A continuing mission to optimize the care of older women with breast cancer

The majority of cases of breast cancer occur in the older population who are often un-represented in clinical trials. Given the growing ageing population globally, it becomes urgent and important to identify an optimal approach so that older women with breast cancer are neither under- or over-treated. An inter-disciplinary research program is ongoing to investigate differing tumor biology according to age, and the potential use of a geriatric assessment tool, aiming to help select older women with primary breast cancer for a personalized and optimal treatment. Full considerations of the biology of the patient’s cancer and the geriatric domains of the patient must be taken into account when making treatment decisions

Treatment Strategies and Survival Outcomes in Breast Cancer

Treatment strategies for breast cancer are wide-ranging and often based on a multi-modality approach, depending on the stage and biology of the tumour and the acceptance and tolerance of the patient. They may include surgery, radiotherapy, and systemic therapy (endocrine therapy, chemotherapy, and targeted therapy). Advances in technologies such as oncoplastic surgery, radiation planning and delivery, and genomics, and the development of novel systemic therapy agents alongside their evaluation in ongoing clinical trials continue to strive for improvements in outcomes. In this Special Issue entitled, ‘Treatment strategies and survival outcomes in breast cancer’, a number of original research articles are included covering a diversity of studies, from pre-clinical and translational biomarker studies to clinical trials and population-based studies. They evaluated survival and other outcomes, including quality of life, in the context of pre-diagnosis (screening), as well as early and advanced stages of breast cancer

Axillary reverse mapping in N0 patients requiring sentinel lymph node biopsy: a systematic review of the literature and necessity of a randomised study

Objectives: Axillary reverse mapping (ARM) is a technique to map and preserve arm lymphatics which may be damaged during surgery, resulting in lymphoedema. This work systematically reviews the incidence of lymphoedema following sentinel lymph node biopsy (SLNB) + ARM, compared to SLNB alone, for clinically node negative disease, as well as recurrence rate, other morbidity and the feasibility and difficulties of ARM. Materials and Methods: The following databases were searched: PubMed, Embase, Cochrane Library. Abstracts submitted to ecognised societies dedicated to research in oncology were included. Studies were eligible if performed within the last 10 years; ARM was used in any form; ARM performed during SLNB +/- axillary lymph node dissection (ALND). Studies were analysed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: No studies were found meeting the initial inclusion criteria. Therefore, studies reporting use of SLNB + ARM (i.e. no comparison to SLNB) were reviewed. A second search was performed to identify studies reporting outcome following SLNB alone. Twelve studies reported data on patients undergoing SLNB + ARM and 23 studies on patients undergoing SLNB. Incidence of lymphoedema following SLNB + ARM was quoted between 0-4% and 0–63.4% following SLNB. Few studies commented on recurrence rate. Studies included were of mainly low level of evidence. Conclusion: Evidence is beginning to emerge for the use of ARM in order to reduce lymphoedema following axillary surgery. However, data regarding oncological safety of ARM is not clear and randomised controlled trials, with adequate follow-up, need to be performed to determine this

Correlation between breast cancer and lifestyle within the Gulf Cooperation Council countries: A systematic review

