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Since there are no published data on breast cancer in British black women, we sought to determine whether, like African-American women, they present at a younger age with biologically distinct disease patterns. The method involved a retrospective review of breast cancer to compare age distributions and clinicopathological features between black women and white women in the UK, while controlling for socioeconomic status. All women presented with invasive breast cancer, between 1994 and 2005, to a single East London hospital. Black patients presented significantly younger (median age of 46 years), than white patients (median age of 67 years (P=0.001)). No significant differences between black and white population structures were identified. Black women had a higher frequency of grade 3 tumours, lymph node-positive disease, negative oestrogen receptor and progesterone receptor status and basal-like (triple negative status) tumours. There were no differences in stage at presentation; however, for tumours of < or =2 cm, black patients had poorer survival than white patients (HR=2.90, 95% CI 0.98-8.60, P=0.05). Black women presented, on average, 21 years younger than white women. Tumours in younger women were considerably more aggressive in the black population, more likely to be basal-like, and among women with smaller tumours, black women were more than twice as likely to die of their disease. There were no disparities in socioeconomic status or treatment received. Our findings could have major implications for the biology of breast cancer and the detection and treatment of the disease in black women. [ABSTRACT FROM AUTHOR]

These guidelines have been developed jointly by the British Gynaecological Cancer Society and British Menopause Society to provide information for all healthcare professionals managing women treated for gynaecological cancer. Menopausal symptoms can have a significant impact on quality of life for women. Cancer therapies, including surgery, pelvic radiotherapy, chemotherapy and endocrine therapy, can all affect ovarian function. The benefits and risks of using hormone replacement therapy are considered by cancer type with guidance on the type of HRT and optimal time of commencement after cancer treatment. Vaginal estrogens can be very effective for improving urogenital symptoms and are safe for the majority of women, including those for whom systemic HRT is contraindicated with rare exceptions. Alternative options to HRT are reviewed including pharmacological and non-pharmacological approaches., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: RM: Grants from GSK, NHS England, Yorkshire Cancer Research, Barts Charity, Rosetrees Trust outside the submitted work, and honoraria for advisory board membership from Astrazeneca/MSD/GSK/EGL. RM was clinical lead/topic advisor for NICE Guideline NG241 Ovarian cancer: identifying and managing familial and genetic risk.SG-M: membership of NICE HRT guidelines committee.TH: Consultancy and lecture fees from Astellas. JS: Funding for conference attendance, speaking and advisory board funding from Bayer, Astellas, Gedeon Richter and Theramex.

