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1.
Journal of Investigative Dermatology ; 142(8):S105, 2022.
Article in English | EMBASE | ID: covidwho-1956223

ABSTRACT

There is global interest in both the beneficial and detrimental health effects of ultraviolet-C (UVC) radiation in the wavelength range 200-230 nm (known as Far-UVC). Technology using Far-UVC is proposed as a highly effective control measure for reducing the transmission of COVID-19. Far-UVC, and other wavelengths of UVC, are well-known to efficiently inactivate pathogens in air and on surfaces. Although studies have shown irradiation of skin with 254 nm UV results in DNA damage in the epidermal basal layer, irradiation with Far-UVC (222 nm) shows minimal DNA damage and only in the granular layer, which is comprised of non-proliferating keratinocytes. Therefore, accumulation of these DNA photoproducts would not be expected to be associated with cancer risk. It has also been shown that even high doses of Far-UVC exposure to human skin do not induce erythema. However, the effects of Far-UVC on the immune system are, to the best of our knowledge, unknown. It is well-reported that both ultraviolet B (UVB 280-315 nm) and ultraviolet-A (UVA 315-400 nm) have effects on cutaneous Langerhans cells (LC), inducing migration from the epidermis to the draining lymph nodes, thereby suppressing skin immune function. Here we present data generated in a range of skin types (Fitzpatrick II-V) demonstrating little or no impact of Far-UVC on the cutaneous immune system, as assessed by Langerhans cell migration, at doses of up to 3,000 mJ/cm2 (US daily limit is 450 mJ/cm2). These results support the safety of filtered Far-UVC use, which could have a transformative effect on public health, allowing effective virus inactivation and reduction of transmission independent of human behavior. Conflict of interest disclosure: the authors state no conflict of interest. However, MJC and RPH are directors of Ten Bio Ltd, a company focused on developing human skin explant models.

2.
Cytopathology ; 33(4):426-429, 2022.
Article in English | EMBASE | ID: covidwho-1937919
3.
Asia Pacific Journal of Cancer Biology ; 7(2):133-141, 2022.
Article in English | EMBASE | ID: covidwho-1887434

ABSTRACT

Background: Personalised nutrition and medicine are the future of healthcare. In relation to cancer, public and healthcare professionals often seek dietary recommendations for cancer prevention. Among the important cancers that can be prevented by diet and lifestyle is colorectal cancer (CRC). CRC is one of the commonest cancers globally, and is a major health concern in Malaysia as it presents with high mortality and morbidity rates, causing a significant socioeconomic burden to the country. While extensive research has been conducted on the treatment and mechanisms of cancer, there have been no reports on the associations between metabolites, novel biomarkers of cancer, and dietary patterns in the context of cancer prevention in the Malaysian multiethnic population. Methods: A case control study will be conducted in Malaysia, involving patients diagnosed with CRC, colorectal adenoma and a group of healthy participants. Multiple endpoints will be analyzed, namely metabolomic signatures, epigenetic marks, inflammatory markers and relationship with dietary patterns will be established. Multiple machine learning models will then be used to develop personalised risk stratification algorithms. Recruitment began in July 2019 and is ongoing due to COVID-19 pandemic. Discussion: This study will be the first to identify alterations in metabolites, inflammatory markers and epigenetic marks associated with dietary patterns and CRC risk in Malaysia. Understanding on how dietary patterns influence CRC risk in the multi-ethnic Malaysian population and identification of novel oncometabolites for CRC risk, will allow for development of personalised evidence-based recommendations in reducing individual risks of CRC

4.
Russian Journal of Cardiology ; 27(3):107-114, 2022.
Article in Russian | EMBASE | ID: covidwho-1870171

ABSTRACT

The review aim was to familiarize biomedical professionals with the latest evidence-based data on the effect of sparsely ionizing radiation (X-ray, γ- and β-radiation) on cardiovascular mortality (ICD-9: 390-459;ICD-10: I00-I99), which is especially important during the coronavirus disease 2019 (COVID-19) pandemic due to the increased use of computed tomography (CT) and X-ray procedures. Information is presented on the officially accepted range of radiation doses (very low doses — 0-0,01 Gy, low doses — 0,01-0,1 Gy, moderate doses — 0,11,0 Gy, high doses — over 1 Gy). The evolution of ideas about the effects of radiation on the prevalence of cardiovascular diseases is discussed: From high and very high doses to the declaration in recent years of the possible effect of low doses. The statements from the documents of authoritative radiation organizations (UNSCEAR, ICRP, NCRP, EPA, etc.) are given, according to which the threshold for increasing cardiovascular mortality is 0,5 Gy (range of moderate doses), and there are no epidemiological justifications for the effects of low doses. According to a data for six countries, the maximum cumulative doses from multiple CT scans for COVID-19 diagnosis are one order less than the threshold dose, and the average cumulative doses are two orders less. Data on the absence or low risk of cancer after CT for this reason are also presented.

