Fears breast cancer progress could stall due to COVID-19 backlog

Around 10,600 fewer breast cancer patients have started treatment in the last year in England.

Breast cancer deaths reached an all-time low before the pandemic, but experts fear these new stats show that this hard-won progress could slow.

The charity estimates around 38,000 fewer people started treatment for all cancer types in England. And breast cancer represents more than a quarter of these ‘missing cancers’ during the pandemic – almost double what might be expected.

These are most likely people who have cancer but haven’t been diagnosed yet.

Considering the huge disruption to cancer services, sadly, these figures are not surprising.

– Professor Charles Swanton, Cancer Research UK’s chief clinician

Impact on screening

The majority of these ‘missing’ breast cancers are early stage disease, based on provisional data from Public Health England’s Rapid Cancer Registration data. Of the breast cancers with a known stage that are missing, almost 95% (93%) were early stage (stage 1 and 2), which are usually more treatable.

These are likely to be cancers that haven’t been picked up in breast screening, which was effectively paused for several months and only started sending out routine invitations again after the first wave.

“We’re seeing the impact of effectively pausing breast screening which detects almost a third of breast cancer cases,” said Swanton.

“But it’s important to remember that cancer screening is for people without symptoms, so it’s vital that if people notice anything usual for them, please don’t wait for screening – get in touch with your GP. In most cases it won’t be cancer, but if it is, catching it early gives the best chance of survival.”

Many people also stayed at home, putting off seeking help for symptoms during the peaks of the pandemic, for fear of catching COVID-19 or not wanting to overwhelm the NHS.

Risking vital progress

The charity fears that progress in reducing breast cancer deaths, which had made huge strides in the last decade, could slow.

Since records began in the 70s, death rates for breast cancer have fallen by almost 40%. This progress is thanks to huge developments in understanding breast cancer and its treatment.

From Cancer Research UK scientists laying the groundwork for the drug Herceptin, to the discovery of the BRCA1 and BRCA2 genes, to the development of a new family of targeted drugs known as PARP inhibitors through Cancer Research UK funded studies, research has played a large role.

But this progress is in jeopardy. It’s important that women come forward with symptoms, and consider screening when invited, but the NHS also needs the capacity to treat these women when they do finally enter the system.

Michelle Mitchell, Cancer Research UK’s chief executive, said: “Science is the route to beating cancer and from cell biology in the lab, to patient trials in hospitals, Cancer Research UK has helped to reduce breast cancer deaths. But these figures are worrying, and we could see progress slow over the coming years as the true effect of the pandemic is revealed.

“The NHS is showing signs of recovery, but a huge effort is still needed to clear the cancer backlog as quickly as possible to help avoid preventable cancer deaths as a consequence of the pandemic.”

Mitchell added that Government must make sure there is enough funding for staff, diagnostic equipment and the research needed to improve cancer care across the UK in the long term, so “cancer patients are given the best chance of surviving their disease”.

“It was such an emotionally charged time”

Charly, pictured with one of her daughters, was diagnosed with breast cancer during the COVID-19 outbreak.

Army veteran, Charly McNelis, 37, was diagnosed with breast cancer in March 2020, at the beginning of the pandemic. The mother-of-two scheduled an appointment with her GP after finding a lump, and was referred to the breast clinic. “I was in a state of panic, I was reading about everything.”

Her biopsy was in early March. “COVID-19 wasn’t really a concern at that point,” she says, but things changed rapidly over the next few weeks.

“I went back for the results on the 10th March and it was confirmed as having cancer. They said I would have chemo first, then radiotherapy and surgery.” Charly asked if the treatment plan might be affected by COVID-19, but the doctors didn’t know enough at that point.

But the situation evolved with the outbreak, with Charly’s appointment being followed by a flurry of calls. “By now the pandemic levels were rising and they explained it didn’t feel safe to go down the chemotherapy route so I would have surgery first, and it should still be a lumpectomy. But by the time I went to meet the surgeon the week after, this changed to a full mastectomy.”

Because of COVID-19, Charly’s doctors changed the chemotherapy drugs to minimise infection risk. She started chemotherapy after surgery, at the beginning of May, which lasted 18 weeks in total.

“It’s such an emotionally charged time and it’s draining – COVID-19 has been a significant factor.”
But while her treatment has been complicated and challenging so far, Charly is positive. “I am lucky in many ways – my cancer is treatable. COVID-19 has impacted my treatment options but has not stopped it, and for that I am grateful. I got my diagnosis, and I got to have treatment, when there’s people out there who haven’t started treatment and are undiagnosed.”