Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Middle Miocene stable carbon and oxygen isotope record of ODP Holes 130-805B and 130-806B

Bulk carbon isotope records are an effective chemostratigraphic tool for the middle Miocene because of the large and systematic variation in first-order d13C signals. Bulk d13C measurements support the presence of a hiatus at 305 mbsf in Hole 805B (latest middle Miocene), provisionally located while on board ship using biostratigraphic and magnetostratigraphic events. Records at Holes 805B and 806B show the middle Miocene Monterey carbon isotope excursion although the record at Hole 806B is apparently more stratigraphically continuous. Detailed analysis of multispecies foraminiferal carbon isotope records during the middle Miocene ("Monterey excursion") segment at Hole 806B support the assertion that this carbon isotope excursion comprises mainly between-reservoir effects. The benthic d18O data increase after 15.3 Ma, which we suggest corresponds to the mid-Miocene cooling step/ice volume increase of other authors. Planktonic foraminiferal d18O evidence exists for steepening of the thermocline at 17.4 Ma. A second-order d13C excursion superimposed at 13.8 Ma on the first-order Monterey excursion is associated with a second-order negative d18O excursion

Whole-rock oxygen and carbon isorope record across the Cretaceous/Tertiary boundary in ODP Hole 130-807C

Whole-rock d18O analyses of the Paleogene and Upper Cretaceous succession at Ocean Drilling Program Hole 807C suggest the presence of hiatuses between 876.95 and 894.47 mbsf and between 1138.82 and 1140.94 mbsf. The d13C data show a pronounced positive excursion between 1130 and 1180 mbsf that corresponds to the positive d13C values characteristic of the Paleocene. Despite the stratigraphic breaks in the section, the d18O data show a systematic increase between 1360 mbsf and the hiatus between 876.95 and 894.47 mbsf, which is consistent with previous suggestions of long-term climatic cooling through the Paleogene. The Cretaceous/Tertiary transition is apparently complete in this section and is of remarkable thickness. The expanded nature of this portion of the succession is probably the result of secondary depositional processes. High-resolution sampling across this boundary may reveal detailed structure of the d13C decline associated with the extinctions that mark the termination of the Cretaceous

Stable carbon and oxygen isotope ratios of Miocene to Recent foraminifera from the Rio Grande Rise, South Atlantic

Miocene to Recent species of planktic foraminifera in the Globorotalia (Globoconella) lineage evolved entirely within the thermocline. All species are most abundant within subtropical-temperate watermasses throughout their history. The near stasis in distribution within the thermocline and the subtropical convergence suggests the major morphological changes in Globorotalia (Globoconella) may have occurred through habitat subdivision rather than by vicariant shifts into new watermasses. At the Rio Grande Rise, in the South Atlantic, modern G. inflata is 0.66-0.84‰ more positive for delta18O than the most enriched coexisting Globigerinoides sacculifer and probably grows in the mid thermocline deeper than 325 m. All extinct globoconellid species have mean delta18O ratios 0.5-0.8‰ more positive than Globigerinoides trilobus and G. sacculifer and probably lived within the thermocline as well. Major events in skeletal evolution are poorly correlated with changes in delta18O in this group. These include evolutionary transitions to compressed, smooth-walled tests and acquisition of keels. In addition, morphological reversals from the umbilically-inflated G. conomiozea to biconvex G. pliozea and to unkeeled G. puncticulata occur in the absence of changes in delta18O signature. Instead, the ranges of delta18O between different species almost completely overlap once corrected for temporal changes in delta18O of sea water. Foraminifera morphologies have been widely considered to evolve in response to changes in watermasses or depth habitats. However, the variety of skeletal shapes in the globoconellid lineage apparently are not adaptations to a progressive radiation from the surface mixed layer into deeper waters