5.
Annals of Oncology ; 33:S184, 2022.
Article in English | EMBASE | ID: covidwho-1850629

ABSTRACT

Background: Risk-stratified BCS, integrating personal, familial variables and a polygenic risk score (PRS) is a promising strategy that may improve current BCS outcomes. Real-time risk assessment and field implementation are some of the main challenges for such an approach. Methods: MyPeBS is an ongoing EU-funded international randomized trial running in 6 countries. Eligible women (wn) aged 40-70 are randomized 1:1 between continuing standard organized BCS as recommended in their participating country/region and switching to risk-stratified BCS, in which BCS schedule and modalities are adapted to the individual predicted 5-year risk of invasive BC (IBC). Primary endpoint is 4-year incidence of stage 2 and higher BC. Secondary endpoints include PROs. 5-year IBC risk is estimated using the Mammorisk® BCSC-derived or the Tyrer Cuzick risk score and the centrally-determined PRS313 obtained from a saliva sample and calibrated for national BC incidence and age. We aim to describe 1) the feasibility of real-time assessment of BC risk and 2) the characteristics and risk profiles of the participants. Results: As of Sept. 7, 2021, 16,550 wn had been randomized. 29% were aged <50 (median age 54 (range 40-70), 13% had a previous benign breast biopsy, 40% a mammographic breast density C or D, 19% a 1st degree family history of breast or ovarian cancer;72% had tertiary education. 36% were estimated at low risk (<1% risk of IBC at 5 years), 29% at average risk, and 35% at high (34%) or very high risk (1%) (>1.67% and >6% risk, respectively). Only 2.5% of DNA extractions were not usable for genotyping, due to DNA concentration or quality;and 98.8% of the eligible DNA samples were successfully genotyped. Median turnover time from saliva sampling to risk result available was 11 weeks despite the COVID pandemic (currently 7 weeks). Conclusions: Real-time BC risk assessment based on a large set of polymorphisms, family, screening and hormonal history, and breast density is feasible within organized screening programmes. Participants are so far representative of different categories with some over-representation of highly educated participants. Clinical trial identification: NCT03672331. Legal entity responsible for the study: Unicancer. Funding: European Commission and French National Cancer Institute. Disclosure: S. Delaloge: Financial Interests, Institutional, Advisory Board: AstraZeneca;Financial Interests, Institutional, Invited Speaker: Exact Sciences;Financial Interests, Institutional, Advisory Board: Novartis;Financial Interests, Institutional, Advisory Board: Pierre fabre;Financial Interests, Institutional, Advisory Board: Orion;Financial Interests, Institutional, Advisory Board: Sanofi;Financial Interests, Institutional, Advisory Board: Rappta;Financial Interests, Institutional, Advisory Board: Cellectis;Financial Interests, Institutional, Advisory Board: Isis/servier;Financial Interests, Institutional, Invited Speaker: Pfizer;Financial Interests, Institutional, Invited Speaker: Seagen;Financial Interests, Institutional, Invited Speaker: Lilly;Financial Interests, Institutional, Invited Speaker: AstraZeneca;Financial Interests, Institutional, Invited Speaker: MSD;Financial Interests, Institutional, Advisory Board, ad board: Besins Healthcare;Financial Interests, Institutional, Invited Speaker: Roche Genentech;Financial Interests, Institutional, Invited Speaker: BMS;Financial Interests, Institutional, Invited Speaker: Puma;Financial Interests, Institutional, Invited Speaker: AstraZeneca;Financial Interests, Institutional, Invited Speaker: Orion;Financial Interests, Institutional, Invited Speaker: Sanofi;Financial Interests, Institutional, Funding: GE;Financial Interests, Institutional, Invited Speaker: Pfizer;Financial Interests, Institutional, Invited Speaker, clinical research funding to my institution: Taiho;Non-Financial Interests, Invited Speaker, Société Française de Sénologie et Pathologie Mammaire: SFSPM. D. Keatley: Financial Interests, Personal, Advisory Board: Public Advisory Board of Heealth Data UK. E. Gauthier: Financial Interests, Personal, Stocks/Shares: Predilife;Financial Interests, Personal, Full or part-time Employment: Predilife. S. Michiels: Financial Interests, Personal, Advisory Role: IDDI;Financial Interests, Personal, Advisory Role: Amaris;Financial Interests, Personal, Advisory Role: Roche;Financial Interests, Personal, Advisory Role: Sensorion;Financial Interests, Personal, Advisory Role: Biophytis;Financial Interests, Personal, Advisory Role: Servier;Financial Interests, Personal, Advisory Role: Yuhan. All other authors have declared no conflicts of interest.

6.
American Family Physician ; 105(4):406-411, 2022.
Article in English | EMBASE | ID: covidwho-1848264

ABSTRACT

Ulcerative colitis is a relapsing and remitting inflammatory bowel disease of the large intestine. Risk factors include recent Salmonella or Campylobacter infection and a family history of ulcerative colitis. Diagnosis is suspected based on symptoms of urgency, tenesmus, and hematochezia and is confirmed with endoscopic findings of continuous inflammation from the rectum to more proximal colon, depending on the extent of disease. Fecal calprotectin may be used to assess disease activity and relapse. Medications available to treat the inflammation include 5-aminosalicylic acid, corticosteroids, tumor necrosis factor-alpha antibodies, anti-integrin antibodies, anti-interleukin-12 and -23 antibodies, and Janus kinase inhibitors. Choice of medication and method of delivery depend on the location and severity of mucosal inflammation. Other treatments such as fecal microbiota transplantation are considered experimental, and complementary therapies such as probiotics and curcumin have mixed data. Surgical treatment may be needed for fulminant or refractory disease. Increased risk of colorectal cancer and use of immunosuppressive therapies affect the preventive care needs for these patients.

