Cancer Diagnoses and Deaths in Hungary, 2011-2023: Nationwide Trends Before, During, and After the COVID-19 Pandemic

Background: The coronavirus disease 2019 (COVID-19) pandemic significantly disrupted cancer screening, diagnosis, and care. This phase of the Hungarian Cancer Epidemiology (HUN-CANCER-EPI) study evaluated trends in cancer incidence and mortality in Hungary during the pre-COVID (2011-2019), COVID (2020-2021), and post-COVID (2022-2023) periods. Methods: Nationwide data from the Hungarian National Health Insurance Fund database were analysed. Age- and sex-adjusted incidence and mortality trends from 2011 to 2019 were modeled using Poisson regression. Changes from trends in 2020-2023 were compared to pre-COVID projections with 95% confidence intervals. Results: From 2011 to 2019, age-standardised cancer incidence declined by 1.9% (95% CI: 1.3% to 2.4%) annually in males and by 1.0% (95% CI: 0.6% to 1.4%) in females. During 2020-2021, incidence dropped sharply below the expected: in 2020 (-12.8% in males and -11.8% in females) and in 2021 (-11.7% and -7.9%, respectively). The largest declines affected prostate, melanoma, and kidney cancer. Rapidly progressing tumors like pancreatic and esophageal showed smaller decreases. By 2023, partial incidence rebounds were observed for prostate cancer, kidney cancer, and melanoma, likely reflecting the recovery of pandemic-delayed diagnoses. Lung and liver cancers showed no rebound. The steepest drops were in males aged 70+, with incomplete recovery. Mortality stayed near expected levels overall, with some exceptions, like melanoma, where the rebound in incidence coincided with increased mortality rates in 2023, which may reflect delayed diagnosis, although this cannot be directly confirmed. Conclusions: The pandemic had lasting, cancer-type-specific impacts on incidence patterns, particularly affecting screening-dependent, slow-growing tumors. Mortality remained largely stable overall during the available follow-up, highlighting the need for targeted recovery strategies and strengthened healthcare system resilience.