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

Global population structure of <i>P</i>. <i>falciparum msp1</i>, <i>msp2</i> and <i>csp</i> gene.

<p>A minimal spanning tree (MST) generated using Bio Numerics software version 7.6.1 showing the relationship from worldwide isolates. Each circle represents and individual haplotype and the size of the circle is proportional to the number of isolates belonging to that haplotypes. The line connecting the circle is branch length.</p

Prevalence of <i>P</i>. <i>falciparum</i> csp haplotype based on NANP and NVDP repeats and their arrangement.

<p>Prevalence of <i>P</i>. <i>falciparum</i> csp haplotype based on NANP and NVDP repeats and their arrangement.</p

Map of India showing the study site.

<p>Map of India showing the study site.</p

Distribution of allelic family and size variations of vaccine candidate genes in Indian <i>P</i>. <i>falciparum</i> isolates.

<p>Distribution of allelic family and size variations of vaccine candidate genes in Indian <i>P</i>. <i>falciparum</i> isolates.</p

Type of repeats sequence with limited polymorphism of <i>P</i>. <i>falciparum glurp</i> gene in the Indian isolates.

<p>Type of repeats sequence with limited polymorphism of <i>P</i>. <i>falciparum glurp</i> gene in the Indian isolates.</p

Genetic diversity and antibody responses against <i>Plasmodium falciparum</i> vaccine candidate genes from Chhattisgarh, Central India: Implication for vaccine development - Fig 5

<p>(A) Total IgG antibody levels against synthetic peptide of the <i>P</i>. <i>falciparum</i> antigens/epitopes. (B) Levels of total IgG antibody responses among different age groups. (Box plots depict median values with 25th and 75th percentile values represented by the bottom and top edges boxes. Small * indicate that the antibody responses statistically significant differences (* p<0.05) when compared among different age groups.</p

Genetic diversity and antibody responses against <i>Plasmodium falciparum</i> vaccine candidate genes from Chhattisgarh, Central India: Implication for vaccine development

<div><p>The genetic diversity in <i>Plasmodium falciparum</i> antigens is a major hurdle in developing an effective malaria vaccine. Protective efficacy of the vaccine is dependent on the polymorphic alleles of the vaccine candidate antigens. Therefore, we investigated the genetic diversity of the potential vaccine candidate antigens i.e. <i>msp-1</i>, <i>msp-2</i>, <i>glurp</i>, <i>csp and pfs25</i> from field isolates of <i>P</i>.<i>falciparum</i> and determined the natural immune response against the synthetic peptide of these antigens. Genotyping was performed using Sanger method and size of alleles, multiplicity of infection, heterogeneity and recombination rate were analyzed. Asexual stage antigens were highly polymorphic with 55 and 50 unique alleles in <i>msp-1</i> and <i>msp-2</i> genes, respectively. The MOI for <i>msp-1</i> and <i>msp-2</i> were 1.67 and 1.28 respectively. A total 59 genotype was found in <i>glurp</i> gene with 8 types of amino acid repeats in the conserved part of RII repeat region. The number of NANP repeats from 40 to 44 was found among 55% samples in <i>csp</i> gene while <i>pfs25</i> was found almost conserved with only two amino acid substitution site. The level of genetic diversity in the present study population was very similar to that from Asian countries. A higher IgG response was found in the B-cell epitopes of msp-1 and csp antigens and higher level of antibodies against csp B-cell epitope and glurp antigen were recorded with increasing age groups. Significantly, higher positive responses were observed in the csp antigen among the samples with ≥42 NANP repeats. The present finding showed extensive diversity in the asexual stage antigens.</p></div

Frequency distribution of different allelic variations of <i>P</i>. <i>falciparum msp1</i>, <i>msp2</i> and <i>glurp</i> genes in Indian isolates.

<p>Frequency distribution of different allelic variations of <i>P</i>. <i>falciparum msp1</i>, <i>msp2</i> and <i>glurp</i> genes in Indian isolates.</p