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COVID must not derail cancer diagnoses

Rapid diag­nos­tic cen­tres were hailed as the great hope pre-coro­n­avirus, but health­care pro­fes­sion­als are in two minds over whether they are still fit for pur­pose


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Rapid diagnosis centres
A woman attends a mobile breast can­cer screen­ing unit. Accord­ing to recent esti­mates, almost one mil­lion women have missed vital breast screen­ing appoint­ments due to COVID-19.

If you take notice of the news head­lines, you would think coro­n­avirus is the only major threat to mor­tal­i­ty and mor­bid­i­ty. Yet post­pon­ing the ear­ly screen­ing of can­cer also kills. Up to 3,600 lives in the UK could be lost to four main can­cers over the next five years due to delays in diag­no­sis caused by the pan­dem­ic, accord­ing to research pub­lished in The Lancet Oncol­o­gy, while almost one mil­lion women have missed vital breast screen­ing.

Since the start of the pan­dem­ic, a per­fect storm has occurred for can­cer diag­no­sis in the UK. Peo­ple have been fright­ened to attend ear­ly scans. There’s also been inter­rup­tions in can­cer screen­ing ser­vices for breast, bow­el and cer­vi­cal can­cer, as well as reduced capac­i­ty at doctor’s surg­eries and a shift in health­care resources to deal with COVID-19.

“The mes­sag­ing to the pub­lic has been beyond extreme and stopped peo­ple pre­sent­ing them­selves. Yet a few weeks’ delay has a huge impact on patient out­comes. We’ve seen sig­nif­i­cant stage shifts across all types of can­cers. Peo­ple who had symp­toms in Feb­ru­ary are only now going for tests. Our data from The Lancet Oncol­o­gy paper is now like­ly to be an under­es­ti­mate,” says Pro­fes­sor Richard Sul­li­van from the Insti­tute of Can­cer Pol­i­cy at King’s Col­lege Lon­don.

Missed diagnostic opportunities have dire consequences

“The impact on screen­ing, espe­cial­ly col­orec­tal, has been high­ly sig­nif­i­cant. As fric­tion ris­es in the path­ways to ear­ly diag­no­sis, more peo­ple are missed. None of this is rock­et sci­ence and the UK gov­ern­ment and SAGE, the Sci­en­tif­ic Advi­so­ry Group for Emer­gen­cies, have either wil­ful­ly ignored this or, unbe­liev­ably, not tak­en this into con­sid­er­a­tion.”

There are now calls for renewed pub­lic health cam­paigns to encour­age more sus­pect­ed can­cer patients to come for­ward for screen­ing, with a focus on pre­sent­ing the NHS as a safe envi­ron­ment for test­ing, since delays in can­cer surgery can make cas­es non-oper­a­ble.

“If we don’t resolve this we’ll see more patients diag­nosed with advanced dis­ease and few­er diag­nosed with ear­ly stages of can­cer. This will impact sur­vival rates. There will be real con­se­quences for some patients in terms of their chances of sur­viv­ing can­cer,” warns Dr Jodie Mof­fat, head of ear­ly diag­no­sis, Can­cer Research UK.

Rapid Diagnostic Centres to the rescue?

Invest­ment in rapid diag­nos­tic cen­tres could help with the back­log. They were designed by the NHS to speed up can­cer diag­noses. Pre-pan­dem­ic, NHS Eng­land com­mit­ted to rolling out these cen­tres, with the aim of cov­er­ing the country’s entire pop­u­la­tion, but this is not expect­ed for sev­er­al years.

“It is not yet clear what impact COVID-19 will have on this roll­out. Dur­ing the peak of the pan­dem­ic, some RDCs remained oper­a­tional, but oth­ers paused, when staff moved to oth­er areas. Con­cerns remain that progress and expan­sion of cen­tres will be lim­it­ed due to the avail­abil­i­ty of work­ers,” says Mof­fat.

undiagnosed cancer

The NHS sees rapid diag­nos­tic cen­tres as piv­otal to restor­ing can­cer screen­ing ser­vices, but some are scep­ti­cal of their poten­tial. “These cen­tres are a red her­ring. The implic­it assump­tion is that these would improve ear­ly diag­no­sis and shift stag­ing. Yet the vast major­i­ty of diag­noses are made through stan­dard routes from pri­ma­ry care to local hos­pi­tal net­works,” says Sul­li­van.

What the near future holds for cancer diagnosis

Despite the gloom dur­ing the pan­dem­ic, there have been some unfore­seen bright spots aside from high­light­ing the need to push for more screen­ing. “Inter­est­ing­ly, with the increased num­ber of hos­pi­talised patients because of COVID-19, the num­ber of chest CT or com­put­ed tomog­ra­phy scans has been grow­ing and, with this rise, the num­ber of inci­den­tal can­cer diag­noses is also on the up,” says Ade Adeye­mi, who heads the glob­al health fel­low­ship at think­tank Chatham House.

Costs have been over­looked in the COVID-can­cer par­a­digm. The fact is can­cers in the lat­ter stages of devel­op­ment are much more cost­ly to treat. “The ear­li­er a can­cer is diag­nosed, the more treat­ment options are avail­able includ­ing less inva­sive inter­ven­tions, which are less expen­sive to the NHS. Lat­er diag­noses also trig­ger longer peri­ods of hos­pi­tal­i­sa­tion affect­ing the allo­ca­tion of in-patient resources,” says Dr Sab­ri­na Ger­main, senior lec­tur­er in med­ical law at City, Uni­ver­si­ty of Lon­don.

The plum­met in fund­ing for med­ical char­i­ties also impacts ear­ly diag­no­sis. There’s been a short­fall of up to £167 mil­lion in can­cer research spend­ing from this sec­tor. “Char­i­ta­ble fun­ders sup­port the major­i­ty of non-com­mer­cial ear­ly-detec­tion research in the UK and there’s a dan­ger that it could be even more great­ly affect­ed,” says Dr Ian Lewis, head of strat­e­gy at the Nation­al Can­cer Research Insti­tute.

Sara Bain­bridge, head of pol­i­cy at Macmil­lan Can­cer Sup­port, sums it all up: “Can­cer must not become the ‘for­got­ten C’ dur­ing this pan­dem­ic.”


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