Scotland cancer rate rebound 'higher than expected'

The number of cases detected was 5.5 per cent higher compared to 2019 - the last full year before the pandemic.

Even after adjusting for the changing age and size of the population, the cancer rate in 2021 - at 644 cases per 100,000 people - was 3.3% higher than it had been in 2019.

READ MORE: Covid conundrum - Why are Scotland's cancer deaths lower in 2022 than before the pandemic? 

Nonetheless, the total number of diagnoses recorded between 2020 and 2021 combined is still nearly 800 fewer than expected.

This "net shortfall" may indicate that there were still hundreds of Scots living with undiagnosed cancers, or that people who would have developed cancer had died with Covid instead.

The report provides an important snapshot into how the NHS and public health fared in the second year of the pandemic.

After falling sharply in 2020, cancer incidence rates in Scotland have rebounded to slightly higher than expected levels (Image: PHS)

Stephanie Sinclair, science communications manager for Worldwide Cancer Research, said: “It’s worrying to see the rate of cancer diagnosis in Scotland increase above and beyond pre-pandemic levels, with a ‘rebound’ effect from the pandemic that many suspected would appear.

"Sadly, cancer is expected to be the leading cause of death worldwide by 2030, so this news only emphasises the need for people to be aware of the symptoms of cancer.

"It also shows that we need to continue to invest in cutting-edge research.”

READ MORE: Are excess deaths really soaring after Covid? 

Kate Seymour, head of advocacy for Macmillan Cancer Support said the "alarming" figures "re-emphasise the urgent need to make cancer waiting times a priority in Scotland".

She added: "We are looking forward to seeing the Scottish Government’s new cancer strategy take precedent and focus on tackling this situation, strengthening our cancer workforce in the years to come.”

Lung cancer remains the most common cancer overall in Scotland, although breast cancer is responsible for the majority of diagnoses in women and prostate cancer for men.

Scotland's ten most common cancers, overall and by male (blue), female (purple) (Image: PHS)

The rate of lung cancer diagnoses in 2021 - at 100 per 100,000 - was "consistent" with 2019, however.

For breast cancer, the diagnosis rate - 174 cases per 100,000 - was 4.5% higher than 2019, while prostate cancer diagnosis rates were up by 6% compared to 2019.

Head and neck cancer, which is particularly prevalent in the west of Scotland, experienced the biggest spike with a case rate of 26 diagnoses per 100,000 people - up by 8% on 2019.

There was evidence that cancer screening had returned to normal following a pause early in the pandemic.

During 2021, 53% of female breast cancer cases detected in women eligible for screening - the 50 to 69 age group - were picked up as a result of routine mammograms.

For colorectal cancer, 32% of cases were detected as a result of screening in the 50 to 74 age group.

Both figures are "consistent" with pre-Covid norms.

There are signs that cervical screening has been slower to recover, however.

In 2021, only 41% of cases in the 25 to 64 age group were picked up as a result of a routine smear test - down from around 48-51% before the pandemic.

The report also highlights that while the issue of under-diagnosis of cancers due to the pandemic "had largely been resolved by 2021", in poorer communities "there was evidence of this persisting to some extent for certain cancer types".

The overall risk of developing cancer in 2021 was 30% higher for Scots living in the most deprived areas compared to the wealthiest.

However, that compares against a gap of 35% pre-pandemic.

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PHS stresses that this reduction is more likely to "reflect under-diagnosis rather than truly lower rates".

For instance, diagnoses for head and neck cancer were 151% more common in poorer areas in 2021, but that compares to a gap of 176% pre-pandemic, which suggests that diagnosis rates for Scots living in the most deprived areas have not yet fully recovered.

A similar pattern was also observed for cervical cancer rates in poorer areas, which appear lower than expected.

Meanwhile, despite warnings of a "cancer timebomb", the report appears to provide reassurance that the pandemic has not led to a surge in late-stage cancer diagnoses.

The pandemic was not associated with an increase in the proportion of lung cancer cases detected at Stages Three or Four. Similar patterns have been seen for other common cancer types, defying expectation (Image: PHS)

In the case of lung cancer, just under half (46.1%) of the cases detected in 2021 were Stage Four with 20.2% diagnosed at Stage Three, in line with pre-Covid trends.

PHS notes that the the pandemic "does not appear to have had any impact on lung cancer staging in 2020 and 2021".

Similarly, there has been no spike in late-stage diagnoses for the other most common cancers, including breast, prostate, and colorectal.

The figures tie in with recent data on excess deaths from the National Records of Scotland, which show that the cancer mortality rate in Scotland during 2022 was 4.9% lower than the five-year average. 

This translated as 182 fewer deaths than expected per 100,000. 

By contrast, the death rate from circulatory causes - such as strokes, blood clots, and heart attacks - was 0.9% higher than the five-year average.