Respiratory viral infection promotes the awakening and outgrowth of dormant metastatic breast cancer cells in lungs (preprint)

Breast cancer is the second most common cancer globally. Most deaths from breast cancer are due to metastatic disease which often follows long periods of clinical dormancy1. Understanding the mechanisms that disrupt the quiescence of dormant disseminated cancer cells (DCC) is crucial for addressing metastatic progression. Infection with respiratory viruses (e.g. influenza or SARS-CoV-2) is common and triggers an inflammatory response locally and systemically2,3. Here we show that influenza virus infection leads to loss of the pro-dormancy mesenchymal phenotype in breast DCC in the lung, causing DCC proliferation within days of infection, and a greater than 100-fold expansion of carcinoma cells into metastatic lesions within two weeks. Such DCC phenotypic change and expansion is interleukin-6 (IL-6)-dependent. We further show that CD4 T cells are required for the maintenance of pulmonary metastatic burden post-influenza virus infection, in part through attenuation of CD8 cell responses in the lungs. Single-cell RNA-seq analyses reveal DCC-dependent impairment of T-cell activation in the lungs of infected mice. SARS-CoV-2 infected mice also showed increased breast DCC expansion in lungs post-infection. Expanding our findings to human observational data, we observed that cancer survivors contracting a SARS-CoV-2 infection have substantially increased risks of lung metastatic progression and cancer-related death compared to cancer survivors who did not. These discoveries underscore the significant impact of respiratory viral infections on the resurgence of metastatic cancer, offering novel insights into the interconnection between infectious diseases and cancer metastasis.

CircRNA-Pro: A Novel Toolkit for High-Precision Detection of Differentially Expressed Circular RNAs and Translatable Circular RNAs (preprint)

With the increasing discovery of circular RNAs (circRNAs) and their critical roles in gene regulation and disease progression, there is a growing need for more accurate and efficient tools for circRNAs research. In response, we have developed an integrated software suite specifically for circRNAs. This all-in-one tool specializes in detecting differentially expressed circRNAs, including those with the potential to be translated into proteins, and allows for comparing against relevant databases, thereby enabling comprehensive circRNA profiling and annotation. To enhance the accuracy in detecting differentially expressed circRNAs, we incorporated three different software algorithms and cross-validated their results through mutual verification. Additionally, this toolkit improves the effectiveness in identifying translatable circRNAs by optimizing Ribo-seq alignment and verifying against public circRNA databases. The performance of circRNA-pro has been evaluated through its application to public RNA-seq and Ribo-seq datasets on breast cancer and SARS-CoV-2 infected cells, and the results obtained have been validated against previous literature and databases. Overall, our integrated toolkit provides a reliable workflow for circRNA research, facilitating insights into their diverse roles across life sciences.

Application of Multidisciplinary Diagnosis and Treatment (MDT) Clinical Teaching Model in the Clinical Teaching of Some Undergraduates of Breast Diseases in Surgery (preprint)

Background Breast surgery, emerging as an independent discipline with a wealth of specialist cases and an extensive case resource library in medical history. Contemporary clinical teaching faces challenges with traditional methods unable to address students' theoretical strength and practical limitations. The COVID-19 pandemic further strained learning environments, limiting students' exposure to patient diagnosis and treatment. Conventional clinical teaching, organized by disciplines, often results in technical isolation and a narrow clinical perspective, impeding the development of well-rounded medical professionals. Multidisciplinary Comprehensive Diagnosis and Treatment (MDT) emerges as a patient-centric, collaborative approach involving various medical departments in clinical decision-making. Despite its success in clinical settings, the effectiveness of MDT in undergraduate medical education remains largely unexplored.Methods This study conducted at the Breast Department of the First Affiliated Hospital of Zhengzhou University, aimed to compare the learning outcomes of clinical interns under traditional and MDT teaching modes. In a randomized controlled trial with 140 participants, the MDT group received comprehensive training from diverse healthcare professionals, while the traditional group had standard teaching. Evaluation included pre-test and post-test assessments on knowledge acquisition, skill acquisition, and clinical decision-making. Longitudinal analysis and statistical tests, including t-tests and multiple regression, were employed.Results A total of 140 clinical medicine students participated, randomly assigned to MDT (n = 70) and Traditional Teaching Mode (n = 70) groups. Key baseline characteristics, such as age, gender, and completion rates, were comparable between groups. For each group’s pre- and post-test scores, MDT group means consistently surpassed Traditional Teaching Mode, with significant differences (p < 0.05).Correlation analysis showed that there were no significant variable correlations between individual performance characteristics and test scores. Post-training, significant score improvements were observed in both groups across all tests (p < 2.2e-16). Utilizing the Wilcoxon rank sum test, pre-test differences were not significant. However, post-test scores favored the MDT group significantly (p = 0.0016, 2.8e-09, 3.6e-07). For students pursuing a master's, no statistically significant differences in specialty choice were observed between groups, though a trend towards more MDT students choosing surgical specialties was noted.Conclusion This study pioneers the application of the MDT teaching method in breast cancer clinical education, comparing its efficacy against traditional teaching modes. Findings demonstrate that MDT-based breast cancer diagnosis and treatment education is more efficient and optimized, offering a transformative basis for clinical undergraduate education reform in China. The results advocate for the reconfiguration of multidisciplinary consultation clinical teaching and traditional methods, promising enhanced educational outcomes and heightened medical student knowledge.

