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

Estimating apparent survival of sub-adult and adult white sharks (Carcharodon carcharias) in central California using mark-recapture methods

Quantifying life history parameters of marine top predators is challenging, as observations are difficult and uncertainty in sex assignment can confound the determination of sex specific parameters. However, these parameters are critical for accurate population assessments and understanding of population dynamics. Using mark recapture observations at white shark foraging aggregation sites, we tested for differences in survival between sexes and estimated apparent survival for sub-adult and adult white sharks in neritic waters off central California. We used 6 years of mark-recapture data and a model that accounted for imperfect detection and imperfect sex assignment. Empirical information based on direct observations suggests that there are no sex-specific or temporal differences in survival during the study period and that survival was estimated to be 0.90; SE = 0.04. Additionally, after animals whose sex was unknown throughout the study period were probabilistically assigned to sex, the ratio in this sample is estimated to be 2.1 males for every female observed. This estimated ratio is lower than the observed ratio of 3:1. We demonstrate that the estimated capture probability for males was roughly twice as high as that for females (0.41, SE = 0.06 and 0.19, SE = 0.07 respectively). Together these results suggest (1) that the sex ratio is uneven but not as skewed as uncorrected observation data would suggest and (2) that unequal mortality in older age classes are not the cause of the observed sex bias but more likely results from disparate mortality earlier in life or differences in behavior. Future research is needed to explore the potential causes of the observed sex bias

Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF

BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes