About this release

This release by Public Health Scotland presents data examining the impact of COVID-19 on the cancer staging distributions, with the focus of the report being 2021 data in comparison with the most recent pre-pandemic Detect Cancer Early (DCE) data (2018 and 2019). Charts and tables from the DCE audit dataset for patients diagnosed with cancer during the full two-year period 1 January 2020 to 31 December 2021 can be found in the full report.

Main points

  • In 2021 there were 4,668 patients diagnosed with breast cancer, 3,706 patients diagnosed with colorectal cancer and 4,862 patients diagnosed with lung cancer. The reduction in diagnoses in 2020 Q2 is associated with the initial COVID-19 lockdown. Breast and colorectal cancer diagnoses increased in late 2020 and into 2021, reaching levels that were similar to or exceeded 2016-2019. Lung cancer diagnoses also increased following 2020 Q2, but have not quite reached pre-pandemic levels (based on 2018-2019 average).

Number of patients diagnosed by cancer type from 2016 to 2021, by quarter

  • There has been a significant stage shift (p=0.017) for breast cancer since the pandemic, with more women diagnosed with late-stage disease (stages 3&4; 13.3% in 2021 vs 11.6% in 2018-2019) and correspondingly fewer women diagnosed with early-stage disease (stages 1&2; 83.9% in 2021 vs 85.7% in 2018-2019). This stage shift was 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.
  • There was no evidence of an overall stage shift for colorectal cancer in 2021 when compared with the pre-pandemic stage distribution (p=0.11). However, the stage distribution of colorectal cancer in different deprivation areas did vary between 2021 and 2018-2019. The proportion of patients diagnosed with stage 1 disease in the least deprived areas fell in 2021. There were 19% more patients with their stage unknown in 2021 than in 2018-2019; this may be due to more patients having incomplete data (as they had not fully completed investigations and procedures by year end) than in the pre-pandemic years.
  • There was a significant association between stage distribution and year (pre-pandemic [2018-2019] vs 2021; p<0.001) for lung cancer; however, this was solely due to the improvement in the quality of recording of staging data. There was a fall from 6.0% with stage unknown in 2018-2019, to 4.1% with stage unknown in 2021. This is a result of concerted efforts by many of the Cancer Audit teams in the NHS Boards.


The DCE data provided use the Quality Performance Indicator (QPI) audit information, rather than the Scottish Cancer Registry. Therefore, these data are not directly comparable to PHS’s cancer incidence publication and are subject to change in future publications, as submissions may be updated to reflect a more accurate and complete set of data from NHS Boards.

General enquiries

If you have an enquiry relating to this publication, please email phs.detectcancerearly@phs.scot.

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Older versions of this publication

Versions of this publication released before 16 March 2020 may be found on the Data and Intelligence, Health Protection Scotland or Improving Health websites.

Last updated: 21 March 2024
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