A stakeholder analysis to prepare for real-world evaluation of integrating artificial intelligent algorithms into breast screening (PREP-AIR study): a qualitative study using the WHO guide (preprint)

Background The national breast screening programme in the United Kingdom is under pressure due to workforce shortages and having been paused during the COVID-19 pandemic. Artificial intelligence has the potential to transform how healthcare is delivered by improving care processes and patient outcomes. Research on the clinical and organisational benefits of artificial intelligence is still at an early stage, and numerous concerns have been raised around its implications, including patient safety, acceptance, and accountability for decisions. Reforming the breast screening programme to include artificial intelligence is a complex endeavour because numerous stakeholders influence it. Therefore, a stakeholder analysis was conducted to identify relevant stakeholders, explore their views on the proposed reform (i.e., integrating artificial intelligence algorithms into the Scottish National Breast Screening Service for breast cancer detection) and develop strategies for managing ‘important’ stakeholders.Methods A qualitative study (i.e., focus groups and interviews, March-November 2021) was conducted using the stakeholder analysis guide provided by the World Health Organisation and involving three Scottish health boards: NHS Greater Glasgow & Clyde, NHS Grampian and NHS Lothian. The objectives included: A) Identify possible stakeholders B) Explore stakeholders’ perspectives and describe their characteristics C) Prioritise stakeholders in terms of importance and D) Develop strategies to manage ‘important’ stakeholders. Seven stakeholder characteristics were assessed: their knowledge of the targeted reform, position, interest, alliances, resources, power and leadership.Results Thirty-two participants took part from 14 (out of 17 identified) sub-groups of stakeholders. While they were generally supportive of using artificial intelligence in breast screening programmes, some concerns were raised. Stakeholder knowledge, influence and interests in the reform varied. Key advantages mentioned include service efficiency, quicker results and reduced work pressure. Disadvantages included overdiagnosis or misdiagnosis of cancer, inequalities in detection and the self-learning capacity of the algorithms. Five strategies (with considerations suggested by stakeholders) were developed to maintain and improve the support of ‘important’ stakeholders.Conclusions Health services worldwide face similar challenges of workforce issues to provide patient care. The findings of this study will help others to learn from Scottish experiences and provide guidance to conduct similar studies targeting healthcare reform.Study registration: researchregistry6579, date of registration: 16/02/2021

Importance of standard precautions to febrile neutropenia prevention in patients with cancer during COVID 19 outbreak (preprint)

Purpose Intensive cytotoxic chemotherapy increases the risk of infection in patients with cancer by inducing bone marrow suppression and mucosal injury. Febrile neutropenia (FN) is the most important clinical adverse event in patients with cancer who receiving cytotoxic chemotherapy. To prevent FN, prophylactic antibiotics, colony stimulating factors (CSFs) and also standard precautions including hand and respiratory hygiene are generally recommended but the exact effect of non-pharmacologic intervention such as standard precaution has not been clearly proven in the clinical setting. we aimed to compare the incidence of FN between pre-coronavirus disease 19 (COVID 19) era versus post-COVID 19 era.Material and methods We retrospectively enrolled patients with breast cancer who received adjuvant adriamycin and cyclosphosphamide (AC) chemotherapy at Jeju national university hospital.Results In total, 149 patients well enrolled, including 94 who received AC chemotherapy in pre-COVDI 19 era and 55 who received at post-COVID 19 era. Sixteen (10.7%) patients experienced the FN. Fourteen events (14.9%) and two events (3.6%) were occurred in pre-COVID 19 and post-COVDI 19 era, respectively. The post-COVID 19 era was the only risk factor for FN. (p = 0.032)Conclusion We found an association between FN occurrence and COVID 19 outbreak; thus, providing indirect evidence of the importance of non-pharmacological measure to reduce FN risk in patients with cancer. Further research is required to confirm the standard precautions for FN prevention in patients with cancer.

