But the pandemic has reversed those gains. A Lancet Oncology Committee report, looking at 44 European countries, notes that the pandemic has resulted in delayed cancer diagnosis, delayed intervention, discontinuation of treatment and many deaths due to Covid-19 among cancer patients. This is largely a result of overcrowding or diversion of health services and too many Covid infections and hospital admissions, leading to long national lockdowns in some countries. The report estimates that up to one million cancer diagnoses may have been missed in Europe during this period. The pandemic has shown us that healthcare resources are finite, so when the demand associated with a disease increases, it affects all patients. In Britain, due to the large first and second waves, the NHS effectively became the Covid Health Service for much of 2020. And this is likely to have had a negative impact on cancer outcome: another Lancet study estimated in 2020 that it delayed diagnosis and treatment in England could increase the rate of breast, colon and lung cancers by up to 9.6%, 16.6% and 5.3% respectively in the coming years. This is largely due to the disruption of screening services and people – even with worrying symptoms – not attending primary care. Of course, countries that were able to contain Covid-19 quickly and limit their number of patients in 2020 managed to keep their health services relatively well-functioning. There’s a term for this, taken from the 2014 Ebola outbreak in west Africa, when women died in childbirth because health care facilities were closed and childhood vaccination programs were disrupted: the “countless dead.” This is how Unicef referred to the people who died from the indirect effects of Ebola, but had to be considered as victims of the epidemic. We are now facing one of the many hidden and immeasurable costs of Covid-19. Intensive care staff in the ICU at Queen Alexandra Hospital in Portsmouth, March 23, 2021. Picture: Adrian Dennis/AFP/Getty Images As we recover from the pandemic, public health experts are calling for concrete actions to reduce individual cancer risk and increase survival for those diagnosed. This requires health systems to initiate awareness and preventive measures. We can’t just pretend the last few years didn’t happen and let the huge number of new patients slip into the existing system. We need to put cancer back on the agenda, including prioritizing cancer patients in our health services. The occurrence of cancer is the result of a complex interaction between genetics, environmental factors, infections and age. The WHO estimates that a third of cancer deaths in the world are due to tobacco smoking, overweight/obesity, a diet low in fruit and vegetables, physical inactivity and excessive alcohol consumption. And the incidence of cancer increases dramatically with age, due to the accumulation of risks over a lifetime. the body’s ability to repair itself decreases as we age. And then there’s just bad luck (combined with genetics and unexplained factors): my father didn’t smoke, didn’t drink, exercised regularly, and ate a varied vegetarian diet. He wasn’t overweight or unhealthy. He was actually an oncologist and ended up being cared for by his colleagues and dying in the ward he once supervised. So it’s worth recognizing that sometimes, there’s only so much we can do to avoid illness. There is no role of shame, guilt or responsibility in illness. So what better way to reduce your chances of getting and dying from cancer? At the individual level, public policy must continue to focus on making healthier choices more accessible and affordable: for example, making it easier for people to walk or exercise with safe bike paths and ensuring that fruit and vegetables are subsidized and available. Vaccination against HPV and hepatitis B is also important if you are in a high-risk group. And we need more awareness about the importance of screening. If you or someone you love is concerned about changes in your health – such as weight loss, extreme fatigue, blood in your urine or stools, persistent cough or lumps – get checked without delay. Early diagnosis is important because it improves survival outcomes. In England, more than 90% of people survive bowel, breast and ovarian cancer for at least five years if diagnosed at an early stage. This allows treatment to begin earlier, before the cancer has spread throughout the body. However, even with a cancer diagnosis, the NHS struggles to provide treatment within the current 62-day target: 36% of patients waited more than 62 days in England, 21% in Scotland and 43% in Wales. The main obstacle is staff shortages, which the Covid-19 pandemic has made more acute. Again, this shows the need for investment in the NHS – not just in infrastructure, but also in the workforce. The challenge is acute for the UK and devolved governments now: we must make cancer a priority and make up for the years lost during the pandemic.
