The global pandemic has been dominating the world of Scottish public health, primary care and acute medicine for the past year. We have watched the daily, weekly and monthly figures of cases, hospital admissions and deaths of the millions whose lives have sadly been affected or lost to Covid-19.

There are, on the other hand, many other worries and statistics that have always got less air time. Concerns about cancer diagnosis (especially delayed screening), treatments and recovery may have been severely impacted on many of thousands of people in Scotland during the pandemic, but the details do not regularly appear on our television screens. It is interesting to give thought to what might happen if we did receive daily reminders.

In the background of the COVID-19 (but in the foreground for World Cancer Day) let us remember that worldwide there were 19.3 million cases and 10 million cancer deaths in 2020. Few of these cancers have preventive vaccines and some of those are of unknown origin; but the risk of around 40% of cancers can be prevented through lifestyle. Attempts to control COVID in this country has shown us that government policies can change our ways of life and this is the support we need to reduce the cancer burden in this country. Equitable approaches to facilitating smoke free environments, healthy diets and active lifestyles as well as cultures which value alcohol free settings are needed more than ever. The relationship between COVID severity, obesity, alcohol intake and smoking have also highlighted the importance of healthy ways of life, but more and more people have less access and less support for making healthy lifestyle choices.

In July 2020, ISD released an updated report on Cancer in Scotland. There are some key findings that should make us think hard about the road ahead in Public Health planning;

  • Cancer is the most common cause of death in Scotland.
  • The risks of developing some cancers have increased over the past 10 years including liver, thyroid breast and skin melanomas.
  • Uptake of cancer screening is 64% for bowel screening (November 2017-April 2019); 73% for cervical screening (2018-19); and 72% for breast screening (2016-17 to 2018-19) and uptake is increasing but is much lower in more deprived areas compared to less deprived areas of Scotland.
  • Survival from cancer is improving over time, but comparisons with other developed countries indicate that cancer survival in Scotland (and other UK countries) is a poorer chance. 

Throughout the COVID pandemic, our NHS staff have also had to manage cancer cases as best they can. For today, let us think hard about that double burden of disease facing public health and how we collectively plan for healthy futures. 

Professor Annie S. Anderson

Professor Bob Steele