The projected impact of the COVID-19 lockdown on breast cancer deaths in England due to the cessation of population screening: a national estimation

Stephen W. Duffy*, Farah Seedat, Olive Kearins, Mike Press, Jackie Walton, Jonathan Myles, Daniel Vulkan, Nisha Sharma, Anne Mackie

*Corresponding author for this work

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    Background: Population breast screening services in England were suspended in March 2020 due to the COVID-19 pandemic. Here, we estimate the number of breast cancers whose detection may be delayed because of the suspension, and the potential impact on cancer deaths over 10 years. 

    Methods: We estimated the number and length of screening delays from observed NHS Breast Screening System data. We then estimated additional breast cancer deaths from three routes: asymptomatic tumours progressing to symptomatically diagnosed disease, invasive tumours which remain screen-detected but at a later date, and ductal carcinoma in situ (DCIS) progressing to invasive disease by detection. We took progression rates, prognostic characteristics, and survival rates from published sources. 

    Results: We estimated that 1,489,237 women had screening delayed by around 2–7 months between July 2020 and June 2021, leaving 745,277 outstanding screens. Depending on how quickly this backlog is cleared, around 2500–4100 cancers would shift from screen-detected to symptomatic cancers, resulting in 148–452 additional breast cancer deaths. There would be an additional 164–222 screen-detected tumour deaths, and 71–97 deaths from DCIS that progresses to invasive cancer. 

    Conclusions: An estimated 148–687 additional breast cancer deaths may occur as a result of the pandemic-related disruptions. The impact depends on how quickly screening services catch up with delays.

    Original languageEnglish
    Pages (from-to)1355-1361
    Number of pages7
    JournalBritish Journal of Cancer
    Issue number9
    Early online date2 Feb 2022
    Publication statusPublished - 18 May 2022

    Bibliographical note

    Funding Information: SWD and DV’s contribution to this work was part-funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, PR-PRU-1217-21601. The views expressed are those of the author(s) and not necessarily those of the NIHR, UK NSC, NHS or the Department of Health and Social Care.

    FS and AM are employed by the UK National Screening Committee (UK NSC), hosted at the Office for Health Improvement and Disparities within the Department of Health and Social Care. MP, JW and OK were employed by Public Health England during this project and are now employed by NHS England and NHS Improvement. All other authors declare no competing interest.

    Open Access: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party
    material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit

    Publisher Copyright: © 2022, The Author(s).

    Citation: Duffy, S.W., Seedat, F., Kearins, O. et al. The projected impact of the COVID-19 lockdown on breast cancer deaths in England due to the cessation of population screening: a national estimation. Br J Cancer 126, 1355–1361 (2022).



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