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A REDUCTION in cancer pathology notifications during COVID-19-related restrictions means there may be thousands of additional undetected cancer cases in the community, with experts concerned there may be a coming surge in diagnoses at more advanced stages of disease.
Cancer pathology notifications are still not back at pre-COVID-19 levels, according to a study published in the MJA.
The researchers reviewed cancer pathology notifications on the Victorian Cancer Registry from 1 April to 15 October 2020. They noticed a significant decline in cancer pathology notifications during the Victorian 2020 lockdowns.
However, what has researchers worried is that as of January 2021, there still hasn’t been the surge of cancer notifications they thought they’d see following the easing of restrictions.
“We expected towards the end of the study period that we would see a greater return to normal or even see a surge in reporting,” said Professor Sue Evans, Director of the Victorian Cancer Registry and one of the study authors.
“But we haven’t seen that yet. It’s not alarming but we are a bit concerned. We’ve seen less of a decline, but we’re still seeing less observed cancer notifications than we would expect even at this point in time.”
In their MJA article, the author found that during 1 April to 15 October 2020, there were 5446 fewer notifications of new cancer diagnoses than predicted by their primary model (predicted, 54 609 v observed, 49 163; relative reduction, –10.0%).
“We estimated that there were 2530 undiagnosed cancers.”
For some cancers, such as breast cancer, there was reduced screening during the COVID-19 period. BreastScreen Victoria, for example, paused its screening services from Wednesday 25 March until Monday 11 May 2020.
“Our most recent annual report shows that we carried out 218 129 breast screens in 2019–20, in comparison to 267 589 in 2018–19 and 260 722 in 2017–18, which illustrates the reduction in screening in the last financial year to June 2020,” a BreastScreen Victoria spokesperson told InSight+.
When they reopened, they spaced their appointment times and increased infection control measures to reduce risk. These safety measures, in combination with clients receiving an invitation, saw a strong demand for appointments by the end of May 2020.
Because of this demand, reduced appointments meant there were increased waiting times for some clinics across Victoria.
A reduction in breast cancer notifications was expected because of screening services being closed; however, there were also higher reductions in notifications for prostate cancer, head and neck tumours, and melanoma.
Reductions were greater for men, people aged 50 years or more, and for people in areas of higher socio-economic status.
“When we looked at cancers that are prevalent in both males and females, we noticed again the vast majority were males,” Professor Evans said.
While GP clinics were open throughout the lockdown periods, many people may have delayed visiting unless it was urgent, or they may have used telehealth services.
While telehealth has had many advantages, its less personal nature may mean GPs don’t get the full picture as patients may not raise seemingly minor changes in their health.
“I think there’s a high likelihood that is happening,” Professor Evans told InSight+.
“It’s hard to know, but it makes sense that men particularly are not going in for general check-ups, and not getting [prostate‐specific antigen] levels taken. Those sorts of things are often deferred when you’re reluctant to go out of the house. It’s likely to play a part in why we’re seeing fewer notifications.”
New South Wales also saw a small reduction of cancer notifications, according to a NSW Health spokesperson:
“There was an approximate 3.7% reduction in electronic notifications of new cancer diagnoses to the NSW Cancer Registry in March to November 2020 compared with the months prior. We are continuing to monitor the data,” the spokesperson said.
The researchers predict that a surge of cancer cases is still to come in the next 6–12 months, and they fear it means people will present at a later, more advanced stage of the disease.
However, what that may mean is unclear.
“We really don’t know what impact this will have on cancer mortality. Some of these cancers it may not impact at all. I think it’ll be an interesting natural experiment to see what happens over time and see whether it impacts survival,” said Professor Evans.
Dr Luc te Marvelde, Head of Data Analytics at the Victorian Cancer Registry and study co-author, told InSight+, in an exclusive podcast, that impacts on stage migration was something they would keep a close eye on.
“The next step is once all the data is processed, we will have a good idea about the stage of diagnosis. We would expect there is a delay in cancer diagnoses and we would expect people to present with a higher stage with more advanced disease. Once the data is processed then we would have a good idea how this would impact survival,” he said.