BACKGROUNDIn the six Gulf Cooperation Council countries (GCCCs), Bahrain, Saudi Arabia, Kuwait, Oman, Qatar and the United Arab Emirates, breast cancer (BC) is the greatest cause of cancer incidence and mortality. Obesity and physical inactivity are established risk factors for BC globally and appear to be more of a problem in high income countries like the GCCCs.AIMTo determine whether obesity and physical inactivity are associated with BC incidence in the GCCCs using the United Kingdom as a comparator. METHODSThis systematic review was carried out according to PRISMA guidelines. A cancer registry and a statistical data search was done to identify the BC incidence over the past two decades and the prevalence of obesity and physical inactivity in the GCCCs. Additionally, a systematic search of the databases, MEDLINE, Web of Science, and PubMed between 1999 and 2019 was performed to determine whether obesity and physical inactivity are risk factors for BC in the GCCCs. All papers were critically appraised according to their research methods and were assessed for quality and risk of bias.RESULTSBC was the top malignancy in each GCC country. Women tended to be diagnosed with BC at a younger age than women in the United Kingdom. The greatest 10-year increase in BC incidence was seen in Saudi Arabia (54.2%), approximately seven times the rate of increase seen in the United Kingdom (7.6%). The prevalence of obesity and physical inactivity was greater in all the GCCCs in comparison to the United Kingdom. A total of 155 full studies were reviewed of which 17 were included. Of those, eight looked at the prevalence of obesity and physical inactivity in the Gulf States and nine looked at these as risk factors for BC. Only one study found an association between BC and obesity (odds ratio = 2.29). No studies looked solely at the link between physical inactivity and BC.CONCLUSIONThe prevalence of obesity and physical inactivity was high within the GCCCs, but the majority of the included studies found no positive correlation between obesity or physical inactivity and BC. A high proportion of women in this study were pre-menopausal which could contribute to the negative findings

Analysis of switching dc-dc converters using a grid-point approach

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An overview of the Nottingham Research Programme on Primary Breast Cancer in Older Women: breast cancer in older women

The incidence of breast cancer increases with age. Despite this, most research in this field is aimed at the younger patient. Preliminary studies have shown that older women with breast cancer have distinct biological features compared to their younger counterparts. In addition, the focus of treatment of older women may not simply be curative but may be a trade-off between risks of treatment and impact on independence and quality of life. The Nottingham research programme is a unique programme dedicated to primary breast cancer in older women. There are two arms of the research programme 1) determining the biological differences of breast cancer in this cohort 2) exploring the use of geriatric assessment to understand the complex needs and factors contributing to treatment decision making in this group of patients. The overall aim of the research programme is to optimise both the biological and geriatric assessment of older women with primary breast cancer, to provide personalised data at diagnosis, on likely survival and quality of life outcomes following breast cancer treatment. This article will outline why this research programme is important, what it has achieved so far and future aspirations

Challenges in Geriatric Oncology—A Surgeon’s Perspective

As our global population ages, we will see more cancer diagnoses in older adults. Surgery is an important treatment modality for solid tumours, forming the majority of all cancers. However, the management of older adults with cancer can be more complex compared to their younger counterparts. This narrative review will outline the current challenges facing older adults with cancer and potential solutions. The challenges facing older adults with cancer are complex and include lack of high-level clinical trials targeting older adults and selection of the right patient for surgery. This may be standard surgical treatment, minimally invasive surgery or alternative therapies (no surgery) which can be local or systemic. The next challenge is to identify the individual patient’s vulnerabilities to allow them to be maximally optimised for treatment. Prehabilitation has been shown to be of benefit in some cancer settings but uniform guidance across all surgical specialties is required. Greater awareness of geriatric conditions amongst surgical oncologists and integration of geriatric assessment into a surgical clinic are potential solutions. Enhanced recovery programmes tailored to older adults could reduce postoperative functional decline. Ultimately, the greatest challenge an older adult with cancer may face is the mindset of their treating clinicians—a shared care approach between surgical oncologists and geriatricians is required

Urotensin II and the Circulatory System

Urotensin II (UII), first isolated from the spinal cord of teleost fish, is the most potent vasoconstrictor known. It is more potent than endothelin-1 and acts through UT-II, a seven-transmembrane-domain, G-protein-coupled receptor. Human UII is an 11-amino-acid cyclic peptide that is expressed in various tissues, including the central nervous system, heart, kidney, and blood vessels. It circulates in human plasma, and its plasma level is elevated in renal failure, congestive heart failure, diabetes, and portal hypertension. In the kidney, UII has vasodilatory and natriuretic effects, mediated through nitric oxide. The development of UII-receptor antagonists may provide a useful research tool, and a novel treatment for cardiorenal diseases