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2. Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Author

Dave, Rajiv V., Kim, Baek, Courtney, Alona, O’Connell, Rachel, Rattay, Tim, Taxiarchi, Vicky P., Kirkham, Jamie J., Camacho, Elizabeth M., Fairbrother, Patricia, Sharma, Nisha, Cartlidge, Christopher W. J., Horgan, Kieran, McIntosh, Stuart A., Leff, Daniel R., Vidya, Raghavan, Holcombe, Chris, Copson, Ellen, Coles, Charlotte E., Cutress, Ramsey I., Gandhi, Ashu, Kirwan, Cliona C., Agrawal, Amit, Benson, John, Forouhi, Parto, Wignarajah, Primeera, Shrotri, Anu, Kattakayam, Arjun, Noronha, Jarin Louis, Martin, Lee, Lafi, Mohamed, Hardy, Rob, Amin, Khalid, AL-Zawi, Abdalla Saad Abdalla, Elamass, Mohamed, Salih, Ali, Alkistawi, Firas Eddin Bachir, Heeney, Anna, Hill, Arnold D. K., Power, Colm, Allen, Michael J., Chouhan, Ashok, Rathinaezhil, Rathi, Shaheed, Samy, Zammit, Charles, Clayton, Gillian, Dua, Sascha, Smith, Simon, Gandamihardja, Tasha, Williams, Chloe, Egbeare, Donna, Davies, Eleri, Sweetland, Helen M., Chopra, Sharat, Goyal, Sumit, Elfadl, Dalia, Rana, Dheer Singh, Kalakouti, Eliana, Barkeji, Musa, Vashisht, Rajiv, Bunza, Ralia, Phyu, Saung Hnin, Hollywood, Ciaran, Azmy, Iman, Massey, Julia, Hargreaves, Anita, Harding-Mackean, Claudia, Ooi, Jane, Seward, Joanna, Mathers, Helen, Scally, Norah, Salman, Reem, Shin, Hyunjin, Turner, Jane, Noor, Lubna, Joshi, Sanjay, Horne, Sarah, Sarakbi, Wail Al, Liptay-Wagner, Peter, Jacklin, Rosamond, Chandrasekharan, Sankaran, Marsh, Simon, Saha, Sunita, Wilson, Christopher, Rutherford, Claire Louise, Doughty, Julie, Romics, Laszlo, Stallard, Sheila, Chaudhry, Anushka, Peck, Jennifer, Coombs, Nathan, Williams, Samantha K., Hawkins, Simon, Kothari, Ashutosh, Hamed, Hisham, Jain, Urvashi, Daltrey, Ian, Abbott, Nick, Mullen, Russell, Dumitru, Dorin, Khalifa, Eiman, Sarker, Masuma, Elahi, M. Bilal, Bichoo, Raouef Ahmed, Gvaramadze, Anzors, Thekkinkattil, Dinesh, Jibril, Jibril, Hadjiminas, Demetrios, St John, Edward R. C., Robb, Henry Douglas, Hogben, Katy, Bakri, Nur Amalina Che, Thiruchelvam, Paul, Exarchos, Georgios, Al-Mufti, Ragheed, Mortimer, Caroline, Mallidis, Evangelos, Karagiannidis, Georgios, Tuffaha, Hussein, Peerlink, Inga, Nair, Rajive, Prusty, Lydia, Sami, Amtul, Knight, Alex, Ravichandran, Duraisamy, Kirkpatrick, Katharine, James, Ruth, Akolekar, Deepika, Mehta, Disha, Barua, Ellora, Knowles, Hannah, Devalia, Haresh, Cox, Karina, Dani, Mohsin, Chalmers, Ritchie, Satpathy, Anjana, Quinn, Edel, Byrne, Gerard, Harvey, James, Murphy, John, Highton, Lyndsey, Sharif, Mohammad Amir, Barnes, Nicola, Dimopoulos, Nikitas, Johnson, Richard, Chatterjee, Sumohan, Fatayer, Hiba, Mathen, Vinod, Taylor, Amanda, Soulsby, Rachel, Walsh, Adam, Thorne, Amanda, Gill, Jasper, Merker, Louise, Critchley, Adam, Pieri, Andrew, Cain, Henry, Ralph, Jane, Kalra, Loraine, Thomas, Robert, Young, Ian, Khan, Lucy R., Elsberger, Beatrix, Smyth, Elizabeth, Urquhart, Gordon, Fuller, Mairi, Masannat, Yazan, Chrysafi, Ada, Salman, Muhammad, Abdalla, El-Rasheed, Zechmeister, Katalin, Hussien, Maged, Youssef, Mina M. G., Tanhueco, Angeline, Salvador, Reginald, Wallace, Sharon, Pain, Simon, Sahu, Ajay, Chambers, Alice, Moody, Alice, Dash, Isabella, Cook, James, Batt, Jeremy, Mullan, Michelle, Shere, Mike, Gallegos, Nicholas, Ainsworth, Rachel, Govindarajulu, Sasi, Potter, Shelley, Rayter, Zenon, Williams, Kate