Diagnostic pathways for breast cancer in 10 International Cancer Benchmarking Partnership (ICBP) jurisdictions: an international comparative cohort study based on questionnaire and registry data

OBJECTIVES

A growing body of evidence suggests longer time between symptom onset and start of treatment affects breast cancer prognosis. To explore this association, the International Cancer Benchmarking Partnership Module 4 examined differences in breast cancer diagnostic pathways in 10 jurisdictions across Australia, Canada, Denmark, Norway, Sweden and the UK.

SETTING

Primary care in 10 jurisdictions.

PARTICIPANT

Data were collated from 3471 women aged >40 diagnosed for the first time with breast cancer and surveyed between 2013 and 2015. Data were supplemented by feedback from their primary care physicians (PCPs), cancer treatment specialists and available registry data.

PRIMARY AND SECONDARY OUTCOME MEASURES

Patient, primary care, diagnostic and treatment intervals.

RESULTS

Overall, 56% of women reported symptoms to primary care, with 66% first noticing lumps or breast changes. PCPs reported 77% presented with symptoms, of whom 81% were urgently referred with suspicion of cancer (ranging from 62% to 92%; Norway and Victoria). Ranges for median patient, primary care and diagnostic intervals (days) for symptomatic patients were 3-29 (Denmark and Sweden), 0-20 (seven jurisdictions and Ontario) and 8-29 (Denmark and Wales). Ranges for median treatment and total intervals (days) for all patients were 15-39 (Norway, Victoria and Manitoba) and 4-78 days (Sweden, Victoria and Ontario). The 10% longest waits ranged between 101 and 209 days (Sweden and Ontario).

CONCLUSIONS

Large international differences in breast cancer diagnostic pathways exist, suggesting some jurisdictions develop more effective strategies to optimise pathways and reduce time intervals. Targeted awareness interventions could also facilitate more timely diagnosis of breast cancer.

Comparing Heat Shock Proteins in Angus and Brahman Cattle and their Effect On Tenderness

ObjectivesHeat shock proteins (HSP) are biomarkers of stress and perform chaperoning functions to fold, unfold, and refold proteins after heat stress. Brahman are more heat tolerant than Angus, while Angus beef has been associated with greater palatability than Brahman. The objectives were to determine if HSP content in the longissimus lumborum differs between Angus and Brahman and examine how HSP content relates to the eating quality of beef.Materials and MethodsAngus and Brahman steers (n = 12 per breed) were finished during summer in Florida and harvested at approximately 17 mo of age. Samples of longissimus lumborum were collected at 1 h after exsanguination and were immediately immersed in liquid nitrogen. Samples were then pulverized, diluted in extraction buffer, and homogenized. The protein samples were assayed to assess protein concentration and subsequently diluted to equal concentrations for loading into acrylamide gels. Proteins were separated by gel electrophoresis, and western blotting was used to evaluate content of aβ-crystallin, HSP27, HSP60, HSP70, and HSP90. Target bands were detected and quantified using LI-COR Odyssey and target signal was normalized to total protein stain. Tenderness was evaluated in 14d-aged steaks using Warner-Bratzler shear force (WBSF) and a trained sensory panel. Data were analyzed using one-way ANOVA and Pearson correlations were conducted for content of HSPs and objective and subjective tenderness.ResultsHSP27, HSP60, and HSP70 did not differ between breeds (P > 0.05); however, HSP90 and aβ-crystallin were greater (P = 0.005) in the longissimus lumborum of Angus compared to Brahman. Even though WBSF did not differ (P = 0.29) between breeds, breed affected (P < 0.0001) sensory tenderness. Content of aβ-crystallin was associated with sensory tenderness (r2 = 0.52, P = 0.0098).ConclusionLongissimus dorsi from the Angus were contained more aβ-crystallin and HSP90 than Brahman. Elevated concentrations of both aβ-crystallin and HSP90 could be breed related or may have been influenced by the season they were harvested. While WBSF was not affected by breed, panelists rated Angus steaks as more tender after aging for 14d. Content of aβ-crystallin is associated with tenderness; however further work is necessary to determine if this small HSP affects proteolysis.