The researchers hope that a combination of media campaigns and GP reassurance will help people feel confident to visit their doctor again.
“The general public need to understand that going to their GP is a safe thing to do.” Professor Evans concluded.
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We also have the huge number of endoscopes and colonoscopies that were delayed. we are now playing catch up but it isnt working, the wait list for category 4 urgent scopes has blown out in some regional hospitals from recommended 30 days to up to a year, For many it will be too late, and their early diagnosis which would have made the difference of life and death will not happen. This is a human tragedy and it will only get worse. many people will die waiting.
For sure. I Chair the GU Oncology stream for the COVID Cancer Taskforce in Victoria and we have been watching this data as it has been updated throughout the pandemic (thanks to Sue and Luc and the amazing team at VCR who produce this data). Our expectation is that there are 1000-1200 Victorian men who would ordinarily have been diagnosed during this period, who are still out there undiagnosed. For very many of these men, a delay won’t really matter, but for some it will. And there will certainly be considerable pressure in both the public and private sectors as we deal with an expected steady increase in activity throughout 2021. We are already experiencing this
Sue Leraci says “It needs to be planned and managed rationally, without the SHOUTING and !!!!!”. The irony of your comment is that nothing was planned and managed rationally. This handling of this pandemic should have been planned years ago. After all they’ve had over a hundred years since the last major one. Instead of which they hit the panic button. They should have isolated the immune-compromised, the major group being ones with significant insulin resistance (individuals who are obese – but wait that’s too politically incorrect, and that would have revealed their other abject failure. Not the elderly). And they should have built large field hospitals. Putting an infected patient onto a general ward is sheer lunacy. The Greeks realised this 3000 years ago and built Lazarettes for the lepers. Perhaps a history lesson is in order.
Sadly we are having to deal with a virus, which, like all virus, has a lifestyle and environmental component to it
It picks off the elderly overweight metabolic disease members of our community. They have a poor immune diet, unlike the typical Ozzie diet. Very vulnerable. Let’s face it keeping it out of nursing homes and the elderly population would result in poor outcomes in only a minimal number . Singapore has shown this with 30 deaths from 60000 cases because they kept it out of the elderly population . 6-10 times more real cases than worldometers shows have been established. No wonder the uk has 20 times lower death rate than 1 year ago as a significant proportion of those that might die have likely done so already . Let’s face it, if the nursing homes in Victoria had been protected as they knew they should , we would have had 100 deaths, not 3% but 0.3 and likely lower as there are plenty of asympt cases . So much for the “could we see 125000 deaths” headlines of 12 months ago. It was never going to happen. We are not the polluted junk eating smoking close living northern hemisphere . What went wrong with the response ? Sadly the 5500000deaths from malnutrition and 1500000 from TB each year in the world will have to also wait . I suspect they want a bit more food not a vaccine
Andrew Renault says “we bring the whole system to a grinding halt for a virus which is killing…….wait……no one.” The irony of that comment is that Australian deaths were limited precisely BECAUSE of the public health measures that were used. Nevertheless, Australia has had 909 deaths from 28,970 cases, which is a little over 3% case mortality – an order of magnitude higher than influenza mortality – and all descending on acute care services at the same time (unlike cancer mortality). Public health emergencies require pragmatic compromises to be made. In the world of cancer screening and treatment, perhaps this has meant that cases were prioritised and the most urgent cases received treatment. Perhaps it also means that over-diagnosis was reduced. Public health emergencies are guided by a different approach and different body of evidence to individual patient care. It needs to be planned and managed rationally, without the SHOUTING and !!!!!.
This is entirely to be expected. As a cancer surgeon I anticipated this right from day one. A thousand people die in Australia every week from cancer. Yet we bring the whole system to a grinding halt for a virus which is killing…….wait……no one. The logic from these politicians and their scientific advisors has been lamentable. I have already been censored by the Medical Board for speaking out against this policy. With the threat of withdrawing my licence to practice. WAKE UP EVERYONE!!!!