New study finds thousands may have undiagnosed and untreated bowel cancer due to COVID-19 disruption

The number of people diagnosed with bowel cancer in England has fallen sharply since the first coronavirus lockdown, a new study published today has found. Between April and October 2020, over 3,500 fewer patients than expected were diagnosed with bowel cancer in England, the University of Oxford-led study discovered.

Bowel cancer is the UK's fourth most common cancer and the second biggest cancer killer. However, it is treatable and curable especially if diagnosed early. Nearly everyone diagnosed at the earliest stage will survive bowel cancer, but this drops significantly as the disease develops.

The study's results suggest that many patients, whose diagnosis has yet to be made, may sadly die unnecessarily. The results are published today in The Lancet Gastroenterology and Hepatology.

Researchers from across the UK looked at the number of referrals for bowel cancer investigation, diagnosis and treatment within the English NHS from 1 January 2019 to 31 October 2020.

The results showed that, compared with an average month in 2019, during April 2020 at the peak of the first wave of coronavirus:

• the number of referrals by GPs to hospital clinics for investigation of possible bowel cancer reduced by 63% (from 36,253 to 13,440),
• the number of colonoscopies performed fell by 92% (from 46,441 to 3,484), and
• the number of people with confirmed bowel cancer referred for treatment fell by 22% (from 2,752 to 2,158), and the number of operations performed fell by 31% from (2,003 to 1,391)

This is the first study to assess the impact of the COVID-19 pandemic on the diagnosis and management of bowel cancer across England.

Lead author of the study Professor Eva Morris (Nuffield Department of Population Health, University of Oxford), who is also a member of our Medical Advisory Board, said: "These results reflect a serious disruption in the normal identification and treatment of patients with bowel cancer.

"Early diagnosis is key to obtaining the best survival for bowel cancer so these delays in diagnosis are likely to have severe consequences on survival rates from the disease."

Genevieve Edwards, Chief Executive at Bowel Cancer UK, said: "This research shows the clear impact of the pandemic on bowel cancer patients, and ultimately, their long-term chances of survival. It also highlights the unintended consequences of the 'stay at home' message and the impact of the temporary disruption to bowel cancer screening and diagnostic services. Sadly, for many, that will have meant a later diagnosis and poorer outcomes as a result.

"NHS staff have worked incredibly hard to keep vital cancer services going, and the NHS continues to be open for anyone worried about symptoms. But it needs additional resources to withstand the pressures caused by the new variant coronavirus sweeping the country, or cancer services – and the patients that rely on them – will suffer in the months ahead."

The study also shows that the first lockdown had a short-term impact on the numbers of people being treated but, reassuringly, the NHS managed to rapidly adapt services to deliver care safely. Unfortunately, however, treatment rates had only just returned to normal by October and, with pressure the NHS is currently under as a result of the second surge of COVID-19 cases, it seems likely that diagnostic and treatment rates will have fallen again. The researchers note that it will be important to continue monitoring these figures to make sure care is maintained for all diseases.

• Read our research blog about new research into impact of coronavirus on bowel cancer treatment and care in England
• Find information and support about coronavirus and bowel cancer
• Read more about how we plan to tackle the endoscopy crisis in our End the Capacity Crisis campaign
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