Memory B cells dominate the early antibody-secreting cell response to SARS-CoV-2 mRNA vaccination in naive individuals independently of their antibody affinity (preprint)

Memory B cells (MBCs) formed over the individual's lifetime constitute nearly half of the adult peripheral blood B cell repertoire in humans. To assess their response to novel antigens, we tracked the origin and followed the differentiation paths of MBCs in the early anti-S response to mRNA vaccination in SARS-CoV-2-naïve individuals on single-cell and monoclonal antibody level. Newly generated and pre-existing MBCs differed in their differentiation paths despite similar levels of SARS-CoV-2 and common corona virus S-reactivity. Pre-existing highly mutated MBCs showed no signs of germinal center re-entry and rapidly developed into mature antibody secreting cells (ASCs). In contrast, newly generated MBCs derived from naïve precursors showed strong signs of antibody affinity maturation before differentiating into ASCs. Thus, although pre-existing human MBCs have an intrinsic propensity to differentiate into ASCs, the quality of the anti-S antibody and MBC response improved through the clonal selection and affinity maturation of naïve precursors.

Utilizing a Floating Sleeve Antenna for Interstitial Microwave Hyperthermia Treatment of Superficial and Deep-seated Breast Tumors (preprint)

Purpose: Breast cancer is a leading cause of mortality among women worldwide. While chemotherapy and radiotherapy are commonly used treatment modalities, they have several side effects that can negatively impact the patient. In this study, we explore the application of a floating sleeve antenna for interstitial microwave hyperthermia for breast tumors.  Method: Two distinct 3D breast models were employed: a simplified semi-spherical and a highly detailed anatomical model. Both models featured superficial and deep-seated tumors. The floating sleeve antenna was inserted into the breast models, and simulations were con-ducted to assess the specific absorption rate (SAR) and temperature distribution.  Results: In the simple model, the superficial tumor reached a maximum temperature of 50.7 ºC, while the deep-seated tumor maintained a uniform temperature of 48.9 ºC. In contrast, the realistic model achieved a maximum temperature of 46.2 ºC for the superficial tumor and 41.47 ºC for the deep-seated tumor within the same 15-minute treatment period. These results demonstrate the ability of the antenna to attain the desired hyperthermia temperatures (above 39 °C to 45 °C).  Conclusion: microwave hyperthermia using a floating sleeve antenna has the potential to be an effective and safe alternative treatment for breast cancer with minimal side effects

Breast Cancer (BC) and Severe COVID-19 (C-19) Outcomes: A Matched Analysis (preprint)

Purpose Patients with cancer receiving anticancer treatment have a higher risk of severe COVID-19 (C-19) outcomes. We examine the association between breast cancer (BC), recent treatment (systemic therapy, surgery, radiation), and C-19 outcomes.Methods Retrospective matched cohort study using the Optum® de-identified COVID-19 Electronic Health Record dataset (2007–2022). Patients with C-19 were categorized into: No cancer, BC with recent treatment, and BC without recent treatment and matched based on age, C-19 diagnosis date, and comorbidity score. We evaluated 30-day mortality, mechanical ventilation, intensive care unit (ICU) stay, and hospitalization. A composite outcome including all outcomes was analyzed. Multivariable logistic regression models were used.Results 2200 matched triplets (1:1:10) of patients with BC recently treated, BC not recently treated, and no cancer were included. Rates of adverse outcomes improved in 2021 compared to 2020. Compared to patients without cancer, those with BC recently treated had a similar risk of adverse outcomes, while patients with BC not recently treated had a lower risk of ICU stay and hospitalization. Using the composite variable, BC recently treated had similar outcomes (OR = 1.02; 95%CI 0.93–1.11) to patients without cancer, while BC patients not recently treated had better outcomes (OR = 0.66; 95%CI 0.59–0.74). Among patients with BC, chemotherapy within 3-months was associated with a higher risk of hospitalization (OR = 2.30; 95%CI 1.76–2.99) and composite outcome (OR = 2.11; 95%CI 1.64–2.72).Conclusion Patients with BC have a similar risk of adverse C-19 outcomes compared to patients without cancer. Among patients with BC, recent chemotherapy was associated with a higher risk of hospitalization.

