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

Assessment of changing pattern of crop water stress in Bangladesh

The Palmers’ crop moisture index (CMI) was used to assess the changing pattern of crop water stress of Bangladesh. Daily rainfall and temperature data for the period 1961–2010 recorded at eleven meteorological stations distributed across the country were used to estimate the time series of CMI. The run theory was used to estimate a set of metrics from CMI to define different characteristics of annual and seasonal crop water stress. The Mann–Kendall trend test was used for the assessment of the significance of the changes in crop water stress indicators at 95% and 99% level of confidence. The results showed that crop water stress in Bangladesh has increased in recent years, particularly in the pre-monsoon season. The annual and pre-monsoon cumulative crop water stress index was found to increase significantly in 5 and 4 out of 11 stations, respectively. As the major portion of total crop in Bangladesh is grown during pre-monsoon season, increasing crop water stress can affect agriculture and food security of Bangladesh. The set of matrices developed in this study can be to understand the different characteristics of water stress and adopting necessary mitigation measures in the context of climate change