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Glass S, Howell A. Diffuse erythema and edema of the oral mucosa. J Am Dent Assoc 2023:S0002-8177(23)00597-4. [PMID: 37877928 DOI: 10.1016/j.adaj.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023]
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Affiliation(s)
- A. Howell
- grid.5379.80000000121662407Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK ,grid.417286.e0000 0004 0422 2524Prevent Breast Cancer Centre, Wythenshawe Hospital Manchester Universities Foundation Trust, Wythenshawe, Manchester, UK ,grid.412917.80000 0004 0430 9259Manchester Breast Centre, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK
| | - S. J. Howell
- grid.5379.80000000121662407Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK ,grid.417286.e0000 0004 0422 2524Prevent Breast Cancer Centre, Wythenshawe Hospital Manchester Universities Foundation Trust, Wythenshawe, Manchester, UK ,grid.412917.80000 0004 0430 9259Manchester Breast Centre, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK
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Howell A, Helmkamp S, Belmont E. Stable polycyclic aromatic carbon (SPAC) formation in wildfire chars and engineered biochars. Sci Total Environ 2022; 849:157610. [PMID: 35907547 DOI: 10.1016/j.scitotenv.2022.157610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/22/2022] [Accepted: 07/20/2022] [Indexed: 06/15/2023]
Abstract
Pyrogenic carbon (PyC) is an important component of wildfire chars and engineered biochars due to its potential environmental longevity, the most environmentally stable fraction of which is called stable polycyclic aromatic carbon (SPAC) and is projected to persist in global environments for >1000 yr. Rigorous characterization of SPAC, whether formed in wildfires or engineered, is essential for accurate global carbon cycle models. However, the quantification of SPAC remains challenging and methods for its direct characterization are often inaccessible and/or highly specialized. Additionally, these methods often rely on SPAC formation measured in laboratory biochars produced in inert environments, which have been shown to correlate poorly with wildfire chars and/or engineered biochars manufactured in oxidative environments. The present study investigated the relationship between SPAC formation and physicochemical metrics - mass loss and molar H:C and O:C ratios - that capture the influences of multiple formation variables, including gas environment temperature, O2 availability, and pyrolysis duration, and negates the need for these variables to be directly measured. SPAC content is measured in this study using hydrogen pyrolysis (HyPy), which is an established accurate method for characterizing that most environmentally stable PyC fraction. Results show that SPAC formation and elemental ratios correlate linearly with increased mass loss, which is reflective of increased pyrolysis severity. The relationship between these char characteristics allows for SPAC prediction based on measurement of mass loss during char formation, as well as the standardized elemental analysis method. In this study, wildfire chars exhibited relatively low SPAC contents of <30 wt% on a dry, ash-free basis, indicating that a significant fraction of PyC formed in these chars remains labile or semi-labile, while engineered biochars had a range of SPAC contents up to approximately 75 wt%. The predictive SPAC models developed in this work can improve global carbon accounting models.
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Affiliation(s)
- Alexandra Howell
- Department of Mechanical Engineering, The University of Wyoming, Laramie, WY, USA
| | - Sophia Helmkamp
- Department of Mechanical Engineering, The University of Wyoming, Laramie, WY, USA
| | - Erica Belmont
- Department of Mechanical Engineering, The University of Wyoming, Laramie, WY, USA.
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Buch M, Buckley P, Bularga A, Bullmore E, Burden L, Burdett T, Burn D, Burns G, Burns A, Busby J, Butcher R, Butt A, Byrne S, Cairns P, Calder PC, Calvelo E, Carborn H, Card B, Carr C, Carr L, Carson G, Carter P, Casey A, Cassar M, Cavanagh J, Chablani M, Chambers RC, Chan F, Channon KM, Chapman K, Charalambou A, Chaudhuri N, Checkley A, Chen J, Cheng Y, Chetham L, Childs C, Chilvers ER, Chinoy H, Chiribiri A, Chong-James K, Choudhury N, Chowienczyk P, Christie C, Chrystal M, Clark D, Clark C, Clarke J, Clohisey S, Coakley G, Coburn Z, Coetzee S, Cole J, Coleman C, Conneh F, Connell D, Connolly B, Connor L, Cook A, Cooper B, Cooper J, Cooper S, Copeland D, Cosier T, Coulding M, Coupland C, Cox E, Craig T, Crisp P, Cristiano D, Crooks MG, Cross A, Cruz I, Cullinan P, Cuthbertson D, Daines L, Dalton M, Daly P, Daniels A, Dark P, Dasgin J, David A, David C, Davies E, Davies F, Davies G, Davies GA, Davies K, Dawson J, Daynes E, Deakin B, Deans A, Deas C, Deery J, Defres S, Dell A, Dempsey K, Denneny E, Dennis J, Dewar A, Dharmagunawardena R, Dickens C, Dipper A, Diver S, Diwanji SN, Dixon M, Djukanovic R, Dobson H, Dobson SL, Donaldson A, Dong T, Dormand N, Dougherty A, Dowling R, Drain S, Draxlbauer K, Drury K, Dulawan P, Dunleavy A, Dunn S, Earley J, Edwards S, Edwardson C, El-Taweel H, Elliott A, Elliott K, Ellis Y, Elmer A, Evans D, Evans H, Evans J, Evans R, Evans RI, Evans T, Evenden C, Evison L, Fabbri L, Fairbairn S, Fairman A, Fallon K, Faluyi D, Favager C, Fayzan T, Featherstone J, Felton T, Finch J, Finney S, Finnigan J, Finnigan L, Fisher H, Fletcher S, Flockton R, Flynn M, Foot H, Foote D, Ford A, Forton D, Fraile E, Francis C, Francis R, Francis S, Frankel A, Fraser E, Free R, French N, Fu X, Furniss J, Garner L, Gautam N, George J, George P, Gibbons M, Gill M, Gilmour L, Gleeson F, Glossop J, Glover S, Goodman N, Goodwin C, Gooptu B, Gordon H, Gorsuch T, Greatorex M, Greenhaff PL, Greenhalgh A, Greenwood J, Gregory H, Gregory R, Grieve D, Griffin D, Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, Jastrub R, Jayaraman B, Jezzard P, Jiwa K, Johnson C, Johnson S, Johnston D, Jolley CJ, Jones D, Jones G, Jones H, Jones H, Jones I, Jones L, Jones S, Jose S, Kabir T, Kaltsakas G, Kamwa V, Kanellakis N, Kaprowska S, Kausar Z, Keenan N, Kelly S, Kemp G, Kerslake H, Key AL, Khan F, Khunti K, Kilroy S, King B, King C, Kingham L, Kirk J, Kitterick P, Klenerman P, Knibbs L, Knight S, Knighton A, Kon O, Kon S, Kon SS, Koprowska S, Korszun A, Koychev I, Kurasz C, Kurupati P, Laing C, Lamlum H, Landers G, Langenberg C, Lasserson D, Lavelle-Langham L, Lawrie A, Lawson C, Lawson C, Layton A, Lea A, Lee D, Lee JH, Lee E, Leitch K, Lenagh R, Lewis D, Lewis J, Lewis V, Lewis-Burke N, Li X, Light T, Lightstone L, Lilaonitkul W, Lim L, Linford S, Lingford-Hughes A, Lipman M, Liyanage K, Lloyd A, Logan S, Lomas D, Loosley R, Lota H, Lovegrove W, Lucey A, Lukaschuk E, Lye A, Lynch C, MacDonald S, MacGowan G, Macharia I, Mackie J, Macliver L, Madathil S, Madzamba G, Magee N, Magtoto MM, Mairs N, Majeed N, Major E, Malein F, Malim M, Mallison G, Mandal S, Mangion K, Manisty C, Manley R, March K, Marciniak S, Marino P, Mariveles M, Marouzet E, Marsh S, Marshall B, Marshall M, Martin J, Martineau A, Martinez LM, Maskell N, Matila D, Matimba-Mupaya W, Matthews L, Mbuyisa A, McAdoo S, Weir McCall J, McAllister-Williams H, McArdle A, McArdle P, McAulay D, McCormick J, McCormick W, McCourt P, McGarvey L, McGee C, Mcgee K, McGinness J, McGlynn K, McGovern A, McGuinness H, McInnes IB, McIntosh J, McIvor E, McIvor K, McLeavey L, McMahon A, McMahon MJ, McMorrow L, Mcnally T, McNarry M, McNeill J, McQueen A, McShane H, Mears C, Megson C, Megson S, Mehta P, Meiring J, Melling L, Mencias M, Menzies D, Merida Morillas M, Michael A, Milligan L, Miller C, Mills C, Mills NL, Milner L, Misra S, Mitchell J, Mohamed A, Mohamed N, Mohammed S, Molyneaux PL, Monteiro W, Moriera S, Morley A, Morrison L, Morriss R, Morrow A, Moss AJ, Moss P, Motohashi K, Msimanga N, Mukaetova-Ladinska E, Munawar U, Murira J, Nanda U, Nassa H, Nasseri M, Neal A, Needham R, Neill P, Newell H, Newman T, Newton-Cox A, Nicholson T, Nicoll D, Nolan CM, Noonan MJ, Norman C, Novotny P, Nunag J, Nwafor L, Nwanguma U, Nyaboko J, O'Donnell K, O'Brien C, O'Brien L, O'Regan D, Odell N, Ogg G, Olaosebikan O, Oliver C, Omar Z, Orriss-Dib L, Osborne L, Osbourne R, Ostermann M, Overton C, Owen J, Oxton J, Pack J, Pacpaco E, Paddick S, Painter S, Pakzad A, Palmer S, Papineni P, Paques K, Paradowski K, Pareek M, Parfrey H, Pariante C, Parker S, Parkes M, Parmar J, Patale S, Patel B, Patel M, Patel S, Pattenadk D, Pavlides M, Payne S, Pearce L, Pearl JE, Peckham D, Pendlebury J, Peng Y, Pennington C, Peralta I, Perkins E, Peterkin Z, Peto T, Petousi N, Petrie J, Phipps J, Pimm J, Piper