Early cancer diagnosis and COVID-19: unpicking the impact of the pandemic

One of the best ways to help people survive cancer is to find it early. That’s why NHS England has a target of diagnosing 75% of cancer cases in stage 1 or 2 by 2028.

Unfortunately – despite the tireless work of NHS staff, as well as a range of national strategies and initiatives – it looks like we’re going to fall well short of that target.

The proportion of people diagnosed early had been stuck at around 54% since 2013. In 2019, it was already clear that we needed to do more, and that we needed the right workforce and equipment to make progress. And then COVID-19 happened.

The pandemic disrupted cancer services and changed people’s behaviours. In England, screening programmes were effectively paused for several months, far fewer people visited the doctor for cancer symptoms and services struggled with increased restrictions and reduced capacity.

And one question we’ve been asked regularly over the last couple of years is: how has the pandemic affected early diagnosis?

Research from earlier in the pandemic tried to model its impact, but the evidence was very limited.

Now, though, we have good quality data for 2020, which means we can begin to answer the question.

But, while we’d love to be able to give you a definitive account of how COVID-19 impacted early diagnosis, it’s a complex, cloudy picture and we still don’t have all the answers.

Even so, what we do know is important, and it needs to be explained.

Numbers vs proportions

In 2020 in England, the proportion of people diagnosed early was 52%, a drop from previous years and putting the 75% ambition even further out of reach. This is definitely a setback.

But looking at the number of people behind this proportion tells an even more concerning story.

Around 27,500 fewer people were diagnosed with cancer in 2020 compared to previous years. That reduction was spread across almost all cancer sites, with drops driven by pauses in screening programmes, worry about COVID-19 and messages to stay home, as well as increased pressure on cancer services.

Our analysis suggests these ‘missing’ cases were disproportionately early-stage ones – we estimate around 72% of them.[2] The impact of the pandemic on early diagnosis now looks even more worrying.

Are these cases “missing”?

We’ve seen multiple articles about finding these cancer cases as soon as possible – clearing the ‘backlog’, so to speak.

For some of the people these cases represent, that makes sense. Screening programmes have been working hard to restore services, sending out invitations to those who may have missed appointments. Meanwhile, more and more people are seeing their doctor with symptoms they are worried about. But we’re concerned that some of these patients may have presented later than they would have otherwise, with more advanced disease. It’s not possible to simply clear the backlog of missed diagnoses because cancer develops over time.

Also, not all these cases are ‘missing’. Sadly, some of these people will have died before their cancer diagnosis, many from COVID-19, which means we’ll never diagnose or treat them.