Bowel cancer – another victim of the COVID-19 pandemic?

By Dr Stuart Griffiths, Director of Research & Services, Yorkshire Cancer Research

On 26 January 2021, the UK passed the terrible milestone of over 100,000 deaths from COVID-19. But as the pandemic has put stress on health services, the victims of the pandemic extend beyond COVID-19 itself.  

Researchers supported by Yorkshire Cancer Research have looked at the impact of COVID-19 on bowel cancer diagnosis and treatment in Yorkshire. Their work formed part of an England-wide study which received media coverage in January. 

Their analysis found that between April and October 2020, 550 fewer people than expected were diagnosed with bowel cancer in Yorkshire. 

To be clear, this doesn’t mean that 550 people have avoided bowel cancer. Most likely, many of these 550 will be diagnosed later than they would have been, were it not for the pandemic. And the later that someone is diagnosed with bowel cancer, sadly the less likely they are to survive it.  

What might have caused this fall in bowel cancer diagnoses? It’s probably because during the pandemic fewer people were coming forward to see their GP with bowel cancer symptoms. This meant the number of people in Yorkshire being referred by GPs to hospitals for further tests– fell by 62% in April 2020, compared to an average month in 2019. The number of diagnostic tests carried out in hospitals was also reduced: in April 2020 just 316 colonoscopies were performed, down by 94% compared to a monthly average of 5,199 in 2019.  

Fewer people being diagnosed with bowel cancer also meant fewer people starting treatment. The number of bowel cancer patients referred to start treatment had fallen by 42% by May. And the number of bowel cancer operations performed in May was down by 40%, compared to the monthly average in 2019.

Despite the huge pressure the NHS has been under, the most recent data from November 2020 shows that cancer services were almost back to normal. However, the fact these services have been able to continue at all is thanks to the incredible dedication of NHS staff. They have worked tirelessly to ensure cancer services were restarted as soon as possible, and are doing everything that they can to continue providing urgent cancer care during this extremely challenging time. 

And like many areas of our life, though the COVID-19 pandemic has had a negative impact overall, it has also led to some innovations. One of these is the use of the faecal immunochemical test (FIT) which measures the presence of blood in poo, a common symptom of bowel cancer. GPs in Yorkshire are now using the results of the FIT as well as a person’s other symptoms when deciding how urgently to refer them for further tests. Results from FIT tests also mean that when a patient goes to hospital for further tests, consultants can decide who to see first. During the pandemic this has meant that more urgent cases are seen first to make best use of scarce hospital resources. 

But getting things back to how they were before isn’t enough. Cancer services were facing huge challenges long before the pandemic, including shortages of trained staff and equipment that undermined diagnostic services. Together with dozens of cancer charities, we’ve been calling on the Government to go further and faster with investment into cancer services, to meet the rising demand as cancer incidence increases. 

I have one simple message to everyone in Yorkshire: if you have any symptoms of bowel cancer (or any cancer, for that matter) get in touch with your GP, without delay. It’s probably not cancer, but if it is, it’s better to find it early when it’s more likely to be treated more successfully.

Bowel cancer symptoms

Symptoms of bowel cancer include:

• a change in your normal bowel habits which last for three weeks or more (pooing more often, with looser, runnier poos)
• blood in your poo or bleeding from your bottom
• a pain or lump in your stomach
• unexplained weight loss
• extreme tiredness

GPs want to see you and are ready to refer you for more tests if needed. Urgent referrals for suspected bowel cancer are back to their normal pre-pandemic levels, so if you need extra tests, you will get them. You may have to wait a little longer than usual, but your GP will be able to give you more information. And remember – if the symptoms do turn out to be caused by bowel cancer, catching it early means it is often easier to treat, and the chances of survival are greater. 

I would also urge GPs to lend their secondary care colleagues a hand and order a FIT test alongside all urgent referrals for suspected bowel cancer to allow them to determine who they need to see first. 

Bowel cancer may have been one of the many ‘hidden victims’ of the COVID-19 pandemic in 2020. Let’s make sure that this doesn’t happen again in 2021.