利用英国威尔士国家癌症临床记录系统，研究 2020 年期间 SARS-CoV-2 大流行对女性乳腺癌、结直肠癌和非小细胞肺癌发病、分期以及诊断相关医疗保健途径的影响。

Impact of the SARS-CoV-2 pandemic on female breast, colorectal and non-small cell lung cancer incidence, stage and healthcare pathway to diagnosis during 2020 in Wales, UK, using a national cancer clinical record system.

机构信息

Public Health Wales, Welsh Cancer Intelligence & Surveillance Unit, Floor 5, Number 2 Capital Quarter, Tyndall Street, Cardiff, CF10 4BZ, UK.

Swansea University, Population Data Science, Swansea, UK SA2 8PP, UK.

出版信息

Br J Cancer. 2022 Aug;127(3):558-568. doi: 10.1038/s41416-022-01830-6. Epub 2022 May 2.

BACKGROUND

COVID-19 pandemic responses impacted behaviour and health services. We estimated the impact on incidence, stage and healthcare pathway to diagnosis for female breast, colorectal and non-small cell lung cancers at population level in Wales.

METHODS

Cancer e-record and hospital admission data linkage identified adult cases, stage and healthcare pathway to diagnosis (population ~2.5 million). Using multivariate Poisson regressions, we compared 2019 and 2020 counts and estimated incidence rate ratios (IRR).

RESULTS

Cases decreased 15.2% (n = -1011) overall. Female breast annual IRR was 0.81 (95% CI: 0.76-0.86, p < 0.001), colorectal 0.80 (95% CI: 0.79-0.81, p < 0.001) and non-small cell lung 0.91 (95% CI: 0.90-0.92, p < 0.001). Decreases were largest in 50-69 year olds for female breast and 80+ year olds for all cancers. Stage I female breast cancer declined 41.6%, but unknown stage increased 55.8%. Colorectal stages I-IV declined (range 26.6-29.9%), while unknown stage increased 803.6%. Colorectal Q2-2020 GP-urgent suspected cancer diagnoses decreased 50.0%, and 53.9% for non-small cell lung cancer. Annual screen-detected female breast and colorectal cancers fell 47.8% and 13.3%, respectively. Non-smal -cell lung cancer emergency presentation diagnoses increased 9.5% (Q2-2020) and 16.3% (Q3-2020).

CONCLUSION

Significantly fewer cases of three common cancers were diagnosed in 2020. Detrimental impacts on outcomes varied between cancers. Ongoing surveillance with health service optimisation will be needed to mitigate impacts.

背景

COVID-19 大流行对行为和卫生服务产生了影响。我们在威尔士人群水平上估计了对女性乳腺癌、结直肠癌和非小细胞肺癌发病率、分期和诊断保健途径的影响。

方法

通过癌症电子记录和住院数据链接确定了成年病例、分期和诊断保健途径（人群约 250 万）。使用多元泊松回归，我们比较了 2019 年和 2020 年的病例数，并估计了发病率比率（IRR）。

结果

总体病例减少 15.2%（n=-1011）。女性乳腺癌的年 IRR 为 0.81（95%CI：0.76-0.86，p<0.001），结直肠癌为 0.80（95%CI：0.79-0.81，p<0.001），非小细胞肺癌为 0.91（95%CI：0.90-0.92，p<0.001）。在 50-69 岁女性和所有癌症 80 岁以上的人群中降幅最大。I 期女性乳腺癌下降 41.6%，但未知期增加 55.8%。结直肠癌 I-IV 期下降（范围 26.6-29.9%），而未知期增加 803.6%。结直肠癌 Q2-2020 全科医生紧急疑似癌症诊断减少了 50.0%，非小细胞肺癌减少了 53.9%。年度筛查发现的女性乳腺癌和结直肠癌分别下降了 47.8%和 13.3%。非小细胞肺癌急诊就诊诊断增加了 9.5%（Q2-2020）和 16.3%（Q3-2020）。