Disability and participation in breast and bowel cancer screening in England: a large prospective study.

BACKGROUND: There is limited information about participation in organised population-wide screening programmes by people with disabilities. METHODS: Data from the National Health Service routine screening programmes in England were linked to information on disability reported by the Million Women Study cohort participants. RESULTS: Of the 473 185 women offered routine breast or bowel cancer screening, 23% reported some disability. Women with disabilities were less likely than other women to participate in breast cancer screening (RR=0.64, 95% CI: 0.62-0.65) and in bowel cancer screening (RR=0.75, 0.73-0.76). Difficulties with self-care or vision were associated with the greatest reduction in screening participation. CONCLUSION: Participation in routine cancer screening programmes in England is reduced in people with disabilities and participation varies by type of disability

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

The burden of risk factors for non-communicable disease in rural Bihar, India: A comparative study with national health surveys

Background The incidence of non-communicable diseases (NCDs) is increasing in rural India. The National Family Health Survey-5 (NFHS-5) provides estimates of the burden of NCDs and their risk factors in women aged 15–49 and men aged 15–54 years. The aim of this study is to estimate the prevalence of hypertension and body-mass index (BMI) in adults aged 35–70 years in rural India and to compare these estimates, where age ranges overlap, to routinely available data. Methods The Non-Communicable Disease in Rural India (NCDRI) Study was a cross-sectional household survey of 1005 women and 1025 men aged 35–70 conducted in Bihar in July 2019. Information was collected on personal characteristics, self-reported medical history and physical measurements (blood pressure, height and weight). Prevalence estimates for hypertension (systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, or diagnosed and treated for hypertension), and for underweight (body-mass index < 18.5 kg/m2), normal weight (18.5–25.0 kg/m2) and overweight (≥ 25.0 kg/m2) were calculated. Where age ranges overlapped, estimates from the NCDRI Study were compared to the NFHS-5 Survey. Results In the NCDRI Study, the estimated prevalence of hypertension was 27.3% (N = 274) in women and 27.6% (N = 283) in men aged 35–70, which was three-times higher in women and over two-times higher in men than in the NFHS-5 Survey. One-quarter (23.5%; N = 236) of women and one-fifth (20.2%; N = 207) of men in the NCDRI Study were overweight, which was approximately 1.5 times higher than in the NFHS-5 Survey. However, where age groups overlapped, similar age-standardized estimates were obtained for hypertension and weight in both the NCDRI Study and the NFHS-5 Survey. Conclusion The prevalence of NCDs in rural India is higher than previously reported due to the older demographic in our survey. Future routine national health surveys must widen the age range of participants to reflect the changing disease profile of rural India, and inform the planning of health services

Night shift work and breast cancer incidence: Three prospective studies and meta-analysis of published studies.

Background It has been proposed that night-shift work could increase breast cancer incidence. A 2007 WHO review concluded, mainly from animal evidence, that shift work involving circadian disruption is probably carcinogenic to humans. We therefore aimed to generate prospective epidemiological evidence on night-shift work and breast cancer incidence. Methods 522,246 Million Women Study, 22,559 EPIC-Oxford, and 251,045 UK Biobank participants answered questions on shift work and were followed for incident cancer. Cox regression yielded multivariable-adjusted breast cancer incidence rate ratios (RRs) and 95% confidence intervals (CIs) for night-shift work vs no night-shift work, and likelihood ratio tests for interaction were used to assess heterogeneity. Our meta-analyses combined these and RRs from the 7 previously published prospective studies (1.4 million women in total), using inverse-variance weighted averages of the study-specific log RRs. Results In the Million Women Study, EPIC-Oxford, and UK Biobank, respectively, 673, 28, and 67 women who reported night-shift work developed breast cancer, and the RRs for any versus no night-shift work were 1.00 (95% CI=0.92-1.08), 1.07 (95% CI=0.71-1.62), and 0.78 (95% CI=0.61-1.00). In the Million Women Study, the RR for ≥20 years of night-shift work was 1.00 (95% CI=0.81-1.23), with no statistically significant heterogeneity by sleep patterns or breast cancer risk factors. Our meta-analysis of all 10 prospective studies included 4660 breast cancers in women reporting night-shift work; compared with other women, the combined RR was 0.99 (95% CI=0.95-1.03) for any night-shift work, 1.01 (95% CI=0.93-1.10) for ≥20 years of night-shift work, and 1.00 (95% CI=0.87-1.14) for ≥30 years. Conclusion The totality of the prospective evidence shows that night-shift work, including long-term shift work, has little or no effect on breast cancer incidence.</p

Night shift work and breast cancer incidence: Three prospective studies and meta-analysis of published studies.

Background It has been proposed that night-shift work could increase breast cancer incidence. A 2007 WHO review concluded, mainly from animal evidence, that shift work involving circadian disruption is probably carcinogenic to humans. We therefore aimed to generate prospective epidemiological evidence on night-shift work and breast cancer incidence. Methods 522,246 Million Women Study, 22,559 EPIC-Oxford, and 251,045 UK Biobank participants answered questions on shift work and were followed for incident cancer. Cox regression yielded multivariable-adjusted breast cancer incidence rate ratios (RRs) and 95% confidence intervals (CIs) for night-shift work vs no night-shift work, and likelihood ratio tests for interaction were used to assess heterogeneity. Our meta-analyses combined these and RRs from the 7 previously published prospective studies (1.4 million women in total), using inverse-variance weighted averages of the study-specific log RRs. Results In the Million Women Study, EPIC-Oxford, and UK Biobank, respectively, 673, 28, and 67 women who reported night-shift work developed breast cancer, and the RRs for any versus no night-shift work were 1.00 (95% CI=0.92-1.08), 1.07 (95% CI=0.71-1.62), and 0.78 (95% CI=0.61-1.00). In the Million Women Study, the RR for ≥20 years of night-shift work was 1.00 (95% CI=0.81-1.23), with no statistically significant heterogeneity by sleep patterns or breast cancer risk factors. Our meta-analysis of all 10 prospective studies included 4660 breast cancers in women reporting night-shift work; compared with other women, the combined RR was 0.99 (95% CI=0.95-1.03) for any night-shift work, 1.01 (95% CI=0.93-1.10) for ≥20 years of night-shift work, and 1.00 (95% CI=0.87-1.14) for ≥30 years. Conclusion The totality of the prospective evidence shows that night-shift work, including long-term shift work, has little or no effect on breast cancer incidence.</p