Opting into breast screening over the age of 70 years : seeking evidence to support informed choice

AIM: To provide evidence specific to the Scottish population regarding the risk-benefit balance of women >70 years opting into continued breast screening, which may be used as a basis for patient information documentation. MATERIALS AND METHODS: The present study consisted of a parallel, retrospective data analysis of breast cancer mortality data for breast cancer cases diagnosed between 2009 and 2013 (n=22,013) followed up to 31/12/18, and breast screening programme data from 2010 and 2015 (n=47,235). Screening outcome measures included recall for assessment, oncome of assessment, and tumour features. Tumours were classified as high, intermediate, or low risk according to grade and presence of invasion. Mortality data were linked to age at diagnosis and cause of death was recorded. RESULTS: The proportion of all deaths due breast cancer is inversely related to age at diagnosis. From 77 years, women are more likely to die with breast cancer, than directly due to breast cancer. Mammographic screening accurately identifies breast cancer in older women; however, many of the cancers detected were considered intermediate or low risk. CONCLUSIONS: Harms may outweigh the benefits of continued breast screening in older women. This information should be available to all older women.Peer reviewe

Time-in-area represents foraging activity in a wide-ranging pelagic forager

Successful Marine Spatial Planning depends upon the identification of areas with high importance for particular species, ecosystems or processes. For seabirds, advancements in biologging devices have enabled us to identify these areas through the detailed study of at-sea behaviour. However, in many cases, only positional data are available and the presence of local biological productivity and hence seabird foraging behaviour is inferred from these data alone, under the untested assumption that foraging activity is more likely to occur in areas where seabirds spend more time. We fitted GPS devices and accelerometers to northern gannets Morus bassanus and categorised the behaviour of individuals outside the breeding colony as plunge diving, surface foraging, floating and flying. We then used the locations of foraging events to test the efficiency of 2 approaches: time-in-area and kernel density (KD) analyses, which are widely employed to detect highly-used areas and interpret foraging behaviour from positional data. For KD analyses, the smoothing parameter (h) was calculated using the ad hoc method (KDad hoc), and KDh=9.1, where h = 9.1 km, to designate core foraging areas from location data. A high proportion of foraging events occurred in core foraging areas designated using KDad hoc, KDh=9.1, and time-in-area. Our findings demonstrate that foraging activity occurs in areas where seabirds spend more time, and that both KD analysis and the time-in-area approach are equally efficient methods for this type of analysis. However, the time-in-area approach is advantageous in its simplicity, and in its ability to provide the shapes commonly used in planning. Therefore, the time-in-area approach can be used as a simple way of using seabirds to identify ecologically important locations from both tracking and survey data

Percutaneous sentinel node removal using a vacuum-assisted needle biopsy in women with breast cancer:a feasibility and acceptability study

AIMS: To assess the feasibility and acceptability of large-gauge percutaneous removal of the axillary sentinel lymph node (SLN) using dual gamma probe and ultrasound guidance.MATERIALS AND METHODS: Technetium nanocolloid was administered the day before surgery. On the day of surgery, potential SLNs were identified with gamma probe and ultrasound scanning. A 7 G vacuum-assisted biopsy (VAB) device was inserted percutaneously deep to the target node and the node(s) removed. The gamma probe was used to confirm removal of radiolabelled tissue. At surgery, any residual radiolabelled or blue nodes were removed. Morbidity was assessed via (1) a pain questionnaire immediately after the percutaneous procedure, (2) relevant items from the FACT B+4 questionnaire 7-10 days after surgery, and (3) case note review 1 month after surgery.RESULTS: Twenty-two patients consented and 20 patients underwent the procedure. Radiolabelled nodal tissue was obtained in 18/20 (90%). The mean procedure time was 11 minutes. Four of 18 patients had metastatic disease identified in the VAB excision tissue with 100% sensitivity for axillary metastasis. At axillary surgery, additional intact SLN or fragments were found in 14 patients. No additional metastatic disease was found at surgery. One patient suffered a pneumothorax during instillation of local anaesthetic. The median pain score was 10/100 by visual analogue scale. Immediate post-procedure haematoma was common (14 of 20) and prolonged manual compression frequent.CONCLUSION: VAB removal of sentinel nodes using dual scanning is feasible. Although preliminary sensitivity and specificity levels are encouraging, complications may discourage widespread implementation.</p

Changes in behaviour drive inter-annual variability in the at-sea distribution of northern gannets

