P28 Impact of the COVID-19 pandemic on cutaneous squamous cell carcinoma pathology reports in England and its nine regions: 1127 fewer cSCCs reported in 2020 compared with that in 2019

Abstract During the COVID-19 pandemic, three waves of infection in 2020–2021 in England were associated with reductions in the reported numbers of many cancers. Possible factors included patient anxiety in attending hospitals, shielding, staff redeployment, and staff and patient sickness. This study analysed national pathology record data to identify whether cutaneous squamous cell carcinoma (cSCC) counts decreased during the COVID-19 pandemic. The Cancerstats2 keratinocyte cancer tool data between January 2016 and December 2021 were assessed. Percentage differences were compared between cSCC reports in England and its regions during each of the three COVID-19 waves and similar time periods in 2019. Crude incidence rates per 100 000 person-years (PY) and incidence rate ratios (IRR) with 95% confidence intervals (CIs) were calculated. From 2016 to 2019, annual cSCC reports totalled 42 180, 44 460, 46 439 and 48 701, respectively (+4.9% mean yearly increase). cSCC reports decreased by 1127 to 47 574 in 2020 (–2.3%), an important finding given the previously increasing trend. cSCC reports increased to 48 798 in 2021 (0% change from 2019). The greatest reductions were in North East England (n = 230; −9.1%) and the East Midlands (n = 299; −9.0%). The crude cSCC incidence rate per 100 000 PY reduced from 86.5 (95% CI 85.7–87.3) in 2019 to 84.1 (95% CI 83.4–84.9) in 2020 (IRR 0.98, 95% CI 0.97–0.99; P < 0.05) and 86.3 (95% CI 85.5–87.1) in 2021 (IRR 1.00, 95% CI 0.99–1.01). During the first wave (April 2020), 42.3% fewer cSCCs were reported in England. In the second (December 2020) and third waves (January 2021), cSCC reports increased (3.6% and 2.5%, respectively). The regional variation in cSCC reports compared with 2019 ranged between −51.4% and −35.5% (first wave), between −6.2% and +35.2% (second wave), and between −23.4% and +26.5% (third wave). This is the largest study to assess the COVID-19 pandemic impact on cSCC counts. The decrease in cSCC reports was less than that reported for melanoma. cSCCs often present symptomatically, possibly making patients more likely to seek medical attention than with melanomas. Study limitations include that the cancerstats2 tool was developed for quality analysis purposes and not for epidemiology. It provides more up-to-date pathology counts but does not undergo the same quality control processes as gold standard, formally registered data. These data are used as a proxy, indicative for diagnoses, but should be interpreted with caution. Although mortality rates for cSCC are low, delayed diagnosis may lead to poorer outcomes. The long-term consequences of delayed cSCC diagnosis during the COVID-19 pandemic will become clearer with time.