Hanley K, Pius R, Plant H, Plein S, Plekhanova T, Plowright M, Polgar O, Poll L, Porter J, Portukhay S, Powell N, Prabhu A, Pratt J, Price A, Price C, Price C, Price D, Price L, Price L, Prickett A, Propescu J, Pugmire S, Quaid S, Quigley J, Qureshi H, Qureshi IN, Radhakrishnan K, Ralser M, Ramos A, Ramos H, Rangeley J, Rangelov B, Ratcliffe L, Ravencroft P, Reddington A, Reddy R, Redfearn H, Redwood D, Reed A, Rees M, Rees T, Regan K, Reynolds W, Ribeiro C, Richards A, Richardson E, Rivera-Ortega P, Roberts K, Robertson E, Robinson E, Robinson L, Roche L, Roddis C, Rodger J, Ross A, Ross G, Rossdale J, Rostron A, Rowe A, Rowland A, Rowland J, Roy K, Roy M, Rudan I, Russell R, Russell E, Saalmink G, Sabit R, Sage EK, Samakomva T, Samani N, Sampson C, Samuel K, Samuel R, Sanderson A, Sapey E, Saralaya D, Sargant J, Sarginson C, Sass T, Sattar N, Saunders K, Saunders P, Saunders LC, Savill H, Saxon W, Sayer A, Schronce J, Schwaeble W, Scott K, Selby N, Sewell TA, Shah K, Shah P, Shankar-Hari M, Sharma M, Sharpe C, Sharpe M, Shashaa S, Shaw A, Shaw K, Shaw V, Shelton S, Shenton L, Shevket K, Short J, Siddique S, Siddiqui S, Sidebottom J, Sigfrid L, Simons G, Simpson J, Simpson N, Singh C, Singh S, Sissons D, Skeemer J, Slack K, Smith A, Smith D, Smith S, Smith J, Smith L, Soares M, Solano TS, Solly R, Solstice AR, Soulsby T, Southern D, Sowter D, Spears M, Spencer LG, Speranza F, Stadon L, Stanel S, Steele N, Steiner M, Stensel D, Stephens G, Stephenson L, Stern M, Stewart I, Stimpson R, Stockdale S, Stockley J, Stoker W, Stone R, Storrar W, Storrie A, Storton K, Stringer E, Strong-Sheldrake S, Stroud N, Subbe C, Sudlow CL, Suleiman Z, Summers C, Summersgill C, Sutherland D, Sykes DL, Sykes R, Talbot N, Tan AL, Tarusan L, Tavoukjian V, Taylor A, Taylor C, Taylor J, Te A, Tedd H, Tee CJ, Teixeira J, Tench H, Terry S, Thackray-Nocera S, Thaivalappil F, Thamu B, Thickett D, Thomas C, Thomas S, Thomas AK, Thomas-Woods T, Thompson T, Thompson AAR, Thornton T, Tilley J, Tinker N, Tiongson GF, Tobin M, Tomlinson J, Tong C, Touyz R, Tripp KA, Tunnicliffe E, Turnbull A, Turner E, Turner S, Turner V, Turner K, Turney S, Turtle L, Turton H, Ugoji J, Ugwuoke R, Upthegrove R, Valabhji J, Ventura M, Vere J, Vickers C, Vinson B, Wade E, Wade P, Wainwright T, Wajero LO, Walder S, Walker S, Walker S, Wall E, Wallis T, Walmsley S, Walsh JA, Walsh S, Warburton L, Ward TJC, Warwick K, Wassall H, Waterson S, Watson E, Watson L, Watson J, Welch C, Welch H, Welsh B, Wessely S, West S, Weston H, Wheeler H, White S, Whitehead V, Whitney J, Whittaker S, Whittam B, Whitworth V, Wight A, Wild J, Wilkins M, Wilkinson D, Williams N, Williams N, Williams J, Williams-Howard SA, Willicombe M, Willis G, Willoughby J, Wilson A, Wilson D, Wilson I, Window N, Witham M, Wolf-Roberts R, Wood C, Woodhead F, Woods J, Wormleighton J, Worsley J, Wraith D, Wrey Brown C, Wright C, Wright L, Wright S, Wyles J, Wynter I, Xu M, Yasmin N, Yasmin S, Yates T, Yip KP, Young B, Young S, Young A, Yousuf AJ, Zawia A, Zeidan L, Zhao B, Zongo O. Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Tekkis NP, Rafi D, Brown S, Courtney A, Kawka M, Howell AM, McLean K, Gardiner M, Mavroveli S, Hutchinson P, Tekkis P, Wilkinson P, Sam AH, Savva N, Kontovounisios C, Tekkis N, Rafi D, Brown S, Courtney A, Kawka M, Howell A, McLean K, Gardiner M, Mavroveli S, Hutchinson P, Tekkis P, Wilkinson P, Sam AH, Savva N, Kontovounisios C, Tekkis N, Rafi D, Brown S, Courtney A, Kawka M, Howell A, McLean K, Gardiner M, Mavroveli S, Hutchinson P, Tekkis P, Wilkinson P, Sam AH, Savva N, Kontovounisios C, Tekkis N, Brown S, Kawka M, Mclean K, Savva N, Wilkinson P, Sam AH, Singal A, Chia C, Chia W, Ganesananthan S, Ooi SZY, Pengelly S, Wellington J, Mak S, Subbiah Ponniah H, Heyes A, Aberman I, Ahmed T, Al-Shamaa S, Appleton L, Arshad A, Awan H, Baig Q, Benedict K, Berkes S, Citeroni NL, Damani A, de Sancha A, Fisayo T, Gupta S, Haq M, Heer B, Jones A, Khan H, Kim H, Meiyalagan N, Miller G, Minta N, Mirza L, Mohamed F, Ramjan F, Read P, Soni L, Tailor V, Tas RN, Vorona M, Walker M, Winkler T, Bardon A, Acquaah J, Ball T, Bani W, Elmasry A, Hussein F, Kolluri M, Lusta H, Newman J, Nott M, Perwaiz MI, Rayner R, Shah A, Shaw I, Yu K, Cairns M, Clough R, Gaier S, Hirani D, Jeyapalan T, Li Y, Patel CR, Shabir H, Wang YA, Weatherhead A, Dhiran A, Renney O, Wells P, Ferguson S, Joyce A, Mergo A, Adebayo O, Ahmad J, Akande O, Ang G, Aniereobi E, Awasthi S, Banjoko A, Bates J, Chibada C, Clarke N, Craner I, Desai DD, Dixon K, Duffaydar HI, Kuti M, Mughal AZ, Nair D, Pham MC, Preest GG, Reid R, Sachdeva GS, Selvaratnam K, Sheikh J, Soran V, Stoney N, Wheatle M, Howarth K, Knapp-Wilson A, Lee KS, Mampitiya N, Masson C, McAlinden JJ, McGowan N, Parmar SC, Robinson B, Wahid S, Willis L, Risquet R, Adebayo A, Dhingra L, Kathiravelupillai S, Narayanan R, Soni J, Ghafourian P, Hounat A, Lennon KA, Abdi Mohamud M, Chou W, Chong L, Graham CJ, Piya S, Riad AM, Vennard S, Wang J, Kawar L, Maseland C, Myatt R, Tengku Saifudin TNS, Yong SQ, Douglas F, Ogbechie C, Sharma K, Zafar L, Bajomo MO, Byrne MHV, Obi C, Oluyomi DI, Patsalides MA, Rajananthanan A, Richardson G, Clarke A, Roxas A, Adeboye W, Argus L, McSweeney J, Rahman-Chowdhury M, Hettiarachchi DS, Masood MT, Antypas A, Thomas M, de Andres Crespo M, Zimmerman M, Dhillon A, Abraha S, Burton O, Jalal AHB, Bailey B, Casey A, Kathiravelupillai A, Missir E, Boult H, Campen D, Collins JM, Dulai S, Elhassan M, Foster Z, Horton E, Jones E, Mahapatra S, Nancarrow T, Nyamapfene T, Rimmer A, Robberstad M, Robson-Brown S, Saeed A, Sarwar Y, Taylor C, Vetere G, Whelan MK, Williams J, Zahid D, Chand C, Matthews M. The impact of the COVID-19 pandemic on UK medical education. A nationwide student survey. Med Teach 2022; 44:574-575. [PMID: 34428109 DOI: 10.1080/0142159x.2021.1962835] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
| | - Damir Rafi
- School of Medicine, Imperial College London, London, UK
| | - Sam Brown
- Leicester Medical School, University of Leicester, Leicester, UK
| | - Alona Courtney
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Michal Kawka
- School of Medicine, Imperial College London, London, UK
| | - Ann-Marie Howell
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Kenneth McLean
- Division of Clinical and Surgical Sciences, University of Edinburgh, Edinburgh, UK
| | - Matthew Gardiner
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
| | | | - Peter Hutchinson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Paris Tekkis
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Paul Wilkinson
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Amir H Sam
- School of Medicine, Imperial College London, London, UK
| | - Nicos Savva
- Division of Management Science and Operations, London Business School, London, UK
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- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - T Ball
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - W Bani
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - A Elmasry
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - F Hussein
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - M Kolluri
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - H Lusta
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - J Newman
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - M Nott
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - M I Perwaiz
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - R Rayner
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - A Shah
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - I Shaw
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | - K Yu
- Plymouth University Peninsula Schools of Medicine and Dentistry
| | | | | | - S Gaier
- Queen Mary University of London
| | | | | | - Y Li
- Queen Mary University of London
| | | | | | | | | | - A Dhiran
- St George's Hospital Medical School
| | - O Renney
- St George's Hospital Medical School
| | - P Wells
- St George's Hospital Medical School
| | | | - A Joyce
- The Queen's University of Belfast
| | | | | | - J Ahmad
- The University of Birmingham
| | | | - G Ang
- The University of Birmingham
| | | | | | | | - J Bates
- The University of Birmingham
| | | | | | | | | | - K Dixon
- The University of Birmingham
| | | | - M Kuti
- The University of Birmingham
| | | | - D Nair
- The University of Birmingham
| | | | | | - R Reid
- The University of Birmingham
| | | | | | | | - V Soran
- The University of Birmingham
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- The University of Cambridge
| | | | | | | | | | - W Chou
- The University of East Anglia
| | | | | | - S Piya
- The University of Edinburgh
| | | | | | - J Wang
- The University of Edinburgh