7.
Int J Radiat Biol ; : 1-15, 2022 May 26.
Article in English | MEDLINE | ID: covidwho-1830591

ABSTRACT

The lessons learned from the Coronavirus Disease 2019 (COVID-19) pandemic are numerous. Low dose radiotherapy (LDRT) was used in the pre-antibiotic era as treatment for bacterially/virally associated pneumonia. Motivated in part by these historic clinical and radiobiological data, LDRT for treatment of COVID-19-associated pneumonia was proposed in early 2020. Although there is a large body of epidemiological and experimental data pointing to effects such as cancer at low doses, there is some evidence of beneficial health effects at low doses. It has been hypothesized that low dose radiation could be combined with immune checkpoint therapy to treat cancer. We shall review here some of these old radiobiological and epidemiological data, as well as the newer data on low dose radiation and stimulated immune response and other relevant emerging data. The paper includes a summary of several oral presentations given in a Symposium on "Low dose RT for COVID and other inflammatory diseases" as part of the 67th Annual Meeting of the Radiation Research Society, held virtually 3-6 October 2021.

8.
Pakistan Journal of Medical and Health Sciences ; 16(2):126-129, 2022.
Article in English | EMBASE | ID: covidwho-1798529

ABSTRACT

Aim: Comparison of safety profile of low dose CT scan chest with standard dose CT scan in Covid 19. Study design: Prospective study Place and duration of study: Department of Radiology, Benazir Bhutto Hospital, Rawalpindi from -01-09-2020 to 31-03-2021. Methods After approval from ERB, 45 COVID-19 positive patients diagnosed by PCR, aged 55 years and above were selected. In the prospective study, these patients with normal CXR were advised for same day chest CT scan. Initially, a standard dose of chest CT scan of 150mAs was applied. After assessing the chest signs of Covid on scan, a low-dose CT of 30mAs was performed instantly. A comparison was made to check the diagnostic accuracy of standard-dose and low-dose CT for the identification of features of typical COVID19 pneumonia. Results: The mean age of patients was 58.27±7.23. An admirable intra-reader agreement was found between low- and standard-dose CT in identifying typical findings of COVID pneumonia (intraclass correlation coefficient [ICC] = 0.98–0.99 with A p value of less than 0.001 of all readers). Mean effective dose values of low and standard dose groups were 1.69±0.38 mSv and 7.21±1.23, correspondingly. Values of absolute cancer risk per mean cumulative effective dose of low & standard dose chest CT examinations were 0.68 × 10−4 and 2.41×10−4 respectively. Conclusions: The low dose CT chest protocol is better than standard dose for the identification of typical COVID-19 pneumonia features in routine practice with substantial decrease in dose of radiation as well as estimated cancer risk.

9.
Oncology Issues ; 37(2):10-11, 2022.
Article in English | EMBASE | ID: covidwho-1795512
10.
2021 IEEE 13th International Conference on Humanoid, Nanotechnology, Information Technology, Communication and Control, Environment, and Management, HNICEM 2021 ; 2021.
Article in English | Scopus | ID: covidwho-1788685

ABSTRACT

In a worldwide perspective of the most common cancer diseases, cervical cancer is ranked fourth most frequent whereas the worldwide mortality rate is at 54.56%. In the Philippines, the second leading site among women is cervical cancer next to breast cancer. Research shows that cervical cancer is one of the most treatable cancer forms if detected and managed early. Currently, the most reliable diagnosis and prevention method of cervical cancer is thru a regular testing via Pap Smear test and HPV vaccination being performed in hospitals worldwide. However, according to the Centers for Disease Control and Prevention in California, the cervical cancer screening rate of regular testing in hospitals went down significantly during the stay-at-home order by the government due to the COVID-19 pandemic. Also, there are limited research based on the behavior information in relation to cervical cancer risk prediction, but existing studies proves the possibility of the risk prediction based on behavior information. This paper presents an Artificial Neural Network-based model for early cervical cancer risk detection based on behavior information. The neural network was trained using scaled conjugate gradient back propagation. The system showed 98% overall correctness in early cervical cancer risk prediction. © 2021 IEEE.

