Pandemic has 'not adversely affected' cancer mortality

There were also early signs that the gulf in outcomes between people living in the most and least deprived areas may have narrowed.

However, PHS stresses that this is more likely due to pauses in routine cancer checks - such as breast screening - which has had a disproportionately negative effect on more affluent patients where uptake is usually higher.

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PHS found that a lower proportion of breast cancers were detected last year at stages one or two, when they are more treatable, with this shift "more apparent for women resident in the least deprived areas of Scotland, likely reflecting the effect of the screening programme being paused for four months in 2020".

Cancer mortality rates for 2020 and 2021 remained within expected parameters based on the pre-pandemic decline (Image: PHS)

Excluding non-melanoma skin cancer - which is easy to treat and usually curable - there were a total of 16,438 cancer deaths in Scotland last year, with lung cancer accounting for nearly a quarter of all cancer deaths followed by colorectal, prostate and breast cancer.

The total number of people dying from cancer each year has increased from around 15,000 in 1996, but that reflects an increased incidence in an older population.

Once mortality rates are adjusted for age, the overall risk of dying from cancer in Scotland decreased by 14 per cent for men and 7% for women between 2012 and 2021.

In men, lung cancer has seen the steepest fall over the past decade - reflecting historical reductions in smoking prevalence as well as improved treatments to extend survival - with women seeing rates of breast cancer death reduce by 15% mainly as a result of breast screening detecting more cases at an early stage and advances in treatment.

The number of cancer deaths has increased as the population ages, but the mortality rate has declined (Image: PHS)

The report on cancer mortality is the second published since the Covid pandemic began.

Statistics have previously shown that around 2,700 fewer cancer cases were diagnosed in Scotland during 2020 compared to 2019.

Most of the decrease has been blamed on under-diagnosis, as a result of screening programmes being temporarily suspended and people with cancer symptoms having been less likely to seek medical attention in the earlier stages of the pandemic.

This has prompted warnings of a looming "cancer timebomb", with referrals and waiting times for diagnostic tests now on the increase.

However, when PHS compared 2020 and 2021 against what would have been expected if the trend of the previous decade had continued, they found that cancer mortality rates "were lower than those before the pandemic and within the expected range of the long-term trend" - in other words, "they were neither higher nor lower than expected".

Mortality rates for all cancer types were within the expected ranges had trends from the decade up to 2019 continued.

The report adds: "The continuing decrease in cancer mortality rates is consistent with long-term trends. Therefore, it appears that the pandemic did not adversely impact cancer mortality rates in 2021."

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Deprivation is associated with a much higher risk of cancer death, due to disproportionate exposure to risks factors such as smoking, but the report notes that so far the pandemic has had "no worsening effect on the socio-economic distribution of mortality rates".

In fact, taking all cancers combined, in 2021 people living in the most deprived areas of Scotland were 64% more likely to die from cancer than those in the least deprived, down from an average difference of 79% between 2015-19.

The report states: "It would appear, at this very early stage, that inequalities in overall cancer mortality did not widen in year one [2020] and narrowed in year two of the pandemic.

"Further investigation will be required to identify if this improvement is real or an artefact of the data."

However, a separate report on stage of detection for breast, colorectal and lung cancers stresses that this is "not a positive outcome" because the narrowing has been driven by later detections among more affluent patients, rather than improvements in poorer communities.

Breast cancer diagnoses are now above average after dipping during pandemic (Image: PHS)

Both breast and colorectal cancer saw increased diagnoses in 2021 compared to pre-pandemic averages.

In 2021, 37.6% of breast cancers were detected at stage 1 for women from the least deprived areas, compared to 41.9% in 2018/19. For women in the most deprived areas, stage 1 detections remained around 36%.

For colorectal cancer, the proportion of patients diagnosed with stage 1 disease in the least deprived areas also fell in 2021.

David Ferguson, Cancer Research UK’s public affairs manager in Scotland, said: "It is an unacceptable reality that in 2022 some people are more likely to die from cancer if they live in an area of higher deprivation.

"We know that people from more deprived areas are not only more likely to get cancer, they are also more likely to be diagnosed at a late stage for certain cancer types, and have greater difficulties accessing cancer services."

Kate Seymour, Head of Advocacy for Macmillan Cancer Support in Scotland said:

“Today’s data shows just how important cancer screening services are: without them when they were paused because of the pandemic in 2020, more people were diagnosed with breast cancer at a later stage rather than detected early.

"And the later people are diagnosed with cancer, the greater the chance they will have poorer health, worse outcomes and need more treatment and support."