| | | | | | | | | | | | | | | | | | | | | | | | - C Obi
- The University of Leicester
| | | | | | | | | | | | | | | | - L Argus
- The University of Manchester
| | | | | | | | | | | | | | | | | | | | | | | | | | - B Bailey
- University of Brighton and Sussex
| | - A Casey
- University of Brighton and Sussex
| | | | - E Missir
- University of Brighton and Sussex
| | - H Boult
- University of Exeter Medical School
| | - D Campen
- University of Exeter Medical School
| | | | - S Dulai
- University of Exeter Medical School
| | | | - Z Foster
- University of Exeter Medical School
| | - E Horton
- University of Exeter Medical School
| | - E Jones
- University of Exeter Medical School
| | | | | | | | - A Rimmer
- University of Exeter Medical School
| | | | | | - A Saeed
- University of Exeter Medical School
| | - Y Sarwar
- University of Exeter Medical School
| | - C Taylor
- University of Exeter Medical School
| | - G Vetere
- University of Exeter Medical School
| | | | | | - D Zahid
- University of Exeter Medical School
| | - C Chand
- University of Hull and the University of York
| | - M Matthews
- University of Hull and the University of York
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Almadih MH, Almudhhi T, Ebrahim S, Howell A, Garrett GR, Bajorek SM, Cheung FB. Acoustic Analysis of the Effects of Vapor-Liquid Interfacial Morphology on Pool-Boiling Heat Transfer. NUCL TECHNOL 2022. [DOI: 10.1080/00295450.2021.2000558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mustafa H. Almadih
- Pennsylvania State University, Department of Mechanical Engineering, University Park, Pennsylvania
- King Abdulaziz City for Science and Technology (KACST), Riyadh 12354, Saudi Arabia
| | - T. Almudhhi
- Pennsylvania State University, Department of Mechanical Engineering, University Park, Pennsylvania
| | - S. Ebrahim
- Kuwait University, Mechanical Engineering Department, College of Engineering and Petroleum, P.O. Box 5969, Safat 13060, Kuwait
| | - A. Howell
- Horizon Image Sciences, 3111 S Williams Street, Englewood, Colorado
| | - G. R. Garrett
- Pennsylvania State University, Department of Nuclear Engineering, University Park, Pennsylvania
| | - S. M. Bajorek
- U.S. Nuclear Regulatory Commission, Office of Nuclear Regulatory Research, Washington, District of Columbia 20555
| | - F. B. Cheung
- Pennsylvania State University, Department of Mechanical Engineering, University Park, Pennsylvania
- Pennsylvania State University, Department of Nuclear Engineering, University Park, Pennsylvania
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Tatovic D, McAteer MA, Barry J, Barrientos A, Rodríguez Terradillos K, Perera I, Kochba E, Levin Y, Dul M, Coulman SA, Birchall JC, von Ruhland C, Howell A, Stenson R, Alhadj Ali M, Luzio SD, Dunseath G, Cheung WY, Holland G, May K, Ingram JR, Chowdhury MMU, Wong FS, Casas R, Dayan C, Ludvigsson J. Safety of the use of Gold Nanoparticles conjugated with proinsulin peptide and administered by hollow microneedles as an immunotherapy in Type 1 diabetes. Immunotherapy Advances 2022; 2:ltac002. [PMID: 35919496 PMCID: PMC9327128 DOI: 10.1093/immadv/ltac002] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/24/2022] [Indexed: 11/17/2022] Open
Abstract
Antigen-specific immunotherapy is an immunomodulatory strategy for autoimmune diseases, such as type 1 diabetes, in which patients are treated with autoantigens to promote immune tolerance, stop autoimmune β-cell destruction and prevent permanent dependence on exogenous insulin. In this study, human proinsulin peptide C19-A3 (known for its positive safety profile) was conjugated to ultrasmall gold nanoparticles (GNPs), an attractive drug delivery platform due to the potential anti-inflammatory properties of gold. We hypothesised that microneedle intradermal delivery of C19-A3 GNP may improve peptide pharmacokinetics and induce tolerogenic immunomodulation and proceeded to evaluate its safety and feasibility in a first-in-human trial. Allowing for the limitation of the small number of participants, intradermal administration of C19-A3 GNP appears safe and well tolerated in participants with type 1 diabetes. The associated prolonged skin retention of C19-A3 GNP after intradermal administration offers a number of possibilities to enhance its tolerogenic potential, which should be explored in future studies
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Affiliation(s)
- D Tatovic
- Diabetes Research Group, Cardiff University School of Medicine, Cardiff, UK
| | | | - J Barry
- Midatech Pharma PLC, Cardiff, UK
| | | | | | - I Perera
- Midatech Pharma PLC, Cardiff, UK
| | - E Kochba
- NanoPass Technologies Ltd., Nes Ziona, Israel
| | - Y Levin
- NanoPass Technologies Ltd., Nes Ziona, Israel
| | - M Dul
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, UK
| | - S A Coulman
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, UK
| | - J C Birchall
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, UK
| | - C von Ruhland
- Central Biotechnology Services, Cardiff University, Cardiff, UK
| | - A Howell
- Diabetes Research Group, Cardiff University School of Medicine, Cardiff, UK
| | - R Stenson
- Diabetes Research Group, Cardiff University School of Medicine, Cardiff, UK
| | - M Alhadj Ali
- Diabetes Research Group, Cardiff University School of Medicine, Cardiff, UK
| | - S D Luzio
- Swansea Trials Unit, Swansea University Medical School, UK
| | - G Dunseath
- Swansea Trials Unit, Swansea University Medical School, UK
| | - W Y Cheung
- Diabetes Research Unit Cymru, Institute for Life Sciences, Swansea University, Swansea, UK
| | - G Holland
- Swansea Trials Unit, Swansea University Medical School, UK
| | - K May
- Department of Cellular Pathology, University Hospital of Wales, Cardiff, UK
| | - J R Ingram
- Division of Infection & Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - M M U Chowdhury
- Welsh Institute of Dermatology, University Hospital of Wales, Cardiff, UK
| | - F S Wong
- Diabetes Research Group, Cardiff University School of Medicine, Cardiff, UK
| | - R Casas
- Division of Pediatrics, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - C Dayan
- Diabetes Research Group, Cardiff University School of Medicine, Cardiff, UK
| | - J Ludvigsson
- Division of Pediatrics, Department of Biomedical and Clinical Sciences, Faculty of Medicine and Health Sciences and Crown Princess Victoria Children´s Hospital, Linköping University, Linköping, Sweden
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8
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Gandhi A, Duxbury P, Murphy J, Foden P, Lalloo F, Clancy T, Wisely J, Kirwan CC, Howell A, Evans DG. Patient reported outcome measures in a cohort of patients at high risk of breast cancer treated by bilateral risk reducing mastectomy and breast reconstruction. J Plast Reconstr Aesthet Surg 2021; 75:69-76. [PMID: 34219040 DOI: 10.1016/j.bjps.2021.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/12/2021] [Accepted: 06/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Many women with increased lifetime risk of developing breast cancer, due to pathogenic gene variants or family history, choose to undergo bilateral risk reducing mastectomies (BRRM). Patient reported outcome measures (PROMS) are an increasingly important part of informed consent but are little studied in women undergoing BRRM. METHODS We used a validated PROMS tool for breast reconstruction (BREAST-Q) in 297 women who had BRRM and breast reconstruction, 81% of whom had no malignancy (Benign Group, BG) and 19% in whom a perioperative breast cancer was diagnosed (Cancer Group, CG). 128 women also completed a Hospital Anxiety & Depression Score (HADS) questionnaire to test if preoperative HADS score could predict PROMS outcomes. RESULTS Women in the CG had lower PROMS scores for satisfaction with their breasts, nipple reconstruction and sexual wellbeing. Both groups reported equal satisfaction with BRRM outcome and psychosocial well-being. Physical well-being PROMS of the abdomen and chest were high in women in both groups as were scores for satisfaction with the care they received. The CG group reported suboptimal quality of patient information. A higher presurgical HADS anxiety score predicted less favourable postoperative psychosocial well-being despite similar levels of satisfaction with aesthetic outcome. CONCLUSION We show a high degree of patient reported satisfaction by woman undergoing BRRM and reconstruction. There was a negative association with a cancer diagnosis on quality of life PROMS and higher preoperative anxiety levels negatively affected postoperative psychosocial well-being. These important findings should be part of the informed consent process during preoperative counselling.
