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Cancer Deaths Double Due To Covid-19

Cancer Deaths Double Due to Covid-19

October is breast cancer awareness month, and this extra awareness may well be more important this year than ever before. This is a time when people come together to share stories and information about the disease, and raise money to help fight it. But breast cancer is something that exists all year round, so our efforts really shouldn’t be limited to just one month.

How Common Is Breast Cancer?

Lung cancer is the only cancer that kills more women each year than breast cancer, making breast cancer the second leading cause of cancer death in women. In the UK, since the early 1970s, breast cancer mortality rates have decreased by 39%, which is almost two fifths. However, breast cancer age-standardised incidence rates for men and women combined have increased by 4% over the last decade (between 2004-2006 and 2014-2016).

For those assigned female at birth, breast cancer is the most common invasive cancer. It accounts for 15% (almost one in six) of all cancer cases in men and women combined, making it the most common cancer in the UK. According to Cancer Research UK, this is how breast cancer looks right now:

  • Between 2015 and 2017, there were around 11,400 breast cancer deaths in the UK per year – around 31 per day.
  • Between 2014 and 2016, there were around 55,200 new invasive breast cancer cases in the UK per year – around 150 per day.

A Rise in Mortality

In women, lung cancer and breast cancer are the two biggest causes of cancer death. Since 1989, improvements in treatment and screening have dramatically improved survival rates for those diagnosed with breast cancer. Only around 2.7%, or 1 in 37, of those diagnosed are expected to die from the disease.

But according to two new studies, the next few years could hold thousands of additional preventable deaths from various types of cancer, including breast cancer. This is because the COVID-19 pandemic and its associated regulations, lockdowns and general disarray have potentially delayed cancer diagnosis and care for thousands of patients this year.

Breast cancer is likely to develop in 1 in 8 women over the course of their lives, and 1 in 870 men. According to a study published in The Lancet Oncology in September, these cases (along with cases of lung, colorectal and esophageal cancer) could normally be prevented through routine diagnostic care like referrals and screenings. Instead, however, they may lead to over 3,000 (10%) more deaths in England over the next five years because of delays in care caused by the coronavirus pandemic.

October is breast cancer awareness month, and this extra awareness may well be more important this year than ever before. This is a time when people come together to share stories and information about the disease, and raise money to help fight it. But breast cancer is something that exists all year round, so our efforts really shouldn’t be limited to just one month.

How Common Is Breast Cancer?

Lung cancer is the only cancer that kills more women each year than breast cancer, making breast cancer the second leading cause of cancer death in women. In the UK, since the early 1970s, breast cancer mortality rates have decreased by 39%, which is almost two fifths. However, breast cancer age-standardised incidence rates for men and women combined have increased by 4% over the last decade (between 2004-2006 and 2014-2016).

For those assigned female at birth, breast cancer is the most common invasive cancer. It accounts for 15% (almost one in six) of all cancer cases in men and women combined, making it the most common cancer in the UK. According to Cancer Research UK, this is how breast cancer looks right now:

  • Between 2015 and 2017, there were around 11,400 breast cancer deaths in the UK per year – around 31 per day.
  • Between 2014 and 2016, there were around 55,200 new invasive breast cancer cases in the UK per year – around 150 per day.

A Rise in Mortality

In women, lung cancer and breast cancer are the two biggest causes of cancer death. Since 1989, improvements in treatment and screening have dramatically improved survival rates for those diagnosed with breast cancer. Only around 2.7%, or 1 in 37, of those diagnosed are expected to die from the disease.

But according to two new studies, the next few years could hold thousands of additional preventable deaths from various types of cancer, including breast cancer. This is because the COVID-19 pandemic and its associated regulations, lockdowns and general disarray have potentially delayed cancer diagnosis and care for thousands of patients this year.

Breast cancer is likely to develop in 1 in 8 women over the course of their lives, and 1 in 870 men. According to a study published in The Lancet Oncology in September, these cases (along with cases of lung, colorectal and esophageal cancer) could normally be prevented through routine diagnostic care like referrals and screenings. Instead, however, they may lead to over 3,000 (10%) more deaths in England over the next five years because of delays in care caused by the coronavirus pandemic.

Only urgent symptomatic cases have been prioritised for diagnostic intervention since the national lockdown was introduced in March, with cancer screening suspended and routine diagnostic work deferred. April 2020 saw the beginnings of this decline in care, with the number of endoscopies performed in this month 90% lower than the number performed in January, February or March.

A statement from lead study author Ajay Aggarwal, MSc, MRCP, FRCR, PhD, of the London School of Hygiene & Tropical Medicine explains that “Whilst currently attention is being focused on diagnostic pathways where cancer is suspected, the issue is that a significant number of cancers are diagnosed in patients awaiting investigation for symptoms not considered [to be] related to… cancer.”

Aggarwal’s study examined the four major tumour types and estimated the impact of delays in diagnosis on cancer survival outcomes for each.

Since lockdown began in March, the authors of the study say there has been an 80% drop in urgent referrals – a major problem where 30-40% of cancers in the UK are diagnosed through these outpatient referrals and routine screenings. An urgent 2-week referral from a GP or a visit to the emergency department is currently the only way for a patient to have their cancer diagnosis confirmed.

As a result of these added hurdles, the study estimates that cancer deaths up to five years after diagnosis will grow to various degrees, with lung cancer experiencing the smallest increase in mortality (4.8%) and colorectal cancer experiencing the largest increase (16.6%). The findings of this study complement an earlier paper published in Annals of Oncology which shows the impact on excess mortality of delays to surgical treatment.

Reflecting “a substantial proportion of deaths in younger/middle-aged people”, the authors of the new study predict that up to 20 years of life could be lost with each death, with a total life-year loss of between 59,204 and 63,229.

Covid-19-related delays in diagnostic care appear to pose the greatest risk to colorectal cancer patients, with 2025 seeing a potential increase in mortality of between 15% and 17%. Assuming the disease will be diagnosed at a more advanced stage than is recommended, breast cancer could see the second highest mortality spike (8-10%) followed by esophageal cancer (6%) and lung cancer (5%).

King’s College London’s Professor Richard Sullivan (cancer policy and global health), who co-authored this study, notes that “these estimates paint a sobering picture and reflect the many young people who are affected by cancer in the prime of life during their most productive years.”

The authors of the study have recommended three solutions which could potentially overcome the setbacks seen in 2020 so far:

  1. Provide health care workers with evidence-based information they can use to manage suspected cases of cancer.
  2. Refer a greater number of patients to NHS hospitals and extend office hours to increase routine and urgent diagnostic care and services.
  3. Target secondary care providers, patients and GPs in public health campaigns that focus on the importance of seeking care if an individual suspects they could have cancer.

Diagnostic services have been back in operation since June 2020, but the capacity of these services has been reduced. This is because many staff have been re-deployed towards critical care to help manage patients with Covid-19, and because of a perceived risk of exposure to SARS-CoV-2 for patients and clinicians.

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