HUNDREDS of patients are risking late cancer diagnoses because they are not going to their GPs with symptoms amid the coronavirus crisis.
Campaigners warned that the delays were storing up a “longer term cancer crisis” that could break the NHS, and stressed that the pandemic has left cancer diagnosis and treatment “in a precarious position”.
Scotland’s interim chief medical officer, Dr Gregor Smith, said doctors had issued 744 urgent referrals with a suspicion of cancer last week, and 948 the week before.
He stressed that the weekly average, based on the previous three years, was 2,700.
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It is thought that people do not want to trouble doctors while the Covid crisis is ongoing, that they worry about catching the virus in hospital, or that some older patients are put off by the idea of video or telephone consultations with GPs.
Dr Smith, whose own background is in general practice, said: “There is strong evidence that a reduction in people coming forward to seek help has led to lower numbers of urgent referrals for suspected cancer.
“This is seen not just in Scotland but seems to be a pattern elsewhere in the UK too.
“GPs are telling me that they’re seeing much fewer people coming forward with these types of symptoms and signs. The volume of referrals received backs this up.
“In fact, there’s been a 72 per cent reduction in urgent suspected cancer referrals compared to the weekly average.
“I don’t believe that these diseases or concerns have simply disappeared so it leaves me worried that there are people out there who are not seeking help from their GP.”
A similar pattern has already been seen in Scotland’s A&E departments, with weekly attendances halving to a record low of just 11,000.
He urged patients worried about lumps, unusual bleeding or a change in their bowel habits to contact their GP, adding: “It’s important to stress that most concerns can be resolved pretty quickly and easily and won’t turn out to be cancer.”
It is not the first time cancer management has been impacted by the epidemic.
In March, routine screening for bowel, cervical and breast cancer was suspended for three months to help free up laboratory resources and reduce the risk of virus transmission from patients travelling to clinics.
Non-urgent cancer surgery has also been put on hold to help free up beds, while some patients who were due to undergo chemotherapy have had their treatment postponed because the risk posed by coronavirus was considered to outweigh the threat from the disease.
Dr Smith acknowledged that “some clinical investigations and cancer treatments may be altered due to the risks of Covid-19”, but added: “If it was urgent before Covid 19, it remains urgent now.”
An ‘urgent referral with a suspicion of cancer’ triggers the waiting time target, meaning that 95% of patients subsequently detected as having cancer should begin treatment within 62 days of that initial referral.
However, bottlenecks at the diagnostic stage - when scans, colonoscopies or other checks are carried out - has meant that the target has not been met since 2012.
In the last three months of 2019 only 84% of patients began treatment within that 62-day window.
READ MORE: Coronavirus - why is England's death rate twice as high as Scotland's?
A fall in demand is likely to speed up diagnosis for those still coming forward, but Professor Michael Griffin, president of the Royal College of Surgeons of Edinburgh, said its members were “extremely concerned” about the long-term implications of the 72% fall in referrals.
He said: “This, along with the cancellation and delay of cancer surgeries due to current Covid-19 pressures, will undoubtedly contribute to a significant backlog of surgeries over the coming months.
“It’s vital the NHS and Government start planning for this now to ensure patients can be treated promptly and safely when surgeons are able to resume these operations.”
Diagnosing cancer early also significantly improves the chances of treatment working.
Janice Preston, who heads up Macmillan Cancer Support in Scotland, said: “While these are exceptional circumstances, speedy diagnosis of cancer continues to be of upmost importance.
“While many people referred for tests won’t have cancer, it’s vital symptoms are investigated as soon as possible.
“Unless this fall is reversed urgently there’s a risk the current crisis could become a longer term cancer crisis.”
Marion O’Neill, Cancer Research UK’s head of external affairs in Scotland, said the situation was “hugely concerning".
She said: “It’s clear the pandemic has left cancer diagnosis and treatment in a precarious position.
“If lots of suspected cancer cases are not investigated until a later date, there’s a risk of breaking an already flooded NHS system.”
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Dr Jeanette Dickson, president of the Royal College of Radiologists, added: “It is worrying that GP referrals for suspected cancer have dropped so drastically.
"In normal circumstances many referrals are in people with a low risk and do not result in a cancer diagnosis.
"We hope that the reduction in referrals will mainly relate to those cases.
“However, it may be that fewer patients with worrying symptoms are going to their GP because they do not want to burden the health service.
"Older people, who are more vulnerable to the risks of coronavirus, may be worried about coming out of self-isolation.”
It came as First Minister Nicola Sturgeon warned that she “will not rush” to lift lockdown restrictions, despite signs that the virus is declining.
There are currently 169 patients being treated for confirmed or suspected Covid-19 in intensive care, down from 211 a week ago.
“What we will start to do is set out our objective, which is to continue to suppress the virus while considering how we can gradually restore some semblance of normality to everyday life,” said Ms Sturgeon.
She added that social distancing restrictions will continue “for some time to come”
On antigen testing, figures show an average of 1,100 people a day in Scotland have been tested for the virus in the past 14 days.
Ms Sturgeon said current daily processing capacity is at 2000 and on track to exceed 3,500 by the end of April, but conceded that there was “work to be done to make sure we’re using that capacity to its maximum”.
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