The Impact of the UK COVID-19 Lockdown on the Screening, Diagnostics and Incidence of Breast, Colorectal, Lung and Prostate Cancer in the UK: a Population-Based Cohort Study (preprint)

Objectives: This study aimed to assess the impact of the COVID-19 lockdown on the screening and diagnosis of breast, colorectal, lung, and prostate cancer. The study also investigated whether the rates returned to pre-pandemic levels by December 2021. Design: Cohort study. Setting: Electronic health records from UK primary care Clinical Practice Research Datalink (CPRD) GOLD database. Participants: The study included individuals registered with CPRD GOLD between January 2017 and December 2021, with at least 365 days of prior observation. Main outcome measures: The study focused on screening, diagnostic tests, referrals and diagnoses of first-ever breast, colorectal, lung, and prostate cancer. Incidence rates (IR) were stratified by age, sex and region, and incidence rate ratios (IRR) were calculated to compare rates during and after lockdown with the reference period before lockdown. Forecasted rates were estimated using negative binomial regression models. Results: Among 5,191,650 eligible participants, the initial lockdown resulted in reduced screening and diagnostic tests for all cancers, which remained dramatically reduced across the whole observation period for almost all tests investigated. For cancer incidence rates, there were significant IRR reductions in breast (0.69), colorectal (0.74), and prostate (0.71) cancers. However, the reduction in lung cancer incidence (0.92) was non-significant. Extrapolating to the entire UK population, an estimated 18,000 breast, 13,000 colorectal, 10,000 lung, and 21,000 prostate cancer diagnoses were missed from March 2020 to December 2021. Conclusion: The national COVID-19 lockdown in the UK had a substantial impact on cancer screening, diagnostic tests, referrals and diagnoses. Although incidence rates started to recover after the lockdown, they remained significantly lower than pre-pandemic levels for breast and prostate cancers and associated tests. Delays in diagnosis are likely to have adverse consequences on cancer stage, treatment initiation, mortality rates, and years of life lost. Urgent strategies are needed to identify undiagnosed cases and address the long-term implications of delayed diagnoses.

Unleashing the Power of Artificial Intelligence: Unraveling the Intricate Dynamics between Viral and Bacterial Infections, Immune Factors, COVID-19, and Cancer in Women's Health (preprint)

The intricate interplay between viral and bacterial infections, immune factors, COVID-19, and cancer in women's health has garnered significant attention in recent research. This comprehensive study aimed to unravel the complex dynamics between these factors and provide valuable insights into their implications for women's health. Through meticulous analysis of available data, this study elucidated the prevalence of viral and bacterial infections in women, encompassing influential pathogens such as influenza, human papillomavirus, Staphylococcus aureus, Escherichia coli, and Streptococcus pneumoniae. Additionally, it explored the relationship between specific cytokine types, including Interleukin-6 (IL-6), Tumor Necrosis Factor-alpha (TNF-α), Interferon-gamma (IFN-γ), and Interleukin-10 (IL-10), and viral infections. The prevalence of various cancer types, such as breast cancer, lung cancer, colorectal cancer, ovarian cancer, and cervical cancer, was also assessed. Furthermore, this study examined the correlations between immune factors and viral infections, uncovering significant associations that shed light on the intricate interplay between immune responses and viral infections. Immune markers such as IL-6, TNF-α, IFN-γ, Interleukin-1beta (IL-1β), and Interleukin-12 (IL-12) exhibited diverse levels of correlation with specific viral infections. These findings hold promise for disease prognosis and treatment optimization. Additionally, the association between bacterial infections and women's health conditions was explored, revealing the impact of pathogens like Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Enterococcus faecalis on gynecological infections, reproductive disorders, and other relevant conditions. This highlights the need for effective strategies to prevent and manage bacterial infections, aiming to mitigate their adverse effects on women's health. In the context of COVID-19, this study investigated immune factors as predictors of disease outcomes in women. Various cytokines, including IL-6, TNF-α, IL-1β, IFN-γ, IL-10, IL-8, IL-4, IL-2, IL-12, and IL-17, demonstrated associations with disease severity, offering potential prognostic markers for identifying individuals at higher risk of severe illness. Furthermore, the relationship between viral and bacterial infections and cancer incidence in women was explored. Viral infections, such as human papillomavirus and influenza, showed associations with specific cancer types, including breast cancer, cervical cancer, lung cancer, skin cancer, and stomach cancer. Bacterial infections, such as Staphylococcus aureus and Escherichia coli, were linked to ovarian cancer, colorectal cancer, pancreatic cancer, bladder cancer, kidney cancer, and esophageal cancer. These findings provide valuable insights into the potential role of infectious etiologies in cancer development among women. In conclusion, this comprehensive study unveils the intricate dynamics between viral and bacterial infections, immune factors, COVID-19, and cancer in women's health. The findings emphasize the importance of considering the interconnectedness of these factors to enhance disease prevention, diagnosis, and treatment strategies in women. Further research is warranted to unravel the underlying mechanisms and translate these findings into clinical applications.

