Heterogeneity of colorectal cancer risk by tumour characteristics: Large prospective study of UK women

Associations between behavioural and other personal factors and colorectal cancer risk have been reported to vary by tumour characteristics, but evidence is inconsistent. In a large UK-based prospective study we examined associations of 14 postulated risk factors with colorectal cancer risk overall, and across three anatomical sites and four morphological subtypes. Among 1.3 million women, 18,518 incident colorectal cancers were identified during 13.8 (SD 3.4) years follow-up via record linkage to national cancer registry data. Cox regression yielded adjusted relative risks. Statistical significance was assessed using correction for multiple testing. Overall, colorectal cancer risk was significantly associated with height, body mass index (BMI), smoking, alcohol intake, physical activity, parity and menopausal hormone therapy use. For smoking there was substantial heterogeneity across morphological types; relative risks around two or greater were seen in current smokers both for signet ring cell and for neuroendocrine tumours. Obese women were also at higher risk for signet ring cell tumours. For adenocarcinomas, the large majority of colorectal cancers in the cohort, all risk factor associations were weak. There was little or no heterogeneity in risk between tumours of the right colon, left colon and rectum for any of the 14 factors examined. These epidemiological findings complement an emerging picture from molecular studies of possible different developmental pathways for different tumour types.Grant sponsor: Cancer Research UK; Grant number: C570/A16491; Grant sponsor: Medical Research Council; Grant number: MR/ K02700X/

Breast cancer histological classification: agreement between the Office for National Statistics and the National Health Service Breast Screening Programme

INTRODUCTION: Epidemiological studies rely on data supplied by central cancer registration sources to be timely, accurate and complete. Validation studies of such data at a national level are limited. Data collected for the Million Women Study was used to compare the level of agreement between the Office for National Statistics (ONS) and the National Health Service Breast Screening Programme (NHSBSP) in the recording of incident screen-detected breast cancer histology between 1996 and 2001. METHODS: 1.3 million women aged 50 to 64 years were recruited into the Million Women Study cohort via the NHSBSP. Incident screen-detected breast cancer histologies were notified separately by the ONS and NHSBSP. ICD-10 and ICD-02 ONS codes and NHSBSP histology data were similarly coded to allow for comparison in terms of cancer invasiveness and morphology. The statistical outcome measures are percentage agreement and the kappa statistic. RESULTS: A total of 5,886 incident screen-detected breast cancers were available for analysis. Of the 5,886 screen-detected cancers reported by the ONS and NHSBSP, 5,684 (96.6%, κ = 0.9) agreed in terms of the degree of invasiveness. Of the 5,458 cancers that had been assigned a specific morphology code, there was exact agreement between the ONS and the NHSBSP in 4,922 cases (90.2%, κ = 0.8). CONCLUSION: There is an excellent level of agreement between the ONS and NHSBSP in the recording of the histology of screen-detected breast cancer. From these results it is not possible to comment on which source of data is the more or less accurate, although the differences are very small

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

Ethnicity and the tumour characteristics of invasive breast cancer in over 116,500 women in England

Background Ethnic minority women are commonly reported to have more aggressive breast cancer than White women, but there is little contemporary national evidence available. Methods We analysed data from the National Cancer Registration and Analysis Service on women diagnosed with invasive breast cancer during 2013–2018. Multivariable logistic regression yielded adjusted odds ratios (and 95% confidence intervals) of less favourable tumour characteristics (high stage, high grade, ER negative, Her2 positive) by ethnicity (black African, black Caribbean, Indian, Pakistani and white) in younger (30–46 years) and older (53–70 years) women. Results In 24,022 women aged 30–46 at diagnosis, all ethnic minority groups apart from Indian women had a significantly greater odds of certain less favourable tumour characteristics compared to white women in fully adjusted models. In 92,555 women aged 53–70, all ethnic minorities had a significantly greater adjusted odds of several of the less favourable tumour characteristics. These differences were most marked in black African and black Caribbean women. Conclusions Ethnic minority women are at greater risk of breast cancers with less favourable characteristics, even after allowing for age and other potential confounders. These differences are greater in older than younger women, and in the Black rather than South Asian ethnic groups

Barriers to and enablers of the early diagnosis of breast cancer among women from ethnic minority backgrounds in the UK: protocol for a qualitative evidence synthesis

Introduction: Breast cancer is the most commonly diagnosed cancer in women of all ethnic groups in the UK. The largest single ethnic groups in the UK are white, Indian, Pakistani, Black African and Black Caribbean. Previous studies have shown that women from ethnic minority groups are more likely to be diagnosed with more advanced disease at presentation compared to women from white backgrounds which is associated with poorer outcomes. Understanding the factors that prevent or enable women from ethnic minority backgrounds to have an early diagnosis of breast cancer is essential to inform the development of interventions or policies that seek to promote early diagnosis of breast cancer in these groups. This qualitative evidence synthesis will identify and synthesise what is known about the topic. Methods and analysis: The proposed review will synthesise studies that report on the experiences of women in the UK from the ethnic groups of interest on the early diagnosis of breast cancer. A search strategy was developed by two researchers and an information specialist. The Medline (OvidSP), Embase (OvidSP), CINAHL (EBSCOHost), PsycINFO (OvidSP) and Cochrane Library (via Wiley) databases will be searched for published articles. Relevant policy documents and reports will be searched for by browsing cancer37 related organisational websites and using Google Advanced Search, and dissertations and theses using ProQuest. Studies will be included if they utilise qualitative methodologies and are about the early diagnosis of breast cancer in UK women aged 18 years and over from the ethnic minority groups of interest. Studies that utilise quantitative methodologies], or collect data using qualitative methods but analyse quantitatively (e.g. open-ended survey questions where free text responses are analysed using descriptive statistics) will be excluded. To maximise inclusion of suitable studies, the search will not be limited by language and start from database inception. Data will be managed using Covidence, and managed for analysis using NVivo. An assessment of the methodological limitations of each study will be performed using the Critical Skills Appraisal Programme tool, and the PRO EDI framework will be used to assess equality, diversity and inclusion in the synthesis. The data will be analysed thematically based on, but not limited to, the Health Belief Model using a best-fit-framework. The confidence in the final synthesised findings will be assessed using the Grade-CERQual tool. Ethics and dissemination: Ethical approval is not required as this is a systematic review of published or publicly available qualitative findings. Results will be published in a peer-reviewed scientific journal, publicised at relevant conferences and on social media. The results will provide comprehensive information on the barriers to early diagnosis of breast cancer in ethnic minority groups, which will inform breast cancer care policies to improve access and delivery of health services, and influence the design of future interventional and qualitative studies. PROSPERO registration number CRD4202457977