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

Coal: A Key Player in Expanded U.S. Energy Exports

In a November 2012 report that received significant attention in the media, the International Energy Agency (IEA) predicted that the United States will be nearly energy self-sufficient by the year 2035. Justifications for this claim include reports of declining oil consumption, the unlocking of natural gas resources through new technologies, and overall increases in U.S. energy production. As natural gas becomes more inexpensive and renewable energy sources continue to increase in usage, the energy mix in the United States (and other countries) is expected to change. The IEA estimates that 40 percent of world electricity generation was fueled by coal in 2011. Coal is the only major energy source for which the United States demonstrates a trade surplus. In 2011, the last calendar year for which data are available, the United States exported more than $16 billion worth of coal, while importing only slightly less than$3 billion in coal. Furthermore, coal is expected to remain one of the largest fuel sources in worldwide energy consumption for at least the next two decades. Second only to oil in meeting the energy needs of the world, coal generates more electricity for the United States and the world than any other single fuel. With the key role that coal currently plays in the U.S. trade balance, and is expected to play in the future, it is interesting to look at recent volatile export price movements of this important U.S. resource.BLS_BTN_Coal_a_key_player.pdf: 100 downloads, before Oct. 1, 2020