No 'cure' within 12 years of diagnosis among breast cancer patients who are diagnosed via mammographic screening: women diagnosed in the West Midlands region of England 1989-2011.

BACKGROUND: We have previously reported that there is little evidence of population 'cure' among two populations of women diagnosed with invasive breast cancer. 'Cure' has not yet been examined in the context of screen-detection. PATIENTS AND METHODS: We examined cancer registry data on 19 800 women aged 50-70, diagnosed with a primary, invasive, non-metastatic breast cancer between 1 April 1989 and 31 March 2011 in the West Midlands region of England, linked to Hospital Episode Statistics (HES) and the National Breast Screening Service (NBSS). Follow-up was complete on all women up to 31 July 2012. Analyses were stratified by screening status, age, tumour stage, deprivation and ethnicity. We estimated net survival for the whole cohort and each subgroup. Population 'cure' was evaluated by fitting flexible parametric log-cumulative excess hazard regression models in which the excess hazard of breast cancer death was assumed to be equal to zero after a given follow-up time. RESULTS: There was an overall lack of evidence for 'cure'. Across all subgroups examined, the general pattern was that of a continuous decrease in net survival over time, with no obvious asymptotic tendency within 12 years of follow-up. Model-based analyses confirmed this observation. CONCLUSIONS: Despite dramatic improvements in survival over past decades, diagnosis with breast cancer remains associated with a small but persistent increased risk of death for all groups of women, including those whose cancer is detected asymptomatically. These findings are unlikely to be due to methodological inadequacies. Communication of these long-term consequences of breast cancer among women recently diagnosed and to those considering undergoing screening should take due consideration of these patterns

Video-sharing platforms in the revised Audiovisual Media Services Directive

Examines the provisions of the draft Directive amending Directive 2010/13 on the provision of audiovisual media services in view of changing market realities, which apply to video-sharing platforms (VSPs). Discusses the scope of the proposed Directive, including services to which the legislation will apply, defined terms of particular concern, the obligations likely to be placed on VSP providers and jurisdictional issues

Do pre-diagnosis primary care consultation patterns explain deprivation-specific differences in net survival among women with breast cancer? An examination of individually-linked data from the UK West Midlands cancer registry, national screening programme and Clinical Practice Research Datalink.

BACKGROUND: In England and Wales breast cancer survival is higher among more affluent women. Our aim was to investigate the potential of pre-diagnostic factors for explaining deprivation-related differences in survival. METHODS: Individually-linked data from women aged 50-70 in the West Midlands region of England, diagnosed with breast cancer 1989-2006 and continuously eligible for screening, was retrieved from the cancer registry, screening service and Clinical Practice Research Datalink. Follow-up was to the end of July 2012. Deprivation was measured at small area level, based on the quintiles of the income domain of the English indices of deprivation. Consultation rates per woman per week, time from last breast-related GP consultation to diagnosis, and from diagnosis to first surgery were calculated. We estimated net survival using the non-parametric Pohar-Perme estimator. RESULTS: The rate of primary care consultations was similar during the 18 months prior to diagnosis in each deprivation group for breast and non-breast symptoms. Survival was lower for more deprived women from 4 years after diagnosis. Lower net survival was associated with more advanced extent of disease and being non-screen-detected. There was a persistent trend of lower net survival for more deprived women, irrespective of the woman's obesity, alcohol, smoking or comorbidity status. There was no significant variation in time from last breast symptom to diagnosis by deprivation. However, women in more deprived categories experienced significantly longer periods between cancer diagnosis and first surgery (mean = 21.5 vs. 28.4 days, p = 0.03). Those whose surgery occurred more than 12 weeks following their cancer diagnosis had substantially lower net survival. CONCLUSIONS: Our data suggest that although more deprived women with breast cancer display lifestyle factors associated with poorer outcomes, their consultation frequency, comorbidities and the breast cancer symptoms they present with are similar. We found weak evidence of extended times to surgical treatment among most deprived women who were not screen-detected but who presented with symptoms in primary care, which suggests that treatment delay may play a role. Further investigation of interrelationships between these variables within a larger dataset is warranted

Can we screen for pancreatic cancer? Identifying a sub-population of patients at high risk of subsequent diagnosis using machine learning techniques applied to primary care data.

BACKGROUND: Pancreatic cancer (PC) represents a substantial public health burden. Pancreatic cancer patients have very low survival due to the difficulty of identifying cancers early when the tumour is localised to the site of origin and treatable. Recent progress has been made in identifying biomarkers for PC in the blood and urine, but these cannot be used for population-based screening as this would be prohibitively expensive and potentially harmful. METHODS: We conducted a case-control study using prospectively-collected electronic health records from primary care individually-linked to cancer registrations. Our cases were comprised of 1,139 patients, aged 15-99 years, diagnosed with pancreatic cancer between January 1, 2005 and June 30, 2009. Each case was age-, sex- and diagnosis time-matched to four non-pancreatic (cancer patient) controls. Disease and prescription codes for the 24 months prior to diagnosis were used to identify 57 individual symptoms. Using a machine learning approach, we trained a logistic regression model on 75% of the data to predict patients who later developed PC and tested the model's performance on the remaining 25%. RESULTS: We were able to identify 41.3% of patients 60 years were similarly identified at 17 months, with 65% sensitivity, 57% specificity and, 61% AUC. We estimate that combining our algorithm with currently available biomarker tests could result in 30 older and 400 younger patients per cancer being identified as 'potential patients', and the earlier diagnosis of around 60% of tumours. CONCLUSION: After further work this approach could be applied in the primary care setting and has the potential to be used alongside a non-invasive biomarker test to increase earlier diagnosis. This would result in a greater number of patients surviving this devastating disease

Ethnicity, deprivation and screening: survival from breast cancer among screening-eligible women in the West Midlands diagnosed from 1989 to 2011.

BACKGROUND: Social inequalities in breast cancer survival are smaller when the cancer is screen-detected. We examined survival from screen-detected and non screen-detected breast cancer by ethnicity and deprivation. METHODS: Cancer registry data for 20 283 women aged 50-70 years, diagnosed between 1989-2011 and invited for screening, were linked with screening and ethnicity data. We examined Asian, Black and White groups, less deprived and middle/more deprived women. Net survival was estimated using ethnic- and deprivation-specific life tables. Estimates were corrected for lead-time bias and over-diagnosis. RESULTS: Net survival varied by screening history. No significant differences in survival were found by ethnicity. Five-year net survival was 90.0% (95% CI, 89.3-90.8%) in less deprived groups and 86.7% (85.9-87.4%) among middle/more deprived women. Screening benefitted all ethnic and both deprivation groups. Whether screen-detected or not, more deprived women had significantly poorer outcomes: 5-year net survival was 78.0% (76.7-79.2%) for deprived women who were not screen-detected compared with 94.0% (93.1-95.1%) for less deprived women who were screen-detected. CONCLUSIONS: The three ethnic groups differed little in their breast cancer survival. Although screening confers a survival benefit to all, there are still wide disparities in survival by deprivation. More needs to be done to determine what underlies these differences and tackle them