The projected impact of the COVID-19 lockdown on breast cancer deaths in England due to the cessation of population screening: a national estimation

Stephen W. Duffy,Mike Press,Daniel Vulkan,Anne Mackie,Farah Seedat,Nisha Sharma,Jackie Walton,Olive Kearins,Jonathan Myles

doi:10.1038/s41416-022-01714-9

Abstract

BackgroundPopulation breast screening services in England were suspended in March 2020 due to the COVID-19 pandemic. Here, we estimate the number of breast cancers whose detection may be delayed because of the suspension, and the potential impact on cancer deaths over 10 years.MethodsWe estimated the number and length of screening delays from observed NHS Breast Screening System data. We then estimated additional breast cancer deaths from three routes: asymptomatic tumours progressing to symptomatically diagnosed disease, invasive tumours which remain screen-detected but at a later date, and ductal carcinoma in situ (DCIS) progressing to invasive disease by detection. We took progression rates, prognostic characteristics, and survival rates from published sources.ResultsWe estimated that 1,489,237 women had screening delayed by around 2–7 months between July 2020 and June 2021, leaving 745,277 outstanding screens. Depending on how quickly this backlog is cleared, around 2500–4100 cancers would shift from screen-detected to symptomatic cancers, resulting in 148–452 additional breast cancer deaths. There would be an additional 164–222 screen-detected tumour deaths, and 71–97 deaths from DCIS that progresses to invasive cancer.ConclusionsAn estimated 148–687 additional breast cancer deaths may occur as a result of the pandemic-related disruptions. The impact depends on how quickly screening services catch up with delays.

Highlights

Population breast screening services in England were suspended in March 2020 due to the COVID-19 pandemic
We estimated the number of invasive cancers which would have been screen-detected in a Further analyses: effect of later diagnosis but still by screening, and progression of ductal carcinoma in situ (DCIS) We carried out two further analyses
The second analysis was to estimate the effect on outcome of delayed diagnosis in cancers that would have been diagnosed as DCIS at the time of the scheduled screen

Summary

Introduction

Population breast screening services in England were suspended in March 2020 due to the COVID-19 pandemic. We estimate the number of breast cancers whose detection may be delayed because of the suspension, and the potential impact on cancer deaths over 10 years. Depending on how quickly this backlog is cleared, around 2500–4100 cancers would shift from screen-detected to symptomatic cancers, resulting in 148–452 additional breast cancer deaths. There would be an additional 164–222 screen-detected tumour deaths, and 71–97 deaths from DCIS that progresses to invasive cancer. CONCLUSIONS: An estimated 148–687 additional breast cancer deaths may occur as a result of the pandemic-related disruptions. The programme screens more than two million women annually and is estimated to prevent 1300 UK deaths annually [3, 5]

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