unknown stage increased 55.8%. Colorectal stages I-IV declined (range 26.6-29.9%), while unknown stage increased 803.6%. Colorectal Q2-2020 GP-urgent suspected cancer diagnoses decreased 50.0%, and 53.9% for non-small cell lung cancer. Annual screen-detected female breast and colorectal cancers fell 47.8% and 13.3%, respectively. Non-smal -cell lung cancer emergency presentation diagnoses increased 9.5% (Q2-2020) and 16.3% (Q3-2020).

Conclusion: Significantly fewer cases of three common cancers were diagnosed in 2020. Detrimental impacts on outcomes varied between cancers. Ongoing surveillance with health service optimisation will be needed to mitigate impacts.

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Conflict of interest statement

ML has received an unrestricted educational grant from Pfizer for research unrelated to this work. ML has received honoraria from Pfizer, EMF Serono, Roche, Bayer, Novartis and Carnall Farrar unrelated to this work. DWH has received research consultancy fees from Pfizer for research unrelated to this work, and his department (Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales) has received analysis partnership funding from Macmillan Cancer Support for unrelated work. The remaining authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Chronology of the SARS-Cov-2 pandemic in Wales in 2020.
Mitigations to health and cancer services during the pandemic(GP=general practioner).
Fig. 2
Fig. 2. Trends in numbers of confirmed incident SARS-CoV-2 infection cases and hospitalised Covid-19 cases in Wales, 2020.
Overlay of the periods of societal lockdowns and the period in which cancer screening programmes were paused.
Fig. 3
Fig. 3. Incident case counts for female breast, colorectal and non-small cell lung cancers for 2019 and 2020.
a Annual counts Caption for b Monthly counts.
Fig. 4
Fig. 4. Cumulative monthly case counts for 2019 and 2020 by stage at diagnosis.
a Female breast cancer b Colorectal cancer.
Fig. 5
Fig. 5. Quarterly counts of incident cases by healthcare pathway to diagnosis, 2019 and 2020.
Female breast cancer, Colorectal cancer, Non-small cell lung cancer.
See this image and copyright information in PMC

References

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    1. Welsh government. COVID-19 Hospital Discharge Service Requirements. 2021. https://gov.wales/hospital-discharge-service-requirements-covid-19 Accessed 12 July 2021.
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