Standard of care genetic testing has undergone significant changes in recent years. The British Gynecological Cancer Society and the British Association of Gynecological Pathologists (BGCS/BAGP) has re-assembled a multidisciplinary expert consensus group to update the previous guidance with the latest standard of care for germline and tumor testing in patients with ovarian cancer. For the first time, the BGCS/BAGP guideline group has incorporated a patient advisor at the initial consensus group meeting. We have used patient focused groups to inform discussions related to reflex tumor testing - a key change in this updated guidance. This report summarizes recommendations from our consensus group deliberations and audit standards to support continual quality improvement in routine clinical settings., Competing Interests: Competing interests: None declared., (© IGCS and ESGO 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: EM – has received grant funding from BGCS, Orion Corporation, Leicester, Leicestershire and Rutland Integrated Care Board, East Genomic Medicine Service Alliance, North East London Cancer Alliance, Intuitive Surgical Ltd, East Midlands Clinical Research Network and Medical Research Council (MRC). AT − Has received financial support to attend meetings from Merck & Co., Inc (MSD). AA − None to declare. CA − None to declare. RA − None to declare. SB – Has received grants to her institution from Astrazeneca and Glaxo Smith Kline (GSK), and consulting fees from Astrazeneca, Epsilogen, GSK, Immunogen MSD, Mersana, Myriad, Novartis, Oncxerna, Seagen, Shattuck Labs, Regeneron and Verastem. She has received honoraria payments for lectures from Abbive, Astrazeneca, GSK, Immunogen, MSD, Mersnae, Pfizer, Roche, Takeda and Novacure, and financial support for attending meetings from Astrazeneca, GSK and Verastem. She is on the Ovacome advisory board (unpaid). RB – Has received honoraria for lecturers and presentations from GSK, Astra Zeneca and EISAI; support to attend meetings from GSK and PharmaAnd. She is an advisory board member for MSD, Clovis, Astra Zeneca, and GSK.She has unpaid board roles for NCRI Gynae Deputy Lead (GTGUK), UKGOM (co-chair) and is the BGCS Medical Oncology Representative. LB – is a director of Buckley Consultants Ltd. NB – Has received financial support from RanD for travel to meetings. SC – None to declare. RE – Has received consulting fees from GSK; honoraria for lecturers from GSK and Astra Zeneca and sits on the for Advisory Board for International Rainbo Study. ME-B – None to declare. CF –Has received payments for participation on a Data Safety Monitoring Board or Advisory Board for GSK, Roche, Ethicon, Astra Zeneca, MSD. JF – Has received consulting fees from ASTELLAS ASP5354 Advisory Board and is a BGCS Council member (unpaid). RG – Has received honoraria payments for lectures from Astra Zeneca, on topics unrelated to this document. AG – has received honoraria for lectrures/presentation from GSK. LH – Has received royalties from Cambridge University Press, support from Mims and Roche and Tata Medical Center to attend meetings, and is an unpaid board member to the Royal College of Radiologists. BK – Has received funding from NIHR Imperial BRC. RM – has received research grant funding from Rosetrees Trust, Barts Charity, NHS England, NHS Innovational Accelerator, Yorkshire Cancer Research and GSK. He has received honoraria from GSK and Astrazeneca for lectures and presentations. He is Chair Trial of the Steering Committee BRCA DIRECT trial, a member NICE National Standards Quality Assurance Board for Ovarian Cancer and Topic Advisor NICE Guideline – [NG241] −- Ovarian cancer: identifying and managing familial and genetic risk. He is a scientific advisor to GO Girls, BRCA Umbrella and acted on an Expert Advisory Group NHS Jewish BRCA Programme. HM – In a trustee of GO Girsls Gynaecological Cancer Charity. AM – has received National Institute for Cancer Research (NCRI) and MERCK received research funding from MDS. She has received payment from EUSA Pharma and Clovis Oncology for advisory board roles and consulting. She has recived payment from GSK for invited lectures and manuscript writing. She has received educational support and support for meeting attendance from MSD and IPSEN. TM – Project lead for NHS transformation project to embed mainstream BRCA testing into practice for breast, ovarian cancers. Nurse advisor to The EVE APPEAL gynae cancer charity. CN – None to declare. SN – has received research grants from GSK, AstraZenenca, North Central London Cancer Alliance and BGCS via her institution. She has received consulting fees from GSK, AstraZeneca and Biontech, and honoraria payments from lectures from GSK and AstraZenca. She has received financial support for attending meetings from MSD. She is an data safety monitoring/advisory board member to AstraZeneca, GSK and Biontech. She has stock options with GSK and AstraZeneca, and she is chair of the GynaeOncology Trials Group UK (previously NCRI) (unpaid). NR – None to declare. NRy – has received grants from the Chief Scientist Office Scotland (NES/CSO Postdoctoral Clinical Lectureship Scheme) and Academy of Medical Sciences to his institution. He has received honorariao payments from GSK for lectures. He is an European Hereditary Tumour Group (EHTG) Board member (unpaid). SS – has received a research grant to University of Birmingham from AoA diagnostics. She has received consultancy fees from GSK and Immunogen, and honoraria for lecturers from Astra Zeneca, Merck and GSK. She is Surgery Lead for the National Ovarian Cancer Audit, England and Wales and Co-Chair Scientific Program, International Gynaecological Cancer Society conference 2024. KV – Councillor for British Association of Gynaecological Pathology (unpaid). AW – has received honoraria for lecturers and presentaions from GSK, Astra Zeneca and Clovis. JW – is President, British Association of Gynaecological Pathologists (unpaid). JM – has received grants to her institution from the National Institute for Health and Care Research (NIHR) and MRC. She is BGCS guidelines subgroup co-chair (unpaid), sitting on BGCS Council in this role, and a NHS Cervical Screening Research Innovation and Development Advisory Committee Member (unpaid). She was an unpaid council member to Cochrane Collaboration (2019–2023) and received financial support to attend a meeting from Cochrane.