Invariant Scattering Transform for Medical Imaging (preprint)

Invariant scattering transform introduces new area of research that merges the signal processing with deep learning for computer vision. Nowadays, Deep Learning algorithms are able to solve a variety of problems in medical sector. Medical images are used to detect diseases brain cancer or tumor, Alzheimer's disease, breast cancer, Parkinson's disease and many others. During pandemic back in 2020, machine learning and deep learning has played a critical role to detect COVID-19 which included mutation analysis, prediction, diagnosis and decision making. Medical images like X-ray, MRI known as magnetic resonance imaging, CT scans are used for detecting diseases. There is another method in deep learning for medical imaging which is scattering transform. It builds useful signal representation for image classification. It is a wavelet technique; which is impactful for medical image classification problems. This research article discusses scattering transform as the efficient system for medical image analysis where it's figured by scattering the signal information implemented in a deep convolutional network. A step by step case study is manifested at this research work.

Resumption of intravenous anti-cancer therapy in breast cancer: a real-world experience during the SARS-CoV-2 pandemic (preprint)

Purpose The coronavirus disease-2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, has delayed medical consultations, especially for patients receiving intravenous anti-cancer therapy. We aimed to investigate alterations in immune function among breast cancer patients who experienced delayed intravenous therapy due to SARS-CoV-2 infection.Methods We performed an observational investigation of breast cancer patients in Nanjing Drum Tower Hospital from December 27, 2022 to January 20, 2023. The patients recovered from SARS-CoV-2 infection were eligible for enrollment. Peripheral blood samples were taken prior to the restart of intravenous anti-cancer therapy to examine hematologic parameters.Results A total of 131 patients were included in the final analysis. Cough (74.0%), fever (62.6%), and expectoration (46.6%) were identified as the most presenting symptoms of SARS-CoV-2 infection in breast cancer. The average nucleic acid conversion time and delayed treatment time was 13.4 days and 13.9 days, respectively. The patients > 60 years old experienced prolonged nucleic acid conversion time (P = 0.017) and delayed treatment time (P = 0.028) compared to those < = 60 years old. Dysregulated lymphocyte subsets and cytokines were found post-SARS-CoV-2 infection. Treatment-related adverse events of grade 3 or 4 occurred in 7.6% after resuming intravenous anti-cancer therapy.Conclusions Our findings reveal that the SARS-CoV-2 infection led to imbalanced immune responses and postponed intravenous anti-cancer therapy in breast cancer. The safety report encourages the timely resumption of intravenous anti-cancer therapy after adequately weighing the risks and benefits.

Impact of COVID-19-related health care disruptions on pathologic cancer staging during the first pandemic year: a retrospective cohort study from March 2018 to March 2021.