11.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779490

ABSTRACT

The COVID-19 pandemic has created many challenges and barriers to care for patients on active cancer treatments including increased risk for morbidity and mortality from COVID-19 infection and restricted access to care. Specific patient groups, such as the uninsured and patients of underrepresented minority communities, have experienced this burden disproportionately. The rapid development and emergency authorization of COVID-19 vaccinations present an opportunity to mitigate some of this increased risk and improve health outcomes for patients on active cancer treatments. However, little is known regarding the rate of vaccination in this patient group. We study the rate of COVID-19 vaccination in a single institution infusion therapy clinic for cancer patients at a large academic county hospital in San Antonio which serves a high-risk patient population with a high representation of minority patient and uninsured patients. Patients were surveyed on arrival to the University Health System outpatient infusion clinic between May 2021 and June 2021. COVID-19 vaccinations became available to this patient population in February 2021. Starting the survey process three months after the first vaccination availability allowed sufficient time for patients to become fully vaccinated. Of the 194 patients surveyed between May 3, 2001 and June 25, 2021, 56% reported receiving at least one dose of a COVID-19 vaccination which is lower than the community vaccination rate of 76%. Patients were given 6 options to choose from for declining the vaccination. They included: 1. I do not think it is safe for me because I have cancer 2. My doctor has not told me to get the vaccine 3. I want the vaccine but have not been able to schedule an appointment 4. I'm afraid of the side effects 5. I already had COVID, so I do not think I need the vaccine 6. Other The most common reason given for declining the vaccination was "My doctor has not told me to get the vaccine" by 30% of patients and the second most common was "I do not think it is safe for me because I have cancer" by 28% of patients. "I'm afraid of the side effects" was thethird most common response given by 23% of patients. Interestingly, access to the vaccine was not a common reason with only 10% of patients reporting this reason for not getting vaccinated. The three most common reasons cancer patients declined the COVD-19 vaccination can all be addressed by improvement in patient/physician communication regarding the known safety of the novel COVID-19 vaccinations and the recommendation for cancer patients to be vaccinated to help improve overall safety of giving immunosuppressive medications during the pandemic. This study shows the impact that healthcare works can make in increasing the COVID-19 vaccination rate in a high-risk population.

12.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779482

ABSTRACT

The Covid-19 pandemic put a considerable strain on U.S. healthcare resources, resulting in significant disruptions in breast cancer care. Treatment protocols across the cancer care continuum were modified to permit continued delivery of critical cancer care with the lowest risk of Covid-19 transmission for both patients and healthcare providers. These deviations from standard treatment protocols revealed to patients the complexity of navigating cancer treatment, including critical dependencies and care coordination. While much of the research on cancer treatment protocols during the pandemic focuses on effectiveness or health outcomes, this research investigates the experiences of breast cancer survivors as they navigated the uncertainties and complexities of their cancer care during the Covid-19 pandemic. Method: We conducted a qualitative content analysis of survey data documenting patient experiences of the impact of Covid-19 related disruptions in cancer care and the challenges of navigating breast cancer treatment during the pandemic. Data for this analysis come from a larger data set collected from a national survey of adult breast cancer survivors, distributed online from 4/2/20 to 4/27/20. We used snowball sampling to recruit adult (>18 years old) breast cancer survivors in the US. A 50-item survey instrument was administered to breast cancer survivors in the U.S to assess the impact of COVID-19 on breast cancer care. SResults: A total of 633 respondents completed the survey. We analyzed data from seven questions eliciting free-text responses detailing the nature of the delays in care and the impact of the delays on the physical, psycho-social, and practical aspects of life, yielding a sample size of 421 respondents. Patients reported experiencing a broad range of challenges across the cancer care continuum based on factors such as tumor type, disease stage, age, location and type of cancer care facility, and whether they were newly diagnosed, in active treatment, or completed active treatment. Respondents reported changes in the sequence, type, frequency, or location of treatment, follow-up, and symptom management. These changes were initiated by both providers and patients. Changes were associated with limited access to ancillary or supportive services such as imaging, labs, physical therapy and mental health care, and restricted availability of medical facilities such as operating rooms or emergency rooms. Balancing the risks of cancer and Covid-19 infection generated considerable uncertainty and anxiety for patients and their families, which they often attributed to feeling unable to reliably assess individual risk or prognosis. Respondents noted that navigating treatment protocol changes was further exacerbated by limitations on usual support services and resources, most notably restrictions prohibiting a companion or caregiver to accompany patients to appointments and changes in the frequency and channels of communication between survivors and their cancer care team. Conclusion: Our results point to the complex challenges and dependencies patient experienced in navigating cancer care during the Covid-19 pandemic. We suggest that a detailed understanding of patient experiences is critical to assessing the impact of the pandemic on cancer care, especially modifications to treatment protocols and other disruptions in care. These findings have implications beyond the crisis of the pandemic and can inform interventions to improve care coordination and communication between patients and providers and identify evidence-based opportunities to enhance breast cancer support and patient navigation in the U.S.

