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. 2024 May;133(5):587-595.
doi: 10.1111/bju.16305. Epub 2024 Feb 27.

During the COVID-19 pandemic 20 000 prostate cancer diagnoses were missed in England

Agnieszka Lemanska  1 , Colm Andrews  2 , Louis Fisher  2 , Seb Bacon  2 , Amir Mehrkar  2 , Peter Inglesby  2 , Simon Davy  2 , Ben Goldacre  2 , Brian MacKenna  2 ; OpenSAFELY Collaborative; Alex J Walker  2
Collaborators, Affiliations

During the COVID-19 pandemic 20 000 prostate cancer diagnoses were missed in England

Agnieszka Lemanska et al. BJU Int. 2024 May.

Abstract

Objectives: To investigate the effect of the COVID-19 pandemic on prostate cancer incidence, prevalence, and mortality in England.

Patients and methods: With the approval of NHS England and using the OpenSAFELY-TPP dataset of 24 million patients, we undertook a cohort study of men diagnosed with prostate cancer. We visualised monthly rates in prostate cancer incidence, prevalence, and mortality per 100 000 adult men from January 2015 to July 2023. To assess the effect of the pandemic, we used generalised linear models and the pre-pandemic data to predict the expected rates from March 2020 as if the pandemic had not occurred. The 95% confidence intervals (CIs) of the predicted values were used to estimate the significance of the difference between the predicted and observed rates.

Results: In 2020, there was a drop in recorded incidence by 4772 (31%) cases (15 550 vs 20 322; 95% CI 19 241-21 403). In 2021, the incidence started to recover, and the drop was 3148 cases (18%, 17 950 vs 21 098; 95% CI 19 740-22 456). By 2022, the incidence returned to the levels that would be expected. During the pandemic, the age at diagnosis shifted towards older men. In 2020, the average age was 71.6 (95% CI 71.5-71.8) years, in 2021 it was 71.8 (95% CI 71.7-72.0) years as compared to 71.3 (95% CI 71.1-71.4) years in 2019.

Conclusions: Given that our dataset represents 40% of the population, we estimate that proportionally the pandemic led to 20 000 missed prostate cancer diagnoses in England alone. The increase in incidence recorded in 2023 was not enough to account for the missed cases. The prevalence of prostate cancer remained lower throughout the pandemic than expected. As the recovery efforts continue, healthcare should focus on finding the men who were affected. The research should focus on investigating the potential harms to men diagnosed at older age.

Keywords: COVID‐19; missed diagnosis; prostate cancer cohort; prostate cancer diagnosis; prostate cancer incidence; prostate cancer prevalence.

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Conflict of interest statement

Disclosure of Interests

Ben Goldacre has received research funding from the Laura and John Arnold Foundation, the NHS National Institute for Health and Care Research (NIHR), the NIHR School of Primary Care Research, NHS England, the NIHR Oxford Biomedical Research Centre, the Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK, the Health Foundation, the World Health Organisation, UK Research and Innovation Medical Research Council (UKRI MRC), Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme; he was previously a Non-Executive Director at NHS Digital; he also receives personal income from speaking and writing for lay audiences on the misuse of science. Amir Mehrkar is a former employee and interim Chief Medical Officer of NHS Digital, a member of the Royal College of General Practitioners health informatics group and the NHS Digital GP data Professional Advisory Group. Brian MacKenna is employed as a pharmacist by NHS England and seconded to the Bennett Institute and is a trustee of the charity Immigrant Counselling and Psychotherapy (ICAP).

Figures

Fig. 1
Fig. 1
Observed and predicted trends over time from January 2015 to July 2023 showing rates per 100 000 registered adult men (A) prostate cancer incidence, (B) prevalence, and (C) deaths. Vertical blue line (March 2020) indicates the start of the COVID-19 restrictions. Red line represents a model (with 95% CIs) of predicted data as if the pandemic had not occurred. Mortality data were only available from February 2019, and they were not modelled.
See this image and copyright information in PMC

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