Inequalities in the decline and recovery of pathological cancer diagnoses during the first six months of the COVID-19 pandemic: a population-based study

  1. Ashleigh C. Hamilton
  2. David W. Donnelly
  3. Maurice B. Loughrey
  4. Richard C. Turkington
  5. Colin Fox
  6. Deirdre Fitzpatrick
  7. Ciaran E. O’Neill
  8. Anna T. Gavin
  9. Helen G. Coleman

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Abstract

Background

The restructuring of healthcare systems to cope with the demands of the COVID-19 pandemic has led to a reduction in clinical services such as cancer screening and diagnostics.

Methods

Data from the four Northern Ireland pathology laboratories were used to assess trends in pathological cancer diagnoses from 1st March to 12th September 2020 overall and by cancer site, sex and age. These trends were compared to the same timeframe from 2017 to 2019.

Results

Between 1st March and 12th September 2020, there was a 23% reduction in cancer diagnoses compared to the same time period in the preceding 3 years. Although some recovery occurred in August and September 2020, this revealed inequalities across certain patient groups. Pathological diagnoses of lung, prostate and gynaecological malignancies remained well below pre-pandemic levels. Males and younger/middle-aged adults, particularly the 50–59-year-old patient group, also lagged behind other population demographic groups in terms of returning to expected numbers of pathological cancer diagnoses.

Conclusions

There is a critical need to protect cancer diagnostic services in the ongoing pandemic to facilitate timely investigation of potential cancer cases. Targeted public health campaigns may be needed to reduce emerging inequalities in cancer diagnoses as the COVID-19 pandemic continues.

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  1. Version published to 10.1038/s41416-021-01472-0
  2. ScreenIT

    SciScore for 10.1101/2021.02.23.21252276: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: (12) Ethical approval for the NICR databases (including the waiving of requirement for individual patient consent) and for data analysis has been granted by the Office for Research Ethics Committees of Northern Ireland (ORECNI reference 15/NI/0203), recently renewed in October 2020 (ORECNI reference 20-NI-0132).
    IRB: (12) Ethical approval for the NICR databases (including the waiving of requirement for individual patient consent) and for data analysis has been granted by the Office for Research Ethics Committees of Northern Ireland (ORECNI reference 15/NI/0203), recently renewed in October 2020 (ORECNI reference 20-NI-0132).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations include basing our data on pathology diagnoses rather than following usual cancer registration methods, and thus have not been as rigorously validated. Further pathology samples taken during January to September 2020 may not yet have been recorded if a result was not available by the end of September 2020. Therefore, the presented figures may represent an underestimation, particularly for later weeks. However, the data for 2017-2019 was also based on pathological samples indicating cancer, in order to provide consistency and to attempt to control for solely clinical diagnoses. The interpretation of the trends observed in the most recent 5 week time period studied, the 9th August to the 12th September, should be interpreted with caution given the instability of health services and rapid changes in restrictions seen during the pandemic so far, as numbers may change on a monthly basis. Prior to the submission of this article, we obtained a brief update for the 5 week period from 6th September to 10th October 2020, which showed that while lung and prostate cancer diagnoses remained 30% and 19% below the level of previous years, diagnoses of gynaecological cancers appeared to have recovered to near expected levels. In addition, some cancer sites such as melanoma, head & neck and upper GI cancers have seen the numbers of diagnoses reduce by 37%, 27% and 23% respectively, despite showing recovery in the previous 5 week period studied. This illustrates the unpredictable n...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2021.02.23.21252276 on medRxiv