13.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779461

ABSTRACT

Introduction: Approximately, 10-15% of breast cancers may be hereditary. Early identification of elevated genetic risk may decrease morbidly and mortality associated with breast cancer for this population by enabling timely implantation of optimized screening techniques. Reaching out to women with breast cancer risk assessment at the time of mammography may provide an opportunity to connect risk perception with risk reduction action. We hypothesized that women receiving a high-risk assessment at the time of mammography would facilitate entry to genetic counseling. Methods: In September 2019, Jefferson Health New Jersey (JHNJ) started utilizing a tool to screen individuals for an increased risk for hereditary breast cancer syndromes (family history screening 7;FHS-7) to all women presenting for mammography at its three breast imaging centers. The FHS-7 tool was embedded into the electronic medical record system and would generate a score based on 7 questions related to a patient's family history of breast, ovarian and bowel cancer. Women who were identified at elevated risk (FHS-7 scores ≥1) were asked by the mammography technician prior to performing the screening mammogram for their permission to be contacted by a high-risk counselor for a formal high-risk assessment and potential genetic counseling/testing. In March 2020, nearly all cancer screening services shut down with the COVID-19 pandemic. Services re-opened in June 2020. We report on our experience in three-time frames: September 2019-February 2020;March 2020-May 2020, and June 2020-present. Results: From September 2019-February 2020: 3, 169 mammograms and FHS-7 screenings were performed. 44 had scores ≥1 (1.4%). 4 (9%) agreed to be contacted for an appointment with a high-risk counselor. Of these, 2 had previously met with genetics. No additional appointments were scheduled. From March 2020-May 2020, 576 mammograms and FHS-7 screenings were performed. 9 had scores ≥1 (1.6%). None agreed to be contacted for an appointment with a high-risk counselor. Two appointments had previously been completed. From June 2020-June 2021, 9, 131 mammogramsand FHS-7 screenings were performed. 240 had scores ≥1 (2.6%). 22 (9%) agreed to be contacted for an appointment with genetics. 11 appointments had previously been completed. 8 (73%) were completed as a consequence of this direct outreach. Conclusion: Although our work was interrupted by the COVID-19 pandemic, screening for hereditary risk at the time of mammography may be an effective way of facilitating referrals for genetic counseling/testing for high-risk patients. Consent to be contacted for a formal high-risk assessment was consistent at 9% pre-mammography closure and post-mammography re-opening. Consent to be contacted for genetics is likely to be associated with breast cancer risk perception. Future Directions: We are planning an educational intervention regarding the FSH-7 risk assessment tool and a positive score's association with the risk of hereditary breast cancer syndromes, as well as the benefits of optimized screening techniques depending on a patient's life-time risk of developing breast cancer. We anticipate that this will likely result in greater acceptance of a formal high-risk assessment for this at-risk population.

14.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779454

ABSTRACT

OBJECTIVES AND RATIONALE Estimating the impact of COVID-19 on cancer screening programs and related outcomes can help health services prepare for potential delays in diagnoses and different demands on treatment services and plan for best approaches to recovery. Simulation modelling enables estimation of outcomes for a range of scenarios. In this study, we estimate the impact of various disruptions and recovery strategies for the Australian biennial mammographic breast screening program (BreastScreen). METHOD Policy1-Breast is a continuous-time, multiple-cohort micro-simulation model that simulates the whole Australian female population, incorporating breast cancer risk and natural history, breast density, menopause, hormone therapy use and breast cancer screening. Firstly, in the early stages of the COVID pandemic we used Policy1-Breast to evaluate how 3, 6, 9 and 12-month pauses to BreastScreen would impact on population-level breast cancer diagnoses, tumour staging, and breast cancer survival, compared to business-as-usual (BAU) outcomes. Secondly, to explore options for recovery after an actual one-month screening pause in April 2020, we evaluated a range of assumed throughput levels following screening resumption (50% or 80% up to December, then 100% to 120% from Jan 2021), comparing various protocols where specific sub-groups of clients were prioritised for screening during the recovery Speriod. Outcomes are reported for the target age range for the BreastScreen program (50-74 years). RESULTS For 3-to 12-month pauses, we estimated a slight reduction in 5-year survival following diagnosis for women directly affected by a pause, but no discernible changes to population-level breast cancer mortality rates up to 2023. We estimated marked fluctuations in population rates of invasive breast cancer diagnoses with a 10% increase in cancer diagnoses between 2020-2021 and 2022-2023. For a 12-month pause to screening we estimate that population-level breast cancers would increase in size (with an additional 4% >15mm at diagnosis) and be more likely to involve the nodes (increasing from 26% to 30% of all cancers). We estimate that median screening intervals during 2020-2021 would increase from 104 weeks under BAU up to 130 weeks with a 12-month pause, and BreastScreen recall rates and false positive recall rates would fluctuate markedly over time. For the second evaluation of a one-month pause followed by various throughput and prioritisation scenarios, we estimated that screen-detected cancer rates would vary markedly with throughput but interval cancer rates would not, leading to fluctuations in program sensitivity of up to 6%. Reflecting the periodic nature of screening participation, we estimated the extent to which longer-term future screening participation rates are expected echo the peaks and troughs in participation due to the impacts of the COVID pandemic in 2020. We estimate that for a given throughput assumption, client prioritisation could lead to different rescreening rates, screening intervals, and time required for prioritisation protocols, with little change to cancer outcomes. CONCLUSION These modelled evaluations estimate short and longer-term effects of COVID-19 on the impact of population breast cancer screening in Australia. The estimated changes in breast cancer rates and characteristics would be expected to have a flow-on effect on the demand for treatment services in terms of throughput and case-mix. Preparing for such outcomes is critical given that treatment services are also directly impacted by the pandemic. The modelled outcomes are likely to be relevant to other high-income settings with established population breast cancer screening programs.

