Breast screening for women aged 45 and over nearly halved during first year of Covid pandemic

1.19m women aged 45 and over were screened for breast cancer in 2020-2

The number of women screened for breast cancer in England nearly halved during the first year of the Covid pandemic.

It meant 7,000 fewer cancers were detected than the year before, a 39% fall, official figures show.

Thalie Martini, CEO at Breast Cancer UK, said the charity has been “concerned that disruption to NHS services would impact people being able to get an early diagnosis”, with the figures sadly showing “that thousands of women may have poorer breast cancer outcomes because of this delay”.

According to data from the NHS Breast Screening Programme, 1.19m women aged 45 and over were screened for breast cancer in 2020-21.

This was a 44% fall on 2019-20 figures, when 2.12 million women in this age group were screened.

Under the screening programme, eligible women in England will usually receive their first routine invitation for breast cancer screening between the ages of 50 and 53 and will normally be invited every three years until they are 70.

For women aged 50 to 70, the number of women screened fell by 39%, dropping from 1.84 million in 2019-20 to 1.12 million in 2020-21.

The Breast Screening Programme provides information on the coverage, screening activity, number and uptake of invitations, as well as the outcome of screening and the rate of cancer detection.

Data showed that 10,813 women aged 45 and over had cancers detected through screening in 2020-21.

This was a 39% decrease from 2019-20, when 17,771 women had cancers detected.

However, with high-risk patients prioritised for checks, there was an increase in the rate of cancers detected. This rose from 8.4 cases per 1,000 women screened in 2019-20 to 9.1 cases per 1,000 women screened in 2020-21.

This pattern remains consistent in women aged 50-70, as although the number of women screened fell, there was an increase in the rate of cancers detected from 8.0 cases per 1,000 women screened in 2019-20, to 8.9 cases per 1,000 women screened in 2020-21.

The uptake of routine invitations for women aged 50 to 70 was 62% in 2020-21 - with 1.08 million women attending from 1.75 million invitations - but this was down from 69% in 2019-20, when 1.79 million women attended from 2.6 million invitations.

Effects of Covid pandemic on breast screening

The NHS Breast Screening Programme was seriously impacted by disruption from the Covid pandemic during 2020-21.

All 78 NHS Breast Screening Units (BSUs) made their own decision to pause screening for approximately three months from March to June 2020.

This was in order to allow staff to be redeployed to respond to the pandemic, and to protect patients and staff from the virus.

However, in April 2020, NHS England and NHS Improvement (NHSEI) issued a system-wide letter which set out that local NHS organisations should step up non-Covid key services as soon as possible, with screening and immunisation services listed as critical services.

Most services continued with, or restarted, screening very high-risk women by mid-April 2020.

All BSUs restarted screening activity between April and September 2020, with the majority restarted by July 2020.

Routine screening for the total eligible population commenced across services in June and July 2020, which resulted in backlogs of women waiting to be invited for screening.

Covid-19 restrictions, such as social distancing and additional infection prevention and control measures impacted on lengthened appointment times and increased time between screening invitations.

Workforce sickness/self-isolation and redeployment was also an issue, and fewer women also presented for breast screening, with shielding and self-isolation contributing factors in this.

Jodie Moffat, head of early diagnosis at Cancer Research UK, added: “Covid-19 has had a devastating impact on the diagnosis and treatment of cancer. During the first year of the pandemic we saw a drop off in the number of women starting treatment for breast cancer in England, which we thought was partly linked to delays in breast cancer screening.

“Despite the tireless work of NHS staff, the NHS has struggled to get through the breast screening backlog, because of a lack of capacity. Clarity is needed on how the extra money promised to the NHS is going to be used to tackle the chronic workforce shortages, which are holding back the recovery of cancer services and are preventing the NHS from being a world class cancer service.”

However, Ms Moffat added that it’s “encouraging to see cancer screening services back up and running” and urges people to keep an eye out for the screening invitations coming through their door.

Baroness Delyth Morgan, chief executive at charity Breast Cancer Now, said: “Improving screening uptake and clearing the backlog of delayed invitations are critical actions that NHS England must prioritise to prevent more women tragically dying from the disease.

“Next year’s screening figures will be the true indicator of how successfully the programme has restarted, recovered and delivered on these actions.”