BACKGROUND: The COVID-19 pandemic has created major disruptions in cancer care, with reductions in diagnostic tests and treatments. We evaluated the impact of these health care-related changes on cancer staging by comparing cancers staged before and during the pandemic. METHODS: We performed a retrospective cohort study at London Health Sciences Centre and St. Joseph's Health Care London, London, Ontario, Canada. We evaluated all pathologically staged breast, colorectal, prostate, endometrial and lung cancers (the 5 most common cancers by site, excluding nonmelanoma skin cancer) over a 3-year period (Mar. 15, 2018-Mar. 14, 2021). The pre-COVID-19 group included procedures performed between Mar. 15, 2018, and Mar. 14, 2020, and the COVID-19 group included procedures performed between Mar. 15, 2020, and Mar. 14, 2021. The primary outcome was cancer stage group, based on the pathologic tumour, lymph node, metastasis system. We performed univariate analyses to compare demographic characteristics, pathologic features and cancer stage between the 2 groups. We performed multivariable ordinal regression analyses using the proportional odds model to evaluate the association between stage and timing of staging (before v. during the pandemic). RESULTS: There were 4055 cases across the 5 cancer sites. The average number of breast cancer staging procedures per 30 days increased during the pandemic compared to the yearly average in the pre-COVID-19 period (41.3 v. 39.6), whereas decreases were observed for endometrial cancer (15.9 v. 16.4), colorectal cancer (21.8 v. 24.3), prostate cancer (13.6 v. 18.5) and lung cancer (11.5 v. 15.9). For all cancer sites, there were no statistically significant differences in demographic characteristics, pathologic features or cancer stage between the 2 groups (p > 0.05). In multivariable regression analysis, for all cancer sites, cases staged during the pandemic were not associated with higher stage (breast: odds ratio [OR] 1.071, 95% confidence interval [CI] 0.826-1.388; colorectal: OR 1.201, 95% CI 0.869-1.661; endometrium: OR 0.792, 95% CI 0.495-1.252; prostate: OR 1.171, 95% CI 0.765-1.794; and lung: OR 0.826, 95% CI 0.535-1.262). INTERPRETATION: Cancer cases staged during the first year of the COVID-19 pandemic were not associated with higher stage; this likely reflects the prioritization of cancer procedures during times of reduced capacity. The impact of the pandemic period on staging procedures varied between cancer sites, which may reflect differences in clinical presentation, detection and treatment.

[COVID-19 and breast cancer screening in Brazil: a comparative analysis of the pre-pandemic and pandemic periods]. / COVID-19 e rastreamento do câncer de mama no Brasil: uma análise comparativa dos períodos pré-pandêmico e pandêmico.

The scope of this study was to evaluate the impacts of COVID-19 on breast cancer screening in Brazil. Data were collected from the Ambulatory Information System relating to "bilateral screening mammography" from January/2015 to December/2021. Analyses were performed by region and for Brazil. The average of exams in each month of the year was calculated based on 2015-2019 data, which was compared, monthly, with the number of exams in 2020 and 2021, obtaining the gross and percentage difference between these values. The same analysis was performed for the total number of exams in 2020 and 2021, individually, and for the two years combined. In 2020 there were reductions in the number of exams, which ranged from 25% (North) to 48% (Northeast), resulting in 1.749 million fewer exams than expected in the country (a drop of 44%). In 2021, the Midwest region presented a number of exams 11% higher than expected, while the other regions presented drops between 17% (North) and 27% (Southeast/South), resulting in 927 thousand exams fewer than expected in Brazil (reduction of 23%). In the joint analysis (2020/2021), reductions varied by region from 11% (Midwest) to 35% (Southeast/South), culminating in 2.676 million exams fewer than expected in Brazil (reduction of 33%).

Objetivou-se avaliar os impactos da COVID-19 no rastreamento do câncer de mama no Brasil. Coletaram-se dados do Sistema de Informações Ambulatoriais referentes a "mamografia bilateral para rastreamento" de janeiro/2015 a dezembro/2021. As análises foram feitas por região e para o Brasil. Calculou-se a média de exames em cada mês do ano com base nos dados de 2015 a 2019, a qual foi comparada, mensalmente, com o quantitativo de exames em 2020 e 2021, obtendo-se a diferença bruta e percentual entre esses valores. A mesma análise foi realizada para o número total de exames em 2020 e 2021, individualmente, e para os dois anos em conjunto. Em 2020 houve quedas no número de exames que variaram de 25% (Norte) a 48% (Nordeste), culminando em 1,749 milhão de exames a menos no país (queda de 44%). Em 2021, a região Centro-Oeste apresentou quantitativo de exames 11% superior ao esperado, enquanto as demais regiões apresentaram quedas entre 17% (Norte) e 27% (Sudeste/Sul), culminando em negativo de 927 mil exames no país (redução de 23%). Na análise conjunta (2020/2021), encontraram-se reduções que variaram de 11% (Centro-Oeste) a 35% (Sudeste/Sul), culminando em negativo de 2,676 milhões de procedimentos no Brasil (queda de 33%).

Impact of the COVID-19 pandemic on cancer diagnoses, stage and survival in Alberta.