15.
Cancer Research ; 82(4 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1779450

ABSTRACT

Background. Lymphovascular invasion (LVI) and breast tumor emboli within dermal and breast lymphatic vessels are prognostic for metastatic spread and poor outcomes, and are abundant in Inflammatory breast cancer (IBC). IBC is an aggressive breast cancer that presents suddenly with breast swelling and redness due to tumor emboli in lymphatics. Lack of breast-feeding and obesity are IBC risk factors. We sought to demonstrate the combinatorial effects of a high-fat diet and nursing on lymphatic function and compare these to IBC tumor induced changes in lymphatic function. We hypothesize that risk factors for aggressive breast cancer may alter lymphatic function in the normal gland prior to tumor initiation. Methods. Following two rounds of pregnancy in 20 multiparous SCID Beige immunocompromised mice, half of the mice were force weaned while half nursed pups. Prior to forced weaning, half of each of these groups were fed a high fat diet (HFD: 60 Kcal %, N = 10) while the other half received a low-fat diet (LFD: 10 Kcal %, N = 10). Consecutive dynamic near-infrared fluorescence (NIRF) lymphatic imaging was performed at 6-7 months (covid interruption) and 14 months after initiating the diet by injecting a near-IR fluorophore into the mammary fatpad and recording lymphatic pulsing over 8 minutes using V++. Matlab and ImageJ were used to quantify pulsing rates on the ventral lymphatics in each animal. Fatpads were Ssubsequently inoculated with SUM149 IBC cells and imaging was repeated 16 months post diet initiation. Lymphatic imaging over time by HFD vs LFD was further studied in nulliparous animals. Tissues were collected for further analyses. ResultsData analysis prior to tumor injection, demonstrated lymphatic pulsing (pulses/4 minutes) increased over time in HFD force weaned (HFFW) and HFD nursing (HFN) animals only (65.5 vs 72.6, P=0.059;60.1 vs 76.6, P=0.0099, respectively). Comparing HFFW and HFN to matched LFD groups (LFFW and LFN), at 14 weeks HFD was associated with increased pumping after forced weaning (62.3 vs. 72.6, P=0.074), and nursing (62.5 vs 76.6, P=0.0023). There was an increase in pulsing after tumor initiation (16 months after initiation of diet) in all groups (80.1, 84.1, 83.2, 82.4, P > 0.05 all comparisons to initial timepoint). In a separate experiment examining HFD (N=5) vs LFD (N=5) in nulliparous mice, lymphatic contractile activity increased in all animals over. time, average ventral lymphatic contractile frequency for LFD and HFD at week 8, 11 and 14 weeks after diet initiation were 5, 8.64, 15.9 pumps/4 mins vs 11.8, 18.5, 28.2 pumps/4 mins, (P = 0.01, 0.05, and 0.0005 respectively). ConclusionsHFD increased lymphatic pulsing rate over time to a significantly greater extent than LFD continuing over 14 months independent of reproductive and nursing status. Tumor initiation prompted further increased pulsing rates beyond that observed after HFD across all groups. The magnitude of the effect of HFD on lymphatic pulsing approached the rate after tumor initiation, while reproductive variables did not impact lymphatic pulsing. Further studies are warranted to demonstrate the relationship if any between lymphatic pumping pre-initiation and LVI after tumor initiation and examine the role of intervention on reducing LVI.