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Affiliation(s)
- A Gandhi
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.
| | - P Duxbury
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - J Murphy
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - P Foden
- Department of Medical Statistics, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - F Lalloo
- Department of Clinical Genetics, Manchester Centre for Genomic Medicine, St Marys Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - T Clancy
- Department of Clinical Genetics, Manchester Centre for Genomic Medicine, St Marys Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - J Wisely
- Department of Clinical Psychology, Laureate House, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - C C Kirwan
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - A Howell
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - D G Evans
- Prevent Breast Cancer Centre, Wythenshawe Hospital, Manchester University Hospital NHS Foundation Trust, Manchester, UK; Division of Evolution and Genomic Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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Howell A, Bretfeld M, Belmont E. Impacts of bark beetle-induced tree mortality on pyrogenic carbon production and heat output in wildfires for fire modeling and global carbon accounting. Sci Total Environ 2021; 760:144149. [PMID: 33341616 DOI: 10.1016/j.scitotenv.2020.144149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
Forests store significant quantities of carbon, and accurate quantification of the fate of this carbon after fire is necessary for global carbon accounting. Pyrogenic carbon (PyC) encompasses various carbonaceous products of incomplete combustion formed during fires and has potential to act as a carbon sink for up to millennia, but current estimates of PyC production in wildfires vary widely. Northern hardwood forests have changed dramatically in recent decades due to insect epidemics, such as the bark beetle epidemic in the Rocky Mountain Region which has caused widespread mortality. This study assessed impacts of bark beetle-induced mortality on fuel pyrolysis kinetics, carbon partitioning of combustion products, and net heat output to aid in forest fire modeling and carbon accounting by comparing healthy and beetle-killed lodgepole pine tree boles burned in a 2018 forest fire in southeast Wyoming, USA with unburned boles. Results showed charring predominantly restricted to the bark and cambium. Significant differences between burned and unburned healthy and beetle-impacted bark/cambium compositions were identified, and PyC production and energy output were quantified. Charring extent and PyC content were found to be greater in beetle-impacted boles due to a reduction in bark/cambium resistance to heating and charring, with 80 times more PyC produced in a beetle-killed bark/cambium than in a healthy bark/cambium. Upon scale-up, total PyC production in the fire-affected area was estimated to be 0.71 GgPyC (82.5 kgPyC/ha). This was found to be significantly enhanced compared to an estimated PyC production of 0.036 GgPyC (4.12 kgPyC/ha) in a hypothetical healthy lodgepole pine ecosystem of equal area. The results of this investigation concluded that the 58% beetle-induced mortality in the Badger Creek Fire area resulted in 3 times more carbon released to the global atmosphere, 20 times more PyC retained onsite and 32% greater heat output during wildfire.
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Affiliation(s)
- Alexandra Howell
- Department of Mechanical Engineering, The University of Wyoming, 1000 E. University Ave., Laramie, WY, USA
| | - Mario Bretfeld
- Department of Ecology, Evolution, and Organismal Biology, Kennesaw State University, 370 Paulding Ave., Kennesaw, GA, USA
| | - Erica Belmont
- Department of Mechanical Engineering, The University of Wyoming, 1000 E. University Ave., Laramie, WY, USA.
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Sarlo Davila KM, Howell A, Nunez A, Orelien A, Roe V, Rodriguez E, Dikmen S, Mateescu RG. Genome-wide association study identifies variants associated with hair length in Brangus cattle. Anim Genet 2020; 51:811-814. [PMID: 32548856 DOI: 10.1111/age.12970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2020] [Indexed: 12/11/2022]
Abstract
Thermal stress limits beef cattle production and a shorter hair coat is a key thermoregulative adaptation that allows cattle to lose heat more efficiently. The objective of this study was to identify genetic variants associated with the length of the undercoat and topcoat of cattle utilizing 1456 Brangus heifers genotyped with the Bovine GGP F250 array. Seven SNPs in the PCCA gene were significantly associated with undercoat length. PCCA belongs to the biotin transport and metabolism pathway. Biotin deficiency has been reported to cause hair loss. Four SNPs in an 110 kb including a missense mutation in the PRLR gene were significantly associated with topcoat length. Whereas the association of this polymorphism with hair length is novel, the SLICK mutation in PRLR has previously been demonstrated to significantly impact hair length in cattle. These newly detected genetic variants may contribute to a shorter hair coat and more thermotolerant animals.
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Affiliation(s)
- K M Sarlo Davila
- Animal Sciences, University of Florida, 2250 Shealy Dr, Gainesville, FL, 32608, USA
| | - A Howell
- Animal Sciences, University of Florida, 2250 Shealy Dr, Gainesville, FL, 32608, USA
| | - A Nunez
- Animal Sciences, University of Florida, 2250 Shealy Dr, Gainesville, FL, 32608, USA
| | - A Orelien
- Animal Sciences, University of Florida, 2250 Shealy Dr, Gainesville, FL, 32608, USA
| | - V Roe
- Animal Sciences, University of Florida, 2250 Shealy Dr, Gainesville, FL, 32608, USA
| | - E Rodriguez
- Animal Sciences, University of Florida, 2250 Shealy Dr, Gainesville, FL, 32608, USA
| | - S Dikmen
- Faculty of Animal Science, Bursa Uludag University, 16059 Nilufer, Bursa, Turkey
| | - R G Mateescu
- Animal Sciences, University of Florida, 2250 Shealy Dr, Gainesville, FL, 32608, USA
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11
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Sheikh S, Wanty N, Mccalla S, Santana A, Saxena Beem S, Walker J, Holt D, Howell A, Holtz K, Williams S, Anandarajah A. AB1360-HPR A MODEL TO IMPROVE MINORITY PATIENT RECRUITMENT IN LUPUS CLINICAL TRIALS - THE AMERICAN COLLEGE OF RHEUMATOLOGY MIMICT PROJECT EXPERIENCE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.6541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:In the US, African Americans and Latinos are underrepresented in lupus clinical trials (LCTs),1despite experiencing the greatest lupus disease burden.2,3Low participation in LCTs results in inadequate data on treatment effectiveness for minority patients, and fewer opportunities for better care and treatment options.1Only one percent of minority patients are referred to clinical trials each year.4Provider barriers to making referrals include limited time and unfamiliarity with lupus and LCT opportunities.4Using US fedral grant funds, the American College of Rheumatology (ACR) developed MIMICT, a two-part model with associated materials to address provider-side LCT referral barriers. The materials include a toolkit for clinical trial sites and an educational toolkit for providers.Objectives:Our objectives are to:•Describe the US LCTs disparities.•Discuss the research methodology to evaluate the two-part MIMICT model.•Assess the feasibility of the model to increase minority involvement in clinical trials.Methods:We designed two studies to evaluate the MIMICT model.The first study used an online, pretest/posttest, two-group evaluation approach to assess the extent to which the educational toolkit increased providers‘ knowledge, attitudes, self-efficacy, and behavioral intentions to refer minority patients to clinical trial. We conducted the study in 2018 with primary care providers (PCPs) and again in 2019/2020 with speciality providers. The second study used a longitudinal, mised methods, case-study approach to explore the real-world use of the toolkits with clinical trial site teams at two university medical centers.Results:In the first study,among MIMCT-exposed PCPs, mean scores indicated statistical significance at p≤0.001 with more knowledge about referring [55.84 (sd=23.51) vs 41.76 (sd=19.98)], more self-efficacy to refer [55.00 (sd=37.22) vs. 37.99 (sd=34.42)], and more intentions to refer [61.36 (43.85) vs. 33.41 (41.16)] African American patients to LCTs among the treatment group than the control group, respectively. This presentation will discuss additional data comparing the study in 2018 and the study in 2019/2020 and look comparatively at outcomes across provider type.In the second study, we found that the driver for successful engagemetn of providers and their subsequent use of the educational toolkit was the development of a trusting relationship between the clinical trial site teams and providers in the community. The development of trust took repeated and varied modes of contact, which we will discuss in-depth.Conclusion:The MIMICT educational toolkit increase knowledge, self-efficacy, and intentions to refer lupus patients to LCTs. However, building trust between LCT sites and local providers takes time and repeated outreach, but the potential benefits to medicine and minority health are substantial.References:[1]The Society for Women’s Health Research. (2011). Dialogues on diversifying clinical trials: successful strategies for engaging women and minorities in clinical trials. Washington, DC: Food and Drug Administration, Office of Women’s Health.[2]Falasinnu, T., Chaichian, Y., Bass, M. B., & Simard, J. F. (2018). The representation of gender and race/ethnic groups in randomized clinical trials of individuals with sytemic lupus erythematosus.Current Rheumatology Reports, 20(4).[3]Pons-Estel, G. J., Alarcon, G. S., Scofield, L., Reinlib, L., & Cooper, G. S. (2010). Understanding the epidemiological progression of systemic lupus erythematosus.Seminars in Arthritis and Rheumatism, 39(4).[4]Korieth, K. (2016). Engaging healthcare providers as research facilitators.The CenterWatch Monthly, 23,1-5.Disclosure of Interests:None declared
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12
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Hanna SJ, Powell WE, Long AE, Robinson EJS, Davies J, Megson C, Howell A, Jones TJ, Ladell K, Price DA, Dayan CM, Williams AJK, Gillespie KM, Wong FS. Slow progressors to type 1 diabetes lose islet autoantibodies over time, have few islet antigen-specific CD8 + T cells and exhibit a distinct CD95 hi B cell phenotype. Diabetologia 2020; 63:1174-1185. [PMID: 32157332 PMCID: PMC7228996 DOI: 10.1007/s00125-020-05114-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 01/13/2020] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS The aim of this study was to characterise islet autoantibody profiles and immune cell phenotypes in slow progressors to type 1 diabetes. METHODS Immunological variables were compared across peripheral blood samples obtained from slow progressors to type 1 diabetes, individuals with newly diagnosed or long-standing type 1 diabetes, and healthy individuals. Polychromatic flow cytometry was used to characterise the phenotypic attributes of B and T cells. Islet autoantigen-specific B cells were quantified using an enzyme-linked immunospot (ELISpot) assay and islet autoantigen-specific CD8+ T cells were quantified using peptide-HLA class I tetramers. Radioimmunoassays were used to detect islet autoantibodies. Sera were assayed for various chemokines, cytokines and soluble receptors via ELISAs. RESULTS Islet autoantibodies were lost over time in slow progressors. Various B cell subsets expressed higher levels of CD95 in slow progressors, especially after polyclonal stimulation, compared with the corresponding B cell subsets in healthy donors (p < 0.05). The phenotypic characteristics of CD4+ and CD8+ T cells were similar in slow progressors and healthy donors. Lower frequencies of CD4+ T cells with a central memory phenotype (CD27int, CD127+, CD95int) were observed in slow progressors compared with healthy donors (mean percentage of total CD4+ T cells was 3.00% in slow progressors vs 4.67% in healthy donors, p < 0.05). Autoreactive B cell responses to proinsulin were detected at higher frequencies in slow progressors compared with healthy donors (median no. of spots was 0 in healthy donors vs 24.34 in slow progressors, p < 0.05) in an ELISpot assay. Islet autoantigen-specific CD8+ T cell responses were largely absent in slow progressors and healthy donors. Serum levels of DcR3, the decoy receptor for CD95L, were elevated in slow progressors compared with healthy donors (median was 1087 pg/ml in slow progressors vs 651 pg/ml in healthy donors, p = 0.06). CONCLUSIONS/INTERPRETATION In this study, we found that slow progression to type 1 diabetes was associated with a loss of islet autoantibodies and a distinct B cell phenotype, consistent with enhanced apoptotic regulation of peripheral autoreactivity via CD95. These phenotypic changes warrant further studies in larger cohorts to determine their functional implications.
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Affiliation(s)
- Stephanie J Hanna
- Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK
| | - Wendy E Powell
- Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK
| | - Anna E Long
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma J S Robinson
- Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK
| | - Joanne Davies
- Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK
| | - Clare Megson
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alexandra Howell
- Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK
| | - Taz J Jones
- Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK
| | - Kristin Ladell
- Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK
| | - David A Price
- Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK
| | - Colin M Dayan
- Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK
| | | | - Kathleen M Gillespie
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, UK
| | - F Susan Wong
- Division of Infection and Immunity, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK.
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13
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Quigley A, Sekiya M, Garcia-Campos A, Paz-Silva A, Howell A, Williams DJL, Mulcahy G. Horses are susceptible to natural, but resistant to experimental, infection with the liver fluke, Fasciola hepatica. Vet Parasitol 2020; 281:109094. [PMID: 32344146 DOI: 10.1016/j.vetpar.2020.109094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/19/2020] [Accepted: 03/21/2020] [Indexed: 10/24/2022]
Abstract
Fasciola hepatica is a common parasite of livestock in Ireland, causing significant economic losses and affecting animal welfare. A previous abattoir study of 200 horses led to an estimated 9.5 % prevalence of infection in horses slaughtered in Ireland. However, the epidemiology and pathogenic significance of this infection in this species is not well-described. The objectives of this study were to determine the susceptibility of horses to oral challenge infection with F. hepatica metacercariae, and to document the course of the infection along with serological and biochemical response. We attempted an experimental infection of horses (n = 10; 9 geldings and 1 mare) with F. hepatica. Four were given 1000 metacercariae, four 500 metacercariae and two were sham-infected. Blood and faecal samples were taken at intervals up to 18 weeks post-infection (wpi). ELISA assays were used to assess sero-conversion in the experimental horses and also in a panel of sera from horses of known fluke status. No flukes were recovered from any of the livers, and neither were any lesions that could be attributed to F. hepatica infection observed. Coproantigen ELISA was negative throughout for all horses. Three antibody detection ELISAs, useful in diagnosing fasciolosis in other species, had limitations as diagnostic aids as determined using a panel of sera from horses of known F. hepatica infection status. This study is limited by the relatively small number of animals included, and the relatively short duration of the study period. Failure to establish infection after oral challenge raises fundamental questions on the pathophysiology and epidemiology of equine fasciolosis.
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Affiliation(s)
- A Quigley
- UCD School of Veterinary Medicine, Dublin, Ireland
| | - M Sekiya
- UCD School of Veterinary Medicine, Dublin, Ireland
| | | | - A Paz-Silva
- Universidad de Santiago de Compostela, Spain
| | - A Howell
- Veterinary Parasitology, Institute of Infection and Global Health, University of Liverpool, UK
| | - D J L Williams
- Veterinary Parasitology, Institute of Infection and Global Health, University of Liverpool, UK
| | - G Mulcahy
- UCD School of Veterinary Medicine, Dublin, Ireland.