E., Bramley, Maria, Absar, Mohammed, Nasir, Nabila, Tabbakh, Rami, Pereira, Bernadette, Gahir, Jasdeep, Bosch, Karen, Fafemi, Oladapo, Touqan, Nader, Oni, Georgette, Khout, Hazem, Asgeirsson, Kristjan, Whisker, Lisa, Lee, Rachel Xue Ning, Macmillan, Robert, McCulley, Stephen, Rasheed, Tuabin, Adwani, Asha, Segaran, Ashvina, Dodwell, David, Remoundos, Dennis, MacLean, Gael, Cuffolo, Giulio, Douek, Michael, Roy, Pankaj, Gathani, Toral, Najeeb, Erum, Simonca, Claudiu, Verroiotou, Maria, Ramzi, Sa’ed, Jenkins, Stephanie C., Gopalan, Vallipuran, Barker, Sarah, McGoldrick, Ciara, Irwin, Gareth W., Mallon, Peter, Sloan, Samantha A., Imran, Abbas, Mondani, Giuseppina, Brown, Iain, Abbas, Imran, Sulieman, Mona, Drew, Philip, King, Polly, English, Rachel Elizabeth, Sharma, Anita, Ives, Charlotte, Ferguson, Douglas, Boundouki, George, Bentley, James, Banks, Jenny, Dunn, Julie, Tillett, Rachel, Olsen, Sisse, Tansley, Anne, Sousa, Emma De, Mitchell, Geraldine, Whitehead, Ian, Henderson, Julia, Rowland, Matthew, Chandrashekar, Mysore, Eid, Raja, Clayton, Elizabeth, Pakzad, Farrokh, Horsnell, Jonathan D., Hague, Matthew, Partlett, Polly, Irvine, Tracey, Kallaway, Charlotte, Fairhurst, Katherine, Laban, Christiana, McIntosh, Jamie, Laurence, Nicola, Sutton, Richard, Sharma, Anup, Banerjee, Dibyesh, Betambeau, Nadine, Bezzaa, Sabrina, Bathla, Sonia, Ray, Atanu, Chagla, Leena, Kiernan, Tamara, Hogan, Brian, Navin, Channegowda, Macinnes, Emma, Turton, Philip, Achuthan, Raj, Kantola, Venla, Mckenzie, Shireen, Dent, Helen, Pogson, Caroline, Waheed, Shamaela, De Silva, Tania S., Suleiman, Usama, Jones, Lucie, Athwal, Ruvinder, Harries, Simon, Krzyzanowska, Catherine, Abbas, Abeera, Hurley, Anna R., Gui, Gerald, Rusby, Jennifer E., Krupa, Katherine, Harborough, Kathryn E., Roche, Nicola, Barry, Peter A., Law, Rebekah, Allum, William H., Lobo, Cheryl, Ntakomyti, Eleni, Franks, Joanna, Cariati, Massimiliano, Patani, Neill, Stanilov, Noyko, Charalampoudis, Petros, Taraki, Zarghuna, McEvoy, Kat, Sait, Mohamed Razick, Robertson, Stuart, Zeidan, Bashar, Rew, David, Mazari, Fayyaz, Alder, Louise, Sakellariou, Vasileios, Hamad, Ahmed, Goyal, Amit, Carmichael, Amtul, Courtney, Carol-Ann, Sibbering, David Mark, Garreffa, Emanuele, Cheung, Kwok-Leung, Williams-Jones, Susan, Wahedna, Yasmin, Ansari, Aonghus, Kenny, Frances, Valassiadou, Kalliope, Lambert, Kelly, Krupa, Jaroslaw, Sardar, Mini V., Kaushik, Monika, Shokuhi, Sheila, Pilgrm, Simon, Sasi, Walid, McManus, Penelope, Parmeshwar, Rishikesh, Somasundaram, Santosh, Gowda, Manoj, Jafferbhoy, Sadaf, Narayanan, Sankaran, Marla, Sekhar, Soumian, Soni, Goh, Ngee-Ming, Vatish, Jamie, Sein, Tin Aung, Agabiti, Ennio, Maalo, Joseph, Chong, Kelvin, Lai, Lee-Min, Elkorety, Mohamed, Monib, Sherif, Thomson, Simon, Mikhael, Youhana, Mirshekar-Syahkal, Bahar, Aitken, Jane, Girgis, Mina, Betal, Dibendu, Rapisarda, Fabio, Cook, Lorna, Odofin, Olubunmi, Bonomi, Riccardo, Wardle, Stacy, Sotheran, Wendy, Athanasiou, Irene, Lund, Jonathan, Callaghan, Maria, Burrah, Rajaram, Vinayagam, Raman, James, Karen, Poonawala, Shabbir, Isgar, Brian, Matey, Pilar, Mylvaganam, Senthurun, Podesta, Carl, Sircar, Tapan, Salem, Fathi, Al-Ishaq, Zaid, Dave, Rajiv V. [0000-0001-6827-8090], McIntosh, Stuart A. [0000-0002-4123-9611], Potter, Shelley [0000-0002-6977-312X], Copson, Ellen [0000-0001-8994-4056], and Apollo - University of Cambridge Repository