16.
Genetics in Medicine ; 24(3):S331-S332, 2022.
Article in English | EMBASE | ID: covidwho-1768099

ABSTRACT

Introduction: The ACMG has recommended returning clinically relevant results for certain genes when identified in research or as secondary findings in diagnostic testing. Research studies have shown that genomic population screening detects patients with previously unrecognized and often actionable health risks or genetic conditions, with acceptably low levels of harm. Cascade testing of relatives at risk is enabled. Screening for recessive disorder carrier status with gene sequencing panels is common in clinical practice. Preventative screenings routinely occur in primary care settings. The cost of reliably sequencing of many genes in a clinically reliable fashion is approaching levels where offering genomic screening tests may be contemplated for entire populations, and the results used for preventative health purposes, including clinical correlation, early screening, and education. In anticipation of universal genome sequence-based screening, integrated with existing health risk screenings, we piloted a novel implementation of clinical genomic population screening in primary care, mostly family medicine clinics. Screening involved clinical sequencing and reporting of 431 genes where variants are associated with personal health risks or recessive disease carrier status. Methods: Interested primary care providers (PCPs) in two Family Medicine practice systems were invited to participate and given onboarding education. Adult patients with any health status were introduced to The Genomic DNA Test and provided test information by their PCPs in the context of preventative health assessment. Patient education materials included paper, online, and video information, a ‘hotline,’ and optional free genetic counseling. Patients completing a bespoke, health system-approved, written clinical consent provided blood or occasionally saliva samples that were NGS sequenced according to validated procedures in a commercial CLIA-certified genetic testing laboratory. Laboratory reports were returned to the PCP and patient after a local genetics professional added a 1-to-3-page messaging document, the Genomic Medicine Action Plan (GMAP). The PDF-format reports and GMAP were placed in the patient’s electronic health record. Only pathogenic (P) and likely pathogenic (LP) variants were reported. Variant classification was according to Sherloc, the performing laboratory’s system. Patients or providers could request free post-test genetic counseling locally, and the performing lab offered free family member testing and limited-cost partner testing for health risk panel genes and recessive disorder panel genes, respectively. Patients with health risk results were defined as being heterozygous for a P/LP variant for a dominant condition or for a recessive condition where some heterozygotes are symptomatic or co-dominant, hemizygous for a P/LP variant for an X-linked recessive condition, or bi-allelic and plausibly in trans for an autosomal (or X-linked in a female) recessive condition. Many such conditions that are common have reduced or low penetrance, and were characterized as increased risk compared to those not having those variants. When increased risk was identified, the GMAP recommended appropriate medical responses and/or patient education. As part of quality assessment of the pilot, the frequencies of reported results and certain events are monitored. Results: Between November 2019 and October 2021, 186 patients with a median age of 58 years were tested by 20 PCPs at no cost to patients or insurance. Testing volumes declined during the COVID-19 pandemic and when other health system events made high demands on PCPs and their staff. Only 13.3% of patients had no reportable variants in any of the 431 genes. Eighty point nine percent were carriers for at least one recessive disease. The most common recessive genes showing carrier status were HFE, SERPINA1, GALT, CFTR, BTD, F5, DHCR7, PC, GAA, GJB2, PMM2, PAH, and PKHD1. Twenty-six percent had at least one potential health risk result identified, 20% if the common thrombophilias are excluded. The most common category was hereditary cancer risk (7.5%), followed by F5, F2, and SERPINC1 thrombophilia variants (6.5%), hereditary hemochromatosis 1 (HFE) (4.3%), cardiovascular disorders, mostly cardiomyopathies (3.8%), alpha-1-antitrypsin deficiency or other pulmonary disorder (3.8%), familial Mediterranean fever heterozygotes (1.6%), G6PD deficiency (1.1%), and lipid disorder (0.5%). Two patients had health risks in two areas, and two in three areas. Interestingly, BRCA1 and BRCA2 variants were only identified in males. Thirteen patients, about 7%, had an amended report issued during the period. This happened when an unreported variant of uncertain significance was reclassified as LP or P, or when LP became P, and the performing laboratory issued an amended report. Surprisingly few patients took advantage of the free genetic counseling. No patient adverse events were reported by the participating PCPs despite ongoing outreach, nor by patients. Conclusion: Genomic population health screening can be successfully implemented in primary care settings with use of limited but essential genetic professional assistance, after careful planning and input from other medical specialties. A significant proportion of adults not selected for health status harbors germline genetic variants associated with increased health risk. In the absence of a culture where routine genomic screening is expected and where patient genomic competency is high, PCP capacity limits are a barrier to universality. Inclusion of genes for both health risk results with variable degrees of penetrance and for recessive carrier status, and multiple simultaneous results, dictates careful messaging of the implications, while doing so in a primary care setting begs a concise and efficient process. Rates of carrier detection were in-line with predictions based on general population frequencies. Rates of health risk detections were higher than earlier research programs because a larger number of genes with a much broader scope of health risk was included, including disorders with low penetrance yet meaningful clinical relevance and carefully-designed care pathways meant to optimize care while avoiding unnecessary additional testing. We conclude that genomic population health screening of primary care patients where large numbers of genes are clinically sequenced is feasible in a real-world health system, and that value exists for some tested patients now. Research to overcome certain technical limitations of current clinical genomic testing methods and to better stratify risk level in the context of incomplete penetrance should enhance the value of universally-offered genomic population health screening in the future.

17.
Journal of the Formosan Medical Association ; 121(3):575-579, 2022.
Article in English | EMBASE | ID: covidwho-1720309
18.
Cancer Epidemiology Biomarkers and Prevention ; 31(1 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1677451

ABSTRACT

The COVID-19 pandemic has placed an unprecedented burden on the healthcare system, disrupting routine care including breast cancer screening. We used data from 2392 women without a history of breast cancer enrolled in the Boston Mammography Cohort Study (BMCS) to investigate whether subgroups defined by age, race, or family history of breast cancer: 1) experienced greater declines in screening or diagnostic imaging during the lockdown;or 2) had slower rebound during reopening. In this interrupted time series analysis, we used Poisson regression with robust standard errors to model expected monthly rates of breast cancer screening and diagnostic imaging from January 2019 through December 2020. We defined the pre-COVID-19 period as January 1, 2019, to February 29, 2020;the lockdown period as March 1 to May 30, 2020;and the reopening period as June 1 to December 31, 2020. We examined changes in trends overall and tested for the difference in trends by age (<50 vs ≤50), race (white vs non-white), and first-degree family history of breast cancer (yes or no). The mean monthly rate of breast cancer screening in the BMCS cohort was 45 per 1000 people during the pre-COVID-19 period, 7 per 1000 people during the lockdown period, and 50 per 1000 people during the reopening period. The mean monthly rate of breast cancer diagnostic imaging was 6 per 1000 people during the pre-COVID-19 period, 3 per 1000 people during the lockdown period, and 6 per 1000 people during the reopening period. During the pre-COVID-19 period, those who are age 50 or older had 5.3% higher monthly trend in breast cancer screening rates (p=0.005) and 9.8% higher monthly trend in diagnostic imaging rates (p=0.0389). During the lockdown period, those who were age 50 or older had a lower monthly trend in breast cancer screening rates compared to those who were younger than 50 (p<0.0001), while those who were white and those with family history have higher monthly trends of breast cancer screening rates compared to their respective counterparts (p<0.0001). During the reopening phase, those who are age 50 or older have 18.5% lower monthly trend in breast cancer screening rates in comparison to those who are younger than 50 (p=0.0008) and those who were white have 36.2% higher monthly trend in breast cancer diagnostic procedure rates in comparison to those who are non-white (p=0.018). Overall, we observed a significant decline in breast cancer screening rates with the advent of the COVID-19 pandemic. For the most part, screening and diagnostic imaging rates during the reopening phase equaled or exceeded those of the pre-COVID-19 period. However, the rate of return to screening was lower in women age 50 or older and the rebound in diagnostic imaging was lower in nonwhite women. Careful attention must be paid as the COVID-19 recovery continues to ensure equitable resumption of care. Future work will examine other factors including insurance status, breast cancer risk scores, and geographic location.

