21 July 2020

Delays to cancer referral through reduced use of the urgent GP referral pathway during the coronavirus pandemic could result in more than a thousand additional deaths in England, new modelling suggests.

The study, published in The Lancet Oncology and supported by Breast Cancer Now, suggests that delays in patients presenting and being referred with suspected cancer by their GP, and resulting bottlenecks in diagnostic services, are likely to have a significant effect on cancer survival.

Scientists at The Institute of Cancer Research, London, used 10-year cancer survival estimates to create models estimating the impact of 25, 50 or 75 per cent reductions in people coming forward with symptoms and receiving urgent GP referrals during lockdown. Their modelling indicated if all these patients then presented and were referred promptly post-lockdown that the delay would see an estimated 181, 361 or 542 excess deaths respectively in England.

The researchers also looked at potential delays in diagnosis due to diagnostic capacity to cope with the backlog. They estimated that, should all patients present in the month post-lockdown but the necessary additional diagnostic capacity be delayed and only provided between 3-8 months after lockdown, this could result in up to 1,231 additional deaths.

In breast cancer, the scientists modelled potential delays in diagnosis in England (due to a drop in urgent referrals and any subsequent backlog in testing) ― finding that if everyone diagnosed with breast cancer experienced a 1-month delay due to the pandemic, this would result in up to 228 additional breast cancer deaths – with a potential 6-month delay for everyone leading to up to 1,629 extra deaths from breast cancer.

In addition, a potential 6-month delay for everyone diagnosed with breast cancer was projected to lead to an additional 34,418 years of life lost to breast cancer in England ― the highest of any cancer type.

Baroness Delyth Morgan, Chief Executive at Breast Cancer Now, which helped fund the study, said:

“It’s extremely worrying to see the devastating impact that the recent drop in referrals to see a specialist could have on cancer survival in the UK.

“Early diagnosis remains absolutely critical. While referrals to see a cancer specialist are starting to recover, we are still some way from this returning to normal – and we urgently need the Government to ensure there will be enough capacity in the NHS workforce to meet the impending influx in demand for testing.

“We are really concerned to now be seeing the first signs of the potential long-term effects of the outbreak on the diagnosis and treatment of breast cancer on the NHS. It’s absolutely heartbreaking to see projections that delays in breast cancer diagnosis due to the pandemic could see tens of thousands of years lost from people’s lives in England, and we need to act now.

“We urge the Government and NHS England to set out clear plans to ensure cancer services can fully recover to pre-pandemic levels as soon as possible, and to ensure anyone with potential symptoms feels safe to come forward and speak to their doctor. These concerning findings also reiterate the critical need to ensure that anyone whose appointment to see a specialist has been delayed during the pandemic is monitored and followed up.

“Crucially, it’s so important all women know that they can and should get in touch with their GP surgery urgently if they notice any unusual changes in their breasts. While most changes won’t be cancer, the sooner breast cancer is diagnosed, the more likely treatment is to be successful. If you’re worried about a possible symptom of breast cancer, please don’t wait to report it. Anyone concerned call our free Helpline on 0808 800 6000 – if you need someone to talk to, our expert nurses are just at the end of the phone.”