BACKGROUND: The COVID-19 pandemic is suspected to have affected cancer care and outcomes among patients in Canada. In this study, we evaluated the impact of the state of emergency period during the COVID-19 pandemic (Mar. 17 to June 15, 2020) on cancer diagnoses, stage at diagnosis and 1-year survival in Alberta. METHODS: We included new diagnoses of the 10 most prevalent cancer types from Jan. 1, 2018, to Dec. 31, 2020. We followed patients up to Dec. 31, 2021. We used interrupted time series analysis to examine the impact of the first COVID-19-related state of emergency in Alberta on the number of cancer diagnoses. We used multivariable Cox regression to compare 1-year survival of the patients who received a diagnosis during 2020 after the state of emergency with those who received a diagnosis during 2018 and 2019. We also performed stage-specific analyses. RESULTS: We observed significant reductions in diagnoses of breast cancer (incidence rate ratio [IRR] 0.67, 95% confidence interval [CI] 0.59-0.76), prostate cancer (IRR 0.64, 95% CI 0.56-0.73) and colorectal cancer (IRR 0.64, 95% CI 0.56- 0.74) and melanoma (IRR 0.57, 95% CI 0.47-0.69) during the state of emergency period compared with the period before it. These decreases largely occurred among early-stage rather than late-stage diagnoses. Patients who received a diagnosis of colorectal cancer, non-Hodgkin lymphoma and uterine cancer in 2020 had lower 1-year survival than those diagnosed in 2018; no other cancer sites had lower survival. INTERPRETATION: The results from our analyses suggest that health care disruptions during the COVID-19 pandemic in Alberta considerably affected cancer outcomes. Given that the largest impact was observed among early-stage cancers and those with organized screening programs, additional system capacity may be needed to mitigate future impact.

COVID-19 and Breast Cancer: Analysis of Surgical Management of a Large Referral Center during the 2020-2021 Pandemic Period.

BACKGROUND: Coronavirus disease-19 (COVID-19) has spread worldwide since December 2019 and was officially declared a pandemic in March 2020. Due to the rapid transmission and the high fatality rate, drastic emergency restrictions were issued, with a negative impact on routine clinical activities. In particular, in Italy, many authors have reported a reduction in the number of breast cancer diagnoses and critical problems in the management of patients who accessed the breast units during the dramatic first months of the pandemic. Our study aims to analyze the global impact of COVID-19 in the two years of the pandemic (2020-2021) on the surgical management of breast cancer by comparing them with the previous two years. METHODS: In our retrospective study, we analyzed all cases of breast cancer diagnosed and surgically treated at the breast unit of "Città della Salute e della Scienza" in Turin, Italy, making a comparison between the 2018-2019 pre-pandemic period and the 2020-2021 pandemic period. RESULTS: We included in our analysis 1331 breast cancer cases surgically treated from January 2018 to December 2021. A total of 726 patients were treated in the pre-pandemic years and 605 in the pandemic period (-121 cases, 9%). No significant differences were observed regarding diagnosis (screening vs. no screening) and timing between radiological diagnosis and surgery for both in situ and invasive tumors. There were no variations in the breast surgical approach (mastectomy vs. conservative surgery), while a reduction in axillary dissection compared to the sentinel lymph node in the pandemic period was observed (p-value < 0.001). Regarding the biological characteristics of breast cancers, we observed a greater number of grades 2-3 (p-value = 0.007), pT stage 3-4 breast cancer surgically treated without previous neoadjuvant chemotherapy (p-value = 0.03), and a reduction in luminal B tumors (p-value = 0.007). CONCLUSIONS: Overall, we report a limited reduction in surgical activity for breast cancer treatment considering the entire pandemic period (2020-2021). These results suggest a prompt resumption of surgical activity similar to the pre-pandemic period.

Preferences and engagement with physical activity resources among cancer survivors during the COVID-19 pandemic.