The at-sea distribution of seabirds primarily depends on the distance from their breeding&nbsp;colony, and the abundance, distribution and predictability of their prey, which are subject to strong spatial and temporal variation. Many seabirds have developed flexible foraging strategies to deal with this variation, such as increasing their foraging effort or switching to more predictable, less energy dense, prey, in poor conditions. These responses may vary both within and between individuals, and understanding this variability is vital to predict the population-level impacts of spatially explicit environmental disturbances, such as offshore windfarms. We conducted a multi-year tracking study in order to investigate the inter-annual variation in the foraging behaviour and location of a population of northern gannets breeding on Alderney in the English Channel. To do so, we investigated the link between individual-level behaviour and population-level behaviour. We found that a sample of gannets tracked in 2015 had longer trip durations, travelled further from the colony and had larger core foraging areas and home range areas than gannets tracked in previous years. This inter-annual variation may be associated with oceanographic conditions indexed by the North Atlantic Oscillation (NAO). Our findings suggest that this inter-annual variation was driven by individuals visiting larger areas in all of their trips rather than individuals diversifying to visit more, distinct areas. These findings suggest that, for gannets at least, if prey becomes less abundant or more widely distributed, more individuals may be required to forage further from the colony, thus increasing their likelihood of encountering pressures from spatially explicit anthropogenic disturbances

Seabird and seal responses to the physical environment and to spatio-temporal variation in the distribution and abundance of Antarctic krill at South Georgia, with implications for local fisheries management

We used 22 years of seasonally and spatially consistent monitoring data to explore marine predator–prey numerical response relationships. Specifically, we tested whether indices of offspring performance (e.g. offspring mass near the time of their independence and/or growth rate) from three Antarctic krill-dependent predators, showed positive relationships with estimates of krill density, determined using fishery-independent acoustic surveys undertaken towards the middle of the predator breeding season. Results showed that indices of predator reproductive performance had little relationship with krill density. In most years, average krill densities were higher on-shelf than off-shelf, potentially providing ecological buffering for predators provisioning offspring. Interestingly, positive response relationships were evident between predator offspring mass and the spatial distribution of krill, measured using indices that represent levels of inequality (patchiness) in krill distribution. These relationships were strongest using indices that reflected the off-shelf krill spatial distribution. We found that krill density and predator offspring mass were also both negatively influenced by sea surface temperature and the Southern Annular Mode, indicating that the environment exerts strong control over ecosystem processes. Finally, we consider the relevance of our results to the ecological framework used by managers responsible for setting catch limits for the regional fishery for krill

Using habitat models for chinstrap penguins, Pygoscelis antarctica, to inform marine spatial management around the South Sandwich Islands during the penguin breeding season

If not carefully managed, harvesting of krill risks disturbing the ecological balance of many Antarctic and sub-Antarctic sites where krill-dependent predators feed. One of the least disturbed sites anywhere within the Southern Ocean and one where krill fishing has so far been virtually non-existent is the South Sandwich Islands volcanic archipelago. Some of the main krill predators breeding at the South Sandwich Islands are penguins, with five species breeding on the islands, the dominant species of which is the chinstrap penguin. In this paper we report on the results of ARGOS PTT deployments during the chinstrap penguin chick-rearing period, using the recorded foraging trips to develop habitat models. Foraging habitats used by chinstrap penguins during the chick-rearing period were best characterised by distance from the colony and sea surface temperature and, using these two covariates, we predicted foraging habitat use around all islands. We show that the provisions of the South Georgia and South Sandwich Islands Marine Protected Area ensure that chinstrap penguins, and other krill-dependent predators with similar foraging ranges, likely have robust protection during the summer. During the winter, when krill predators are likely to forage further offshore, seasonal sea ice provides a physical barrier to exclude the fishery, again ensuring the islands’ unique biodiversity receives strong protection. However, to the north of the marginal sea ice zone, competition between krill predators and the fishery could exist if the fishery were ever to explore new locations for resource extraction. We make a number of conclusions, including the need for winter tracking data to inform future management options

Enhancing the ecosystem approach for the fishery for Antarctic krill within the complex, variable and changing ecosystem at South Georgia

The objective of the ecosystem approach to fisheries management is to sustain healthy marine ecosystems and the fisheries they support. One of the earliest implementations was in the Southern Ocean, where decision rules and stock reference points were developed for managing the Antarctic krill fishery, together with an ecosystem-monitoring programme intended to aid management decisions. This latter component has not been incorporated directly into management, so here, we consider variability in the krill fishery at South Georgia, relating it to physical and biological monitoring indices, finding sea surface temperature to be a key correlate with both annual catch and long-term biological indices. Some indices from krill predators showed significant positive relationships with krill harvesting in the preceding winter, presumably indicative of the importance of winter foraging conditions. We explore how ecological structure affects results, examining two monitoring sites 100 km apart. Results suggest different biological conditions at the two sites, probably reflecting different scales of ecosystem operation, emphasizing that an appreciation of scale will enhance krill fishery management. Finally, in reviewing different drivers of ecological change, we identify important additional monitoring that would help better reflect ecosystem status, improve the utility of CEMP, providing information necessary for the ecosystem approach at South Georgia