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Powell WE, Hanna SJ, Hocter CN, Robinson E, Lewis M, Dunseath G, Luzio S, Howell A, Dayan CM, Wong FS. Detecting autoreactive B cells in the peripheral blood of people with type 1 diabetes using ELISpot. J Immunol Methods 2019; 471:61-65. [PMID: 31152768 DOI: 10.1016/j.jim.2019.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 05/28/2019] [Indexed: 01/12/2023]
Abstract
Type 1 diabetes mellitus (T1D) is an autoimmune disorder where T lymphocytes damage the islet beta cells but B lymphocytes also play an important role. Although changes in peripheral B cell phenotype have been observed, little is known about the B cells that secrete the autoantibodies. We developed a sensitive B cell enzyme-linked immunospot assay (ELISpot assay) to detect individual B cell antibody responses to glutamic acid decarboxylase (GAD) and islet antigen-2 (IA-2). We found that even healthy donors have B cells that secrete antibodies in response to GAD and IA-2 in the ELISpot. There was increased B cell reactivity to autoantigens in the peripheral blood of individuals with newly-diagnosed, but not long-standing, type 1 diabetes. However, no correlation with serum autoantibody levels was found, indicating that additional factors such as antigen affinity or exposure to antigens in vivo are required for antibody secretion, and that even healthy donors have potentially autoreactive B cells.
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Affiliation(s)
- W E Powell
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
| | - S J Hanna
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
| | - C N Hocter
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
| | - E Robinson
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
| | - M Lewis
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
| | - G Dunseath
- Diabetes Research Unit Cymru, Grove Building, Swansea University, Swansea SA2 8PP, UK
| | - S Luzio
- Diabetes Research Unit Cymru, Grove Building, Swansea University, Swansea SA2 8PP, UK
| | - A Howell
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
| | - C M Dayan
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
| | - F S Wong
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff CF14 4XN, UK.
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15
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Howell A, Newton-Cross P, Dewar J. “Moving forwards with Fibromyalgia”: the role of the physical activity specialist to reduce the pressure on secondary care pain clinics. Physiotherapy 2019. [DOI: 10.1016/j.physio.2018.11.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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16
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Evans D, Thomas S, Caunt J, Burch A, Brentnall A, Roberts L, Howell A, Wilson M, Fox R, Hillier S, Sibbering D, Moss S, Wallis M, Eccles D, Duffy S. Final Results of the Prospective FH02 Mammographic Surveillance Study of Women Aged 35-39 at Increased Familial Risk of Breast Cancer. EClinicalMedicine 2019; 7:39-46. [PMID: 31008449 PMCID: PMC6472550 DOI: 10.1016/j.eclinm.2019.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/24/2018] [Accepted: 01/16/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Many women who are at increased risk of breast cancer due to a mother or sister diagnosed with breast cancer aged under 40 do not currently qualify for surveillance before 40 years of age. There are almost no available data to assess whether mammography screening aged 35-39 years would be effective in this group, in terms of detection of breast cancer at an early stage or cost effective. METHODS A cohort screening study (FH02) with annual mammography was devised for women aged 35-39 to assess the sensitivity and screening performance and potential survival of women with identified tumours. FINDINGS 2899 women were recruited from 12/2006-12/2015. These women underwent 12,086 annual screening mammograms and were followed for 13,365.8 years. A total of 55 breast cancers in 54 women occurred during the study period (one bilateral) with 50 cancers (49 women) (15 CIS) adherent to the screening. Eighty percent (28/35) of invasive cancers were ≤ 2 cm and 80% also lymph node negative. Invasive cancers diagnosed in FH02 were significantly smaller than the comparable (POSH-unscreened prospective) study group (45% (131/293) ≤ 2 cm in POSH vs 80% (28/35) in FH02 p < 0.0001), and were less likely to be lymph-node positive (54% (158/290, 3 unknown) in POSH vs 20% (7/35) in FH02: p = 0.0002. Projected and actual survival were also better than POSH. Overall radiation dose was not higher than in an older screened population at mean dose on study per standard sized breast of 1.5 mGy. INTERPRETATION Mammography screening aged 35-39 years detects breast cancer at an early stage and is likely to be as effective in reducing mortality as in women at increased breast cancer risk aged 40-49 years.
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Affiliation(s)
- D.G. Evans
- Prevent Breast Cancer Centre, Wythenshawe Hospital Manchester Universities Foundation Trust, Wythenshawe, Manchester M23 9LT, UK
- Genomic Medicine, Division of Evolution and Genomic Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester Universities Foundation Trust, St. Mary's Hospital, Oxford Road, Manchester M13 9WL, UK
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Christie Hospital, Withington, Manchester M20 4BX, UK
| | - S. Thomas
- Breast Test Wales, 18 Cathedral Road, Cardiff CF11 9LJ, UK
| | - J. Caunt
- Breast Test Wales, 18 Cathedral Road, Cardiff CF11 9LJ, UK
| | - A. Burch
- Breast Test Wales, 18 Cathedral Road, Cardiff CF11 9LJ, UK
| | - A.R. Brentnall
- Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine' Charterhouse Square, London EC1M 6BQ, UK
| | - L. Roberts
- Prevent Breast Cancer Centre, Wythenshawe Hospital Manchester Universities Foundation Trust, Wythenshawe, Manchester M23 9LT, UK
| | - A. Howell
- Prevent Breast Cancer Centre, Wythenshawe Hospital Manchester Universities Foundation Trust, Wythenshawe, Manchester M23 9LT, UK
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, Christie Hospital, Withington, Manchester M20 4BX, UK
| | - M. Wilson
- Breast Screening Unit, Nightingale Centre, Wythenshawe Hospital, Manchester University Foundation Trust, Wythenshawe, Manchester M23 9LT, UK
| | - R. Fox
- Breast Test Wales, 18 Cathedral Road, Cardiff CF11 9LJ, UK
| | - S. Hillier
- Breast Test Wales, 18 Cathedral Road, Cardiff CF11 9LJ, UK
| | | | - S. Moss
- Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine' Charterhouse Square, London EC1M 6BQ, UK
| | - M.G. Wallis
- Cambridge Breast Unit, NIHR Cambridge Biomedical Research Unit, Box 97, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
| | - D.M. Eccles
- Faculty of Medicine, University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | | | - S. Duffy
- Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine' Charterhouse Square, London EC1M 6BQ, UK
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17
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Halmo SM, Sensibaugh CA, Bhatia KS, Howell A, Ferryanto EP, Choe B, Kehoe K, Watson M, Lemons PP. Student difficulties during structure-function problem solving. Biochem Mol Biol Educ 2018; 46:453-463. [PMID: 30369042 DOI: 10.1002/bmb.21166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 06/28/2018] [Accepted: 08/10/2018] [Indexed: 06/08/2023]
Abstract
Protein structure-function is a key concept in biochemistry. We used the perspective of domain-specific problem-solving to investigate students' solutions to a well-defined protein structure-function problem. We conducted think-aloud interviews with 13 undergraduate students and performed qualitative content analysis to examine the differences in the domain-general and domain-specific knowledge among correct and incorrect solutions. Our work revealed that students used domain-general and domain-specific knowledge in their problem solving. We also identified difficulties for students with the amino acid backbone, amino acid categorization, and causal mechanisms of noncovalent interactions. Using the identified difficulties, we make recommendations for the design of instructional materials targeted to improve protein structure-function problem solving in the biochemistry classroom. © 2018 International Union of Biochemistry and Molecular Biology, 46(5):453-463, 2018.
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Affiliation(s)
- Stephanie M Halmo
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia, 30602
| | - Cheryl A Sensibaugh
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia, 30602
| | - Kush S Bhatia
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia, 30602
| | - Alexandra Howell
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia, 30602
| | - Ersta P Ferryanto
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia, 30602
| | - Bryant Choe
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia, 30602
| | - Kaitlin Kehoe
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia, 30602
| | - Morgan Watson
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia, 30602
| | - Paula P Lemons
- Department of Biochemistry and Molecular Biology, University of Georgia, Athens, Georgia, 30602
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18
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Donnelly LS, Shaw RL, Pegington M, Armitage CJ, Evans DG, Howell A, Harvie MN. 'For me it's about not feeling like I'm on a diet': a thematic analysis of women's experiences of an intermittent energy restricted diet to reduce breast cancer risk. J Hum Nutr Diet 2018; 31:773-780. [PMID: 29926996 DOI: 10.1111/jhn.12571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Weight-loss programmes requiring intermittent energy restriction offer an alternative to continuous energy restriction programmes that typically have low adherence. We reported greater weight loss, better adherence and spontaneous reduced energy intake on healthy eating days with intermittent as opposed to continuous energy restriction. The present study aims to explore why intermittent energy restriction diets exert these positive effects. METHODS Semi-structured interviews were carried out with 13 women aged 39-62 years, who followed a 4-month intermittent energy restriction (2 days of low energy/low carbohydrate, 5 days of healthy eating). Nine of the 13 women successfully lost >5% of their total body weight. Data were analysed using thematic analysis. RESULTS The intermittent regimen redefined the meaning of dieting and normal eating. Women reconceptualised dieting as only two low energy days per week, even though this often differed from their pre-diet eating patterns. Women reported that they could adhere more closely to the rules of the intermittent diet compared to previously attempted continuous diets. They found that the intermittent diet was less cognitively demanding because the restrictive and clear rules of the intermittent diet were easier to understand and easier to follow than with continuous dieting. CONCLUSIONS Many participants found intermittent dieting preferable to previous experiences of continuous dieting. The findings provide some insight into the ways in which intermittent dieting is successful, and why it could be considered a viable alternative to continuous energy restriction for weight loss.
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Affiliation(s)
- L S Donnelly
- Nightingale and Prevent Breast Cancer Centre, Manchester University NHS Foundation trust, Wythenshawe, Manchester, UK
| | - R L Shaw
- School of Life and Health Sciences, Aston University, Birmingham, West Midlands, UK
| | - M Pegington
- Nightingale and Prevent Breast Cancer Centre, Manchester University NHS Foundation trust, Wythenshawe, Manchester, UK
| | - C J Armitage
- Manchester Centre for Health Psychology, School of Psychological Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - D G Evans
- Nightingale and Prevent Breast Cancer Centre, Manchester University NHS Foundation trust, Wythenshawe, Manchester, UK.,Genomic Medicine, Manchester Academic Health Sciences Centre, University of Manchester and Central Manchester Foundation Trust, Manchester, UK.,The Christie NHS Foundation Trust, Withington, Manchester, UK
| | - A Howell
- Nightingale and Prevent Breast Cancer Centre, Manchester University NHS Foundation trust, Wythenshawe, Manchester, UK.,The Christie NHS Foundation Trust, Withington, Manchester, UK
| | - M N Harvie
- Nightingale and Prevent Breast Cancer Centre, Manchester University NHS Foundation trust, Wythenshawe, Manchester, UK
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19
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Howell A, Harkness E, Fox J, Astley S, Wiseman J, Eriksson M, Wilson M, Warren R, Hall P, Cuzick J, Evans G. Abstract P4-08-01: Not presented. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-08-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was not presented at the symposium.
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Affiliation(s)
- A Howell
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - E Harkness
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - J Fox
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - S Astley
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - J Wiseman
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - M Eriksson
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - M Wilson
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - R Warren
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - P Hall
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - J Cuzick
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
| | - G Evans
- University Hospital of South Manchester, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom; Karolinska Institute, Stockholm, Sweden; University of Cambridge, Cambridge, United Kingdom; Queen Mary University of London, London, United Kingdom
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20
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Sestak I, Smith S, Sleeth M, Howell A, Cuzick J. Abstract P5-15-01: Participant-reported symptoms as predictors of long-term adherence of endocrine therapy in the International breast cancer intervention studies 2 (IBIS-2). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-15-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Aromatase inhibitors (AIs) reduce the risk of breast cancer in women at increased risk and reduce recurrence in those with ductal carcinoma in situ (DCIS) (IBIS-2, MAP.3, NSABP B-33). The effectiveness of AIs depends on full adherence. We have previously reported adherence figures for the International Breast Cancer Intervention Studies 2 (IBIS-2) when 5 years of active treatment was not completed. Here, we assess reports of early symptoms on 5-year adherence with anastrozole in the prevention (versus placebo) and DCIS (versus tamoxifen) IBIS-2 after active treatment has been completed by all women.
Methods: In IBIS-2, 3864 postmenopausal women in the prevention study were randomised to placebo vs. anastrozole (1mg/day) and 2980 postmenopausal women with DCIS were randomised to tamoxifen (20mg/day) vs. anastrozole (1mg/day). Women were excluded from the analyses (n=491 [262 prevention; 229 DCIS]) due to breast cancer, death, major adverse events, or failure to initiate preventive therapy. Adherence (<4.5 years, ≥4.5 years) was calculated using the Kaplan-Meier method. The primary objective was to determine overall adherence to endocrine treatment in both studies separately. Secondary objectives were to estimate the effect of early symptoms (6 months visit) on adherence by study and by treatment arm separately.
Results: In the IBIS-2 prevention study (N=3615), overall adherence to treatment was 67.7% and was statistically not significantly different between anastrozole (66.5%) and placebo (69.0%) (OR=0.89 (0.78-1.03), P=0.11). Adherence was significantly lower regardless of treatment allocation for those who developed arthralgia (68.3% vs. 72.8%, P=0.008) or gynaecological symptoms (vaginal changes, irregular bleeding) (65.1% vs. 72.2%, P=0.007), but not for those who reported hot flushes (71.1% vs. 71.8%, P=0.92), compared with those who did not report these symptoms at 6 months. In the IBIS-2 DCIS study (N=2759), adherence to treatment was 70.1% overall (anastrozole (70.2%) or tamoxifen (70.0%) (OR=1.01 (0.86-1.19), P=0.92)). Women treated with anastrozole reported significantly more arthralgia (30.6% vs. 20.5%, P<0.001), but significantly fewer hot flushes (41.1% vs. 47.0%, P=0.002) and gynaecological symptoms (7.0% vs. 12.6%, P<0.001) compared with those on tamoxifen. However, none of these symptoms had an impact on adherence to either anastrozole or tamoxifen. In both studies, the majority of symptoms were of mild or moderate severity and we observed significant trends for lower adherence with increasing severity for all symptoms irrespective of allocated treatment arm.
Conclusions: In the IBIS-2 trials, we observed no significant differences in adherence between either anastrozole vs. placebo (prevention), or anastrozole vs. tamoxifen (DCIS). Significant associations between early symptoms and adherence were observed only in the prevention study, regardless of treatment allocation. Reporting symptoms in the first 6 months of preventive and adjuvant therapy is unlikely to explain non-adherence to medication. Further research is required to identify modifiable factors which may be altered by behavioural interventions to improve adherence.
Citation Format: Sestak I, Smith S, Sleeth M, Howell A, Cuzick J. Participant-reported symptoms as predictors of long-term adherence of endocrine therapy in the International breast cancer intervention studies 2 (IBIS-2) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-15-01.
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Affiliation(s)
- I Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Leeds, United Kingdom; Institute of Cancer Sciences, University of Manchester, United Kingdom
| | - S Smith
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Leeds, United Kingdom; Institute of Cancer Sciences, University of Manchester, United Kingdom
| | - M Sleeth
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Leeds, United Kingdom; Institute of Cancer Sciences, University of Manchester, United Kingdom
| | - A Howell
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Leeds, United Kingdom; Institute of Cancer Sciences, University of Manchester, United Kingdom
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Leeds, United Kingdom; Institute of Cancer Sciences, University of Manchester, United Kingdom
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21
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Sestak I, Smith SG, Howell A, Forbes JF, Cuzick J. Early participant-reported symptoms as predictors of adherence to anastrozole in the International Breast Cancer Intervention Studies II. Ann Oncol 2018; 29:504-509. [PMID: 29126161 PMCID: PMC5834118 DOI: 10.1093/annonc/mdx713] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Anastrozole reduces breast cancer risk in women at high risk, but implementing preventive therapy in clinical practice is difficult. Here, we evaluate adherence to anastrozole in the International Breast Cancer Intervention Study (IBIS)-II prevention and ductal carcinoma in situ (DCIS) trials, and its association with early symptoms. Patients and methods In the prevention trial, 3864 postmenopausal women were randomized to placebo versus anastrozole. A total of 2980 postmenopausal women with DCIS were randomized to tamoxifen versus anastrozole. Adherence to trial medication was calculated using the Kaplan-Meier method and all P-values were two-sided. Results In the prevention trial, adherence was 65.8% [anastrozole (65.7%) versus placebo (65.9%); HR = 0.97 (0.87-1.09), P = 0.6]. Adherence was lower for those reporting arthralgia in the placebo group (P = 0.02) or gynecological symptoms in the anastrozole group (P = 0.003), compared with those not reporting these symptoms at 6 months. In the DCIS study, adherence was 66.7% [anastrozole (67.5%) versus tamoxifen (65.8%); HR = 1.06 (0.94-1.20), P = 0.4]. Hot flashes were associated with greater adherence in the anastrozole arm (P = 0.02). In both studies, symptoms were mostly mild or moderately severe, and adherence decreased with increasing severity for most symptoms. Drop-outs were highest in the first 1.5 years of therapy in both trials. Conclusions In the IBIS-II prevention and DCIS trials, over two-thirds of women were adherent to therapy, with no differences by treatment groups. Participants who reported specific symptoms in the IBIS-II prevention trial had a small but significant effect on adherence, which strengthened as severity increased. Strategies to promote adherence should target the first year of preventive therapy.