PURPOSE: The COVID-19 pandemic has imposed additional barriers to physical activity (PA) in cancer survivors. Adaptations to PA programmes are needed during the pandemic. Therefore, the purpose of this study was to evaluate (1) the PA preferences of cancer survivors prior to and during the pandemic and (2) the available resources to engage in PA during the pandemic. METHODS: Using a cross-sectional study design, cancer survivors were recruited globally to participate in a self-administered survey assessing their PA preferences and available PA resources during the pandemic. Descriptive statistics were used to determine trends in PA preferences and resources. A sub-group analysis was conducted for age, gender, education, and PA levels. RESULTS: Cancer survivors (N = 493) were mainly women (70.4%) diagnosed with breast cancer (29.0%), with a mean age of 48.7 ± 15.8 years, and 87.1 ± 81.9 months since diagnosis. Since the start of the pandemic, cancer survivors were primarily walking (82.6%), and performing PA alone (62.7%) and at home (46.6%). Sub-group analysis revealed education level, PA levels, and age to be associated with significant differences in PA preferences. The most common equipment available to survivors in their homes were exercise mats (40.6%) and free weights (39.8%). Few survivors were made aware of at-home PA resources (19.1%), and approximately half indicated wanting to receive these resources (49.6%). CONCLUSIONS: Understanding cancer survivors' preferences and resources for PA during the pandemic is critical to designing effective home-based interventions. Interventions and recommendations should be tailored based on the level of education and PA participation, as well as age.

Patients’ experiences undergoing breast evaluation in Rwanda’s Women’s Cancer Early Detection Program (preprint)

Purpose There is urgent need for interventions to facilitate earlier diagnosis of breast cancer in low- and middle-income countries where mammography screening is not widely available. Understanding patients’ experiences with early detection efforts, whether they are ultimately diagnosed with cancer or benign disease, is critical to optimize interventions and maximize community engagement. We sought to understand the experiences of patients undergoing breast evaluation in Rwanda’s Women’s Cancer Early Detection Program (WCEDP).Methods We conducted in-person semi-structured interviews with 30 patients in two districts of Rwanda participating in the WCEDP. Patients represented a range of ages and both benign and malignant diagnoses. Interviews were recorded, transcribed, translated, and thematically analyzed.Results Participants identified facilitators and barriers of timely care along the breast evaluation pathway. Community awareness initiatives were facilitators to care-seeking, while persistent myths and stigma about cancer were barriers. Participants valued clear clinician-patient communication and emotional support from clinicians and peers. Poverty was a major barrier for participants who described difficulty paying for transport, insurance premiums, and other direct and indirect costs of hospital referrals in particular. COVID-19 lockdowns caused delays for referred patients. Although false-positive clinical breast exams conferred financial and emotional burdens, participants nonetheless voiced appreciation for their experience and felt empowered to monitor their own breast health and share knowledge with others.Conclusion Rwandan women experienced both benefits and burdens as they underwent breast evaluation. Enthusiasm for participation was not reduced by the experience of a false positive result. Reducing financial, logistical and emotional burdens of the breast diagnostic pathway through patient navigation, peer support and decentralization of diagnostic services could improve patients’ experience.

Relationship between regular cervical cancer screening and social background in Japan during the COVID-19 pandemic (preprint)

Background: Among Organization for Economic Co-operation and Development countries, Japan has one of the lowest cervical cancer screening rates. The cancer screening rate has reportedly worsened with the coronavirus disease of 2019 (COVID-19) pandemic. This study investigated the COVID-19 history and socioeconomic background of people who did not undergo on-time cervical cancer screening (CCS) during the two years of COVID-19-related restrictions in Japan. Methods: We used data from the Japan COVID-19 and Society Internet Survey, a nationwide, internet-based, self-report, cohort observational study conducted in 2022. The outcome variable was identified by asking whether the respondent had undergone on-time CCS within the last two years. This study used multivariate log-binomial regression models to evaluate inequalities during regular checkups for CCS. Adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) were estimated to incorporate socioeconomic background variables. Results: Of 12,066 respondents, 6469 (53.6%) had yet to undergo CCS within two years. The prevalence ratio (PR) of on-time CCS was 0.70 (95% CI: 0.63–0.79) for those in their 20s and 0.78 (95%CI:0.70-0.87) for those in their 60s, compared to their 40s. Moreover, socioeconomic inequities were found in the following groups: unemployed/student, unmarried, high school graduate or lower, and household income below 4 million yen. PR of on-time CCS with a history of COVID-19, unvaccinated status, or fear of COVID-19 was not significantly different from that of respondents who underwent CCS. However, the PR of those who had not undergone on-time CCS was significantly lower than that of respondents who had undergone breast cancer screening (PR: 0.29, 95% CI: 0.28–0.31). Conclusion: the relationship between socioeconomic inequalities and CCS hesitancy was prevalent among the younger respondents. Our findings will help policymakers identify problems and strategies to improve CCS screening rates in Japan.