During the COVID-19 pandemic, pressures on clinical services required adaptation to how care was prioritised and delivered for women with gynecological cancer. This document discusses potential 'salvage' measures when treatment has deviated from the usual standard of care. The British Gynaecological Cancer Society convened a multidisciplinary working group to develop recommendations for the onward management and follow-up of women with gynecological cancer who have been impacted by a change in treatment during the pandemic. These recommendations are presented for each tumor type and for healthcare systems, and the impact on gynecological services are discussed. It will be important that patient concerns about the impact of COVID-19 on their cancer pathway are acknowledged and addressed for their ongoing care., Competing Interests: Competing interests: None declared., (© IGCS and ESGO 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

The British Gynecological Cancer Society and the British Association of Gynecological Pathologists established a multidisciplinary consensus group comprising experts in surgical gynecological oncology, medical oncology, genetics, and laboratory science, and clinical nurse specialists to identify the optimal pathways to BRCA germline and tumor testing in patients with ovarian cancer in routine clinical practice. In particular, the group explored models of consent, quality standards identified at pathology laboratories, and experience and data from pioneering cancer centers. The group liaised with representatives from ovarian cancer charities to also identify patient perspectives that would be important to implementation. Recommendations from these consensus group deliberations are presented in this manuscript., Competing Interests: Competing interests: SS has received honoraria from Astra Zeneca outside the submitted work. CF has received honoraria from Ethicon, Tesaro, MSD/Astra Zeneca, Clovis, Roche, GSK. RM reports grants from Barts Charity, grants from The Eve Appeal, personal fees from Astra Zeneca, MSD, outside the submitted work. RB reports personal fees from GSK, personal fees from AstraZeneca, personal fees from Clovis, from Tesaro, outside the submitted work. RE reports personal fees from Astra Zeneca, personal fees from Clovis Pharma, personal fees from GSK, outside the submitted work., (© IGCS and ESGO 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Building on previous work indicating that mood instability is the hallmark of neuroticism, our aim was to examine whether changes in exercise, sleep duration and leisure predicted decreases in mood instability with time., Methods: We used data from 3374 participants of the British Health and Lifestyle Study who answered the Eysenck Personality Inventory-Neuroticism subscale (EPI-N) and the General Health Questionnaire on two occasions 7 years apart. We predicted mood instability scores derived from the EPI-N at follow-up using self-reported changes in exercise, sleep duration and leisure hours between the two time points as independent variables., Results: We confirmed the observation that mood instability decreases with age. Maintaining one's exercise at baseline level decreased mood instability (beta=-0.21) while sleeping less increased mood instability (beta=0.14). Change in leisure time was not independently related to mood instability after accounting for the two other lifestyle factors., Conclusion: Personality, at least with regard to mood instability, can be modified by lifestyle factors. Exercise and sleep support mood stability and could be important components of preventative mental health (as well as physical health) benefits., (© 2013.)

Objective: To determine the effectiveness of an intervention to enhance self management support for patients with chronic conditions in UK primary care., Design: Pragmatic, two arm, cluster randomised controlled trial., Setting: General practices, serving a population in northwest England with high levels of deprivation., Participants: 5599 patients with a diagnosis of diabetes (n=2546), chronic obstructive pulmonary disease (n=1634), and irritable bowel syndrome (n=1419) from 43 practices (19 intervention and 22 control practices)., Intervention: Practice level training in a whole systems approach to self management support. Practices were trained to use a range of resources: a tool to assess the support needs of patients, guidebooks on self management, and a web based directory of local self management resources. Training facilitators were employed by the health management organisation., Main Outcome Measures: Primary outcomes were shared decision making, self efficacy, and generic health related quality of life measured at 12 months. Secondary outcomes were general health, social or role limitations, energy and vitality, psychological wellbeing, self care activity, and enablement., Results: We randomised 44 practices and recruited 5599 patients, representing 43% of the eligible population on the practice lists. 4533 patients (81.0%) completed the six month follow-up and 4076 (72.8%) the 12 month follow-up. No statistically significant differences were found between patients attending trained practices and those attending control practices on any of the primary or secondary outcomes. All effect size estimates were well below the prespecified threshold of clinically important difference., Conclusions: An intervention to enhance self management support in routine primary care did not add noticeable value to existing care for long term conditions. The active components required for effective self management support need to be better understood, both within primary care and in patients' everyday lives., Trial Registration: Current Controlled Trials ISRCTN90940049.