The number of people being diagnosed with cancer early in England has plummeted during the Covid pandemic, sparking fears that many will only be treated when it is too late to save them. Official figures show a third fewer cancers were detected at stage one, when the chances of survival are highest, in the early months of the pandemic than during the same months a year before. Cancer experts fear that the figures, which have been collected by Public Health England’s National Cancer Registration and Analysis Service, mean thousands of people have the disease but have not yet started treatment because of “a shift to later diagnosis”. They urged anyone with possible symptoms of the disease to get them checked out immediately. “While it’s fantastic that Covid rates are dropping and lockdown is easing, the knock-on impact of the pandemic on cancer care cannot be overstated,” said Steven McIntosh, the executive director of advocacy and communications at Macmillan Cancer Support. “We are likely to be dealing with Covid’s long shadow for many years to come.” While 18,400 people in England had their cancer diagnosed at stage one between March and June 2019, this dropped by 33% to 12,400 in the same period last year – a fall of 1,500 people a month. Those months in 2020 were when the first wave of the pandemic led to disruption of normal NHS services and left many patients who needed care for a range of non-Covid conditions too scared to visit the GP or hospital in case they became infected. Macmillan Cancer Support, which obtained the data, said the sharp fall could mean some cancers have now progressed to a point where they can no longer be treated because of the delays in diagnosis. McIntosh said: “There are major concerns that there may be a shift to later diagnosis as a result of later presentations and longer waits. When cancer is diagnosed at a later or more advanced stage, it can be more difficult to treat or may be incurable, which can have a huge impact on a person’s treatment and prognosis. “This data supports the widespread concern that the disruption caused by Covid-19 will lead to many people being diagnosed with more advanced cancer due to reduced numbers going to their GP with symptoms, delayed tests and longer waiting times.” Citing lengthening waits for diagnostic tests and cancer care, McIntosh added: “From the calls we’re getting to Macmillan’s advice line we’re hearing that it is the most worrying time in recent history to get a cancer diagnosis. Many [patients] are living with the knowledge that delays could affect the success of their treatment, and possibly their chances of survival.” It appears that disproportionate numbers of people with early signs of cancer did not seek or could not obtain NHS care as the pandemic wreaked havoc. In contrast, the number of people diagnosed with advanced or stage four cancer – by which time their cancer has spread and they cannot be cured – fell much less dramatically than those detected at stage one. The number of stage four diagnoses fell over the same period by 15% from 10,900 in 2019 to 9,200 in 2020. A new Macmillan analysis of NHS performance data on cancer care in the wake of Covid has revealed falls in the number of people in England who are able to access cancer care within timescales supposedly guaranteed under the NHS constitution. Eleven per cent fewer people had cancer surgery in February 2021 compared with February 2020, and just 69.7% of patients started their cancer treatment within the maximum 62 days in February – the lowest percentage ever – even though the NHS target is 85%, the analysis found. About 370,000 fewer people with suspected cancer saw a specialist between March 2020 and February 2021 and the same period a year earlier – a 15% drop. It would take the NHS 18 months working at 110% capacity to catch up on missing cancer diagnoses and 15 months to clear the cancer treatment backlog, Macmillan estimates. Sir David Nicholson, the boss of the NHS in England until 2014, recently warned that the size of the backlog of care caused by the pandemic was “truly frightening” and that long delays for surgery and other treatment are set to become a problem for the government. “The whole issue of access [to care] is a greater threat to the NHS than privatisation because poor access undermines confidence among those people who fund the service – taxpayers,” he said. NHS Providers, which represents health service trusts in England, believes it could take between three and five years for some hospitals to treat everyone in their own backlog. Recent research by pollsters Ipsos Mori found that “improving waiting times for routine operations” is the change in the NHS that the public most want to see, with 50% identifying that as their top priority. Health Foundation analysis found that 4.6 million fewer people received planned treatment in hospital during 2020 than in 2019 and that GPs referred 6 million fewer patients to hospital during that period. Clare Turnbull, a professor of translational cancer genetics at the Institute of Cancer Research, said: “Covid is important but cancer is a significant health problem. You don’t want to miss the window of your cancer being picked up and treated while it can be cured and you have a normal life expectancy. “The danger is that if you pass through that window then your cancer turns out to have progressed and no longer be treatable. So people with possible signs of cancer should contact their GP … and everyone, whether symptomatic or asymptomatic, should attend cancer screening appointments when they are invited.” A spokesperson for the NHS said: “Fewer people came forward for checks earlier in the pandemic but our message has been the same throughout – come and get checked if you have a worrying symptom. “Thanks to the hard work of NHS staff, the majority of cancer treatment has continued over the last year and the most recent data shows that, in February, 174,000 were referred for urgent checks with over 90% seen within two weeks, and 22,000 people began treatment, 95% within a month.”