In Malaga province, 9,309 cancers were diagnosed in 2020. Statistically there should have been more, according to the experts: up to 20 per cent more.
"Specifically, 17.6 per cent more", details the always precise oncologist Emilio Alba: "There are many people out there (he points to a window) who have cancer without knowing it."
In a recent report, Spain’s Ministry of Health recognises "a reduction in diagnoses" that it attributes to several causes derived from the pandemic: the suspension of screening programmes, difficulties in accessing primary and hospital care, the delay in appointments for medical tests and a fear of infection from Covid-19.
"They have focused on curing the coronavirus crisis and have forgotten to prevent other diseases," claims Paloma Gómez, of the Spanish Association Against Cancer (AECC) in the province, convinced of the need to banish the telephone filtering system in health centres: “We have the right to be seen by a doctor. Many people do not know how to express what is happening to them on the phone. There are symptoms that seem mild, such as back pain or fatigue, which may be something else. She knows what she is talking about: she started working with the association three decades ago, before she was diagnosed with breast cancer herself.
Although in recent years the stigmas that the disease carries have been removed, the word still falls like a stone on patients. And many of them, since the start of the Covid-19 pandemic, have had to receive the diagnosis and be treated alone, without the support family or friends.
“The normal thing when they tell you that you have cancer is that you block everything else out, and that you no longer listen to anything else that the doctor says. " Do you know what it must be like to go to your first chemo session alone?" she asks.
After the first wave of the virus, which devastated early detection programmes, the authorities realised the importance of recovering chronic patients with other pathologies, who had stopped going to their health centres.
But in some cases it was too late.
Emilio Alba believes that "it is not yet possible to measure the magnitude" of the problem and predicts that "we will have to wait two or three years to know what the impact will be" of the underdiagnosis, although he reminds that many screening tests, such as mammograms, colonoscopies have returned as normal to health facilities.
Surgeon César Ramírez confesses that in recent months "fewer cancers have been diagnosed for surgery than in any other year." Specialising in cancer surgery, Ramírez has suffered the consequences of the health system stopping its activity in its tracks to focus on the coronavirus first hand: “A close relative who lives in Melilla spent four months unable to undergo a colonoscopy, despite the fact that he had bleeding. In the end he was diagnosed with colon cancer. The scenario is, to say the least, worrying: “Under normal conditions, 33 per cent of colon cancers are diagnosed in preventative stool test screening campaigns. Now that figure has dropped to five per cent.”
The Spanish Society of Medical Oncology (SEOM) speaks of a “diagnostic limbo”. Its president, Álvaro Rodríguez-Lescure, considers that the pandemic “behaves like a black hole that absorbs human, therapeutic, technological and technical resources”, a situation that “must be reversed” because the delay in detection supposes “a very negative impact in the options that we have so that the treatments affect the survival of the patients.”
The AECC also reminds of the ramifications that go beyond the diagnoses: claiming the pandemic has aggravated the "unequal" situation of the sick, and those more vulnerable to poverty and disorders such as depression and anxiety. The health care phobia that the coronavirus has generated in a large part of the population constitutes another obstacle to early detection. “People are still afraid to go to the doctor. We have to make them lose the fear”, says Paloma.
Because cancer, often silent and deadly, does not wait. And at least two out of ten cases have yet to be diagnosed.