19.
Cancer Epidemiology Biomarkers and Prevention ; 31(1 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1677445

ABSTRACT

Background: Comprehensive cancer control (CCC) plans are region-specific blueprints that identify cancer priorities and health equity informed strategies to address cancer burden and are supported by the National Comprehensive Cancer Control Program through the Centers for Disease Control and Prevention (CDC). Although CCC plans are created by stakeholder coalitions, few have focused on community engaged approaches, which may diminish their applicability for community members. Thus, in preparation for its forthcoming 2022-2027 CCC plan, the Illinois Comprehensive Cancer Control Program collaborated with the University of Illinois Cancer Center's Community Engagement and Health Equity office to implement a community engagement strategy to address cancer burden. Objective: To describe the development and implementation of a community engagement strategy for the 2022-2027 Illinois CCC plan. Method: The goal of the community engagement strategy was to identify barriers, facilitating factors and recommendations related to cancer burden and equity in Illinois by engaging diverse community stakeholders. A statewide town hall and focus groups (FGs) were implemented in early 2021. Thedevelopment and analysis of the community engagement strategy were guided by the Model for Analysis of Population Health and Health Disparities, CDC's CHANGE Action Guide, and the Community ToolBox. Semistructured guides included questions about fundamental causes of health, social and physical contexts, individual demographics and risk factors, and biologic responses and pathways. The town hall was open to Illinoisians over 18 years of age. FG participants were selected using purposive sampling to maximize group heterogeneity. Eight FGs were held, one each for: rural residents, survivors, young survivors, caregivers, and Spanish speakers, and three that were a mix of community members. Town hall notes and FGs were analyzed using content analysis. Results were synthesized and a final report was included in the forthcoming plan. Results: Town hall and FG (n=8) participants (n=115) included cancer survivors (36%), caregivers (27%), Latinos (17%), African Americans (23%), and rural residents (14%). Throughout the development of the plan, data were continuously reviewed with the coalition developing the CCC Plan. The final report described multi-level factors that contribute to cancer disparities among Illinoisians, proposed recommendations to improve health across the cancer continuum across multiple levels, funding priorities, and the impact of COVID-19 on cancer care. Participant quotes supported strategies throughout the plan. Conclusion: A robust community engagement strategy for the forthcoming 2022-2027 Illinois CCC Plan was implemented through a successful academic-state public health department partnership. This strategy ensures that the plan reflects the expertise and voices of Illinoisians impacted by cancer. This engagement strategy, framed around health determinants that impact cancer risk and outcomes, may be replicated by other coalitions creating CCC plans.

20.
Cancer Epidemiology Biomarkers and Prevention ; 31(1 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1677435

ABSTRACT

Introduction: Cancer clinical trial conduction during the COVID-19 pandemic required a rapid move to virtual engagement to support participant and research team safety. We were faced with the challenge of translating our approach from in-person to virtual engagement for recruitment, enrollment, and delivery of the study intervention. We present our strategies to conduct cancer clinical trials focused on cancer risk reduction during the COVID-19 pandemic. Subject Recruitment: Our multimodal approach utilized online platforms and established approaches like posters, flyers, and collaborating with community health workers to recruit participants. Our virtual engagement strategies include direct outreach to potential participants via email, the electronic medical record (EMR), and social media. Contact via email and the EMR was guided by study-defined eligibility criteria. Social media outreach was through institutional Twitter, Facebook, and video channel accounts. Twitter posts and chats were employed. Enrollment: e-consenting and remote consenting processes were instituted via REDCAP. Delivery of the Educational Risk Reduction Intervention: We also conducted the intervention using the Zoom platform and through a recorded video of the educational risk reduction intervention, which is shared with the participant via REDCAP. Challenges: As documented by others, the greatest challenge to virtual engagement is lack of internet access and lack of digital literacy. These factors have a greater impact on underserved populations, including the elderly, those with low socioeconomic status, those located farther from the cancer center, and racially/ethnically diverse populations. Conclusion: By translating study outreach and processes to virtual engagement, we were able to facilitate clinical trial access across diverse community subgroups and support subject participation in clinical trials during the COVID-19 pandemic.

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