Subjects
692/700/784, article, 692/4028/67/1347, 692/700/3934, 692/700/1538, 692/4028/546
Abstract

Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown.

Published
2021
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3. Dermoscopy as an adjunct to surgical excision of nonmelanoma Skin lesions: a systematic review and Meta-analysis.

Author

HURLEY, ANNA R., TOTTY, JOSHUA P., and PINDER, RICHARD M.

Subjects
*DERMOSCOPY, *BASAL cell carcinoma, *RANDOM effects model, *SURGICAL excision, *MOHS surgery, *SQUAMOUS cell carcinoma, *SKIN cancer
Abstract

Background: Nonmelanoma skin cancers (NMSC) have an incidence of 152,000 cases per year in the United Kingdom (UK), which continues to rise. Incomplete excision rates for NMSC are estimated to be around 10 percent and result in patients having a higher risk of recurrence or having to undergo further treatment.Objective: The objective of our study was to determine whether the use of dermoscopy as an adjunct to clinical examination could improve the rates of incomplete excision in NMSC lesions.Methods: Electronic literature search of MEDLINE, EMBASE, and Cochrane Central databases plus manual reference checks of articles on dermoscopy use in surgery between inception and November 2020. Two levels of screening were used on 452 studies. A random effects model was used in the meta-analysis, with the DerSimonian-Laird method used to pool data.Results: A total of six fully extracted studies were included with a total of 592 patients; with five of these studies reported on basal cell carcinomas and one reported on squamous cell carcinomas. The odds ratio of incomplete excision when guided by dermoscopy was 0.29 (95%CI 0.25; 0.34). Heterogeneity was assessed with the I2 statistic and was found to be 0 percent.Limitations: The number of studies included was small, with three of the studies from the same authors. Studies included are nonrandomized and as such hold a significant risk of bias.Conclusion: Incomplete excision rates were reduced when using dermoscopy to mark surgical excision margins in comparison to naked eye evaluation alone. [ABSTRACT FROM AUTHOR]

Published
2022

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