Using a risk assessment framework to spatially and temporally spread the fishery catch limit for Antarctic krill in the west Antarctic Peninsula: A template for krill fisheries elsewhere

The west Antarctic Peninsula is an important breeding and foraging location for marine predators that consume Antarctic Krill (Euphasia superba). It is also an important focus for the commercial fishery for Antarctic krill, managed by the Commission for the Conservation of Antarctic Marine Living Resources (CCAMLR). Aiming to minimise ecosystem risks from fishing, whilst enabling a sustainable fishery, CCAMLR has recently endorsed a new management framework that incorporates information about krill biomass estimates, sustainable harvest rates and a risk assessment to spatially and temporally distribute catch limits. We have applied a risk assessment framework to the west Antarctic Peninsula region (Subarea 48.1), with the aim of identifying the most appropriate management units by which to spatially and temporally distribute the local catch limit. We use the best data currently available for implementing the approach, recognising the framework is flexible and can accommodate new data, when available, to improve future estimates of risk. We evaluated 36 catch distribution scenarios for managing the fishery and provide advice about the scale at which the krill fishery can be managed. We show that the spatial distribution with which the fishery currently operates presents some of the highest risks of all scenarios evaluated. We highlight important issues that should be resolved. We emphasize that for the risk assessment to provide robust estimates of risk, it is important that the management units are at a similar scale to ecosystem function. Managing the fishery at small scales has the lowest risk but may necessitate a high level of management interaction. Our results offer advice to CCAMLR about near-term management and could provide a template for the rest of the southwest Atlantic (Area 48), or fisheries elsewhere. As each data layer influences the outcome of the risk assessment, we recommend that updated estimates of the distribution, abundance and consumption of krill, and estimates of available krill biomass will be key as CCAMLR moves forward to develop a longer-term management strategy. Finally, we highlight that the endeavours reported here are the result of a community effort, demonstrating the value of common enterprise

Using seabird and whale distribution models to estimate spatial consumption of krill to inform fishery management

Ecosystem dynamics at the northwest Antarctic Peninsula are driven by interactions between physical and biological processes. For example, baleen whale populations are recovering from commercial harvesting against the backdrop of rapid climate change, including reduced sea ice extent and changing ecosystem composition. Concurrently, the commercial harvesting of Antarctic krill is increasing, with the potential to increase the likelihood for competition with and between krill predators and the fishery. However, understanding the ecology, abundance, and spatial distribution of krill predators is often limited, outdated, or at spatial scales that do not match those desired for effective fisheries management. We update current knowledge of predator dependence on krill by integrating telemetry-based data, at-sea observational surveys, estimates of predator abundance, and physiological data to estimate the spatial distribution of krill consumption during the austral summer by three species of Pygoscelis penguin, 11 species of flying seabirds, one species of pinniped, and two species of baleen whale. Our models show that the majority of important areas for krill predator foraging are close to penguin breeding colonies in nearshore areas where humpback whales also regularly feed, and along the shelf-break, though we caution that not all known krill predators are included in these analyses. We show that krill consumption is highly variable across the region, and often concentrated at fine spatial scales, emphasizing the need for the management of the local krill fishery at relevant temporal and spatial scales. We also note that krill consumption by recovering populations of krill predators provides further evidence in support of the krill surplus hypothesis, and highlight that despite less than comprehensive data, cetaceans are likely to consume a significant proportion of the krill consumed by natural predators but are not currently considered directly in the management of the krill fishery. If management of the krill fishery is to be precautionary and operate in a way that minimizes the risks to krill predator populations, it will be necessary in future analyses, to include up-to-date and precise abundance and consumption estimates for pack-ice seals, finfish, squid, and other baleen whale species not currently considered

Mammographic density adds accuracy to both the Tyrer-Cuzick and Gail breast cancer risk models in a prospective UK screening cohort

This work was supported by the National Institute for Health Research (NIHR) and Genesis Breast Cancer Prevention Appeal (references GA10-033 and GA13-006). This article presents independent research funded by the NIHR under its Programme Grants for Applied Research (grant RP-PG-0707-10031). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The authors also acknowledge the support of Medical Research Council Health eResearch Centre grant MR/K006665/1