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Affiliation(s)
- I Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
| | - S G Smith
- Leeds Institute of Health Science, University of Leeds, Leeds, UK
| | - A Howell
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - J F Forbes
- Department of Surgical Oncology, Calvary Mater Newcastle Hospital, Newcastle, Australia
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
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22
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Baildam AD, Howell A, Miller JP, Blann AD. Tamoxifen Increases von Willebrand Factor in Women who Underwent Breast Cancer Surgery. Thromb Haemost 2017. [DOI: 10.1055/s-0037-1615776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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23
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Evans DG, Harkness EF, Howel S, Woodward ER, Howell A, Lalloo F. Young age at first pregnancy does protect against early onset breast cancer in BRCA1 and BRCA2 mutation carriers. Breast Cancer Res Treat 2017; 167:779-785. [PMID: 29116468 PMCID: PMC5807493 DOI: 10.1007/s10549-017-4557-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 10/24/2017] [Indexed: 11/11/2022]
Abstract
Purpose Previous research assessing the impact of pregnancy and age at first pregnancy on breast cancer risk in BRCA1 and BRCA2 mutation carriers has produced conflicting results, with some studies showing an increased risk following early first pregnancy in contrast to the reduced risk in the general population of women. The present study addresses these inconsistencies. Methods Female BRCA1 and BRCA2 carriers from North West England were assessed for breast cancer incidence prior to 50 years of age comparing those with an early first full-term pregnancy (< 21 years) to those without a full-term pregnancy. Breast cancer incidence per decade from 20 years and Kaplan–Meier analyses were performed. Results 2424 female mutation carriers (1278 BRCA1; 1146 BRCA2) developed 990 breast cancers under the age of 50 years. Women who had their first term pregnancy prior to age 21 (n = 441) had a lower cancer incidence especially between age 30–39 years. Kaplan–Meier analysis showed an odds ratio of 0.78 for BRCA1 (p = 0.005) and 0.73 for BRCA2 (p = 0.002). Conclusions The present study demonstrates a clear protective effect of early first pregnancy on breast cancer risk in both BRCA1 and BRCA2 mutation carriers.
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Affiliation(s)
- D G Evans
- Manchester Centre for Genomic Medicine, Manchester Academic Health Sciences Centre (MAHSC), Institute of Human Development, St Mary's Hospital, University of Manchester, Manchester, M13 9WL, UK. .,Prevent Breast Cancer Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, M23 9LT, UK. .,Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK. .,Manchester Breast Centre, The University of Manchester, Manchester, M20 4BX, UK.
| | - E F Harkness
- Prevent Breast Cancer Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, M23 9LT, UK.,Division of Informatics, Imaging and Data Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
| | - S Howel
- Prevent Breast Cancer Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, M23 9LT, UK.,Manchester Breast Centre, The University of Manchester, Manchester, M20 4BX, UK.,Department of Medical Oncology, The Christie, Manchester, M20 4BX, UK
| | - E R Woodward
- Manchester Centre for Genomic Medicine, Manchester Academic Health Sciences Centre (MAHSC), Institute of Human Development, St Mary's Hospital, University of Manchester, Manchester, M13 9WL, UK.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK
| | - A Howell
- Prevent Breast Cancer Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, M23 9LT, UK.,Manchester Breast Centre, The University of Manchester, Manchester, M20 4BX, UK
| | - F Lalloo
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK
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24
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Garbarino J, Howell A, Owen J. Two further episodes of a defective Optima CLX laryngoscope blade. Anaesthesia 2017; 72:1031. [DOI: 10.1111/anae.13990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J. Garbarino
- Royal Manchester Children's Hospital; Manchester UK
| | - A. Howell
- Royal Manchester Children's Hospital; Manchester UK
| | - J. Owen
- Royal Manchester Children's Hospital; Manchester UK
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25
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Maxwell A, Lim Y, Hurley E, Evans D, Howell A, Gadde S. False-negative MRI breast screening in high-risk women. Clin Radiol 2017; 72:207-216. [DOI: 10.1016/j.crad.2016.10.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/14/2016] [Accepted: 10/26/2016] [Indexed: 01/09/2023]
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Cuzick J, Sestak I, Bianco A, Strobbe L, Bergh J, Hanusch C, Neven P, Dowsett M, Forbes JF, Buzdar A, Smith R, Howell A. Abstract P2-09-03: Long-term comparison of anastrozole versus tamoxifen: Results from LATTE/ATAC. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-09-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Previous reports from the Anastrozole Tamoxifen Alone or in Combination (ATAC) trial have shown significantly prolonged disease-free survival, lower rates of recurrence and distant recurrence, and reduced contralateral breast cancer in patients treated with anastrozole compared to tamoxifen (Cuzick et al., Lancet, 2010). Here, we compare the long-term effects of anastrozole versus tamoxifen in patients randomised to either monotherapy arm in the ATAC trial.
Methods: Postmenopausal women with hormone receptor positive breast cancer randomised to anastrozole or tamoxifen in the main ATAC trial were eligible for the LATTE observational study. The primary objective was to compare the long-term effects of tamoxifen and anastrozole on time to recurrence and death beyond 10 years after randomisation. Secondary objectives included time to distant recurrence, cancer-specific survival, new breast primaries, other cancers, fractures, and cardiac/cerebrovascular events. Cox proportional hazard methods were used to compute hazard ratios (95% CI) for recurrence from the time of last publication (10 years median follow-up).
Results: 2452 women from 11 countries were entered into the LATTE study. 40 women withdrew consent and 759 women died or had a recurrence within 10 years, which left 1653 women for analysis (838 anastrozole vs. 815 tamoxifen). A total of 118 breast events (69 anastrozole (8.2%) vs. 49 tamoxifen (6.0%)) were reported. No significant difference between the two treatment arms were observed (HR=1.36 (0.94-1.97), P=0.098). 57 women had a distant recurrence (33 (3.9%) vs. 24 (2.9%)), 41 reported a loco-regional recurrence (23 (2.7%) vs. 18 (2.2%)), and 26 contra-lateral breast cancer were recorded (17 (2.0%) vs. 9 (1.1%)). None of the treatment comparisons were statistically significant. 305 deaths were recorded (147 (17.5%) vs. 158 (19.4%)), of which 31 were due to breast cancer. Significantly fewer gynaecological cancers were recorded with anastrozole (7 vs. 16; OR=0.42 (0.15-1.09), P=0.05), but overall the effect on other cancers was not significant (54 (6.4%) vs. 64 (7.9%). Fractures, cardiovascular, and cerebrovascular events were evenly distributed between the treatment arms.
Conclusions: Although anastrozole was associated with significant fewer recurrences compared to tamoxifen in the first 10 years of follow-up, in this analysis, with limited number of patients, we could not find a significant difference between the two treatment arms.
Citation Format: Cuzick J, Sestak I, Bianco A, Strobbe L, Bergh J, Hanusch C, Neven P, Dowsett M, Forbes JF, Buzdar A, Smith R, Howell A. Long-term comparison of anastrozole versus tamoxifen: Results from LATTE/ATAC [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-09-03.
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Affiliation(s)
- J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - I Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - A Bianco
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - L Strobbe
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - J Bergh
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - C Hanusch
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - P Neven
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - M Dowsett
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - JF Forbes
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - A Buzdar
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - R Smith
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
| | - A Howell
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, London, United Kingdom; University of Naples, Naples, Italy; Canisius Wilhemina Hospital, Nijmegen, Netherlands; Karolinska Institutet and University Hospital, Stockholm, Sweden; Frauenklinik vom Rotkreuzklinikum München, Munich, Germany; UZ Leuven, Leuven, Belgium; Institute of Cancer Research, London, United Kingdom; Calvary Mater Hospital, Newcastle, Australia; MD Anderson, Houston; American Cancer Society, Atlanta; University of Manchester, Manchester, United Kingdom
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Smith SG, Sestak I, Forbes J, Howell A, Cuzick JJ. Abstract S5-03: Menopausal symptoms as predictors of long-term adherence in the International breast cancer intervention study (IBIS-1). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-s5-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Tamoxifen reduces the risk of breast cancer among women at increased risk of the disease. The effectiveness of the drug is dependent on its appropriate use for the duration of therapy. Adherence for the full course of preventive therapy ranges from 60-80%. Early discontinuation is largely attributed to side-effects, but no studies have validated this using 5-year follow-up data. We assessed the role of menopausal side-effects on long-term adherence in the UK arm of the International Breast Cancer Intervention Study (IBIS-1).
In the IBIS-1 trial, 4279 women in the UK were randomised to placebo vs. tamoxifen (20mg/day). A total of 292 were excluded (breast cancer, death, or other cancer), leaving 3987 to be included in the analysis (2000 placebo arm, 1987 tamoxifen arm). Adherence was calculated using data from six monthly clinical visits during the trial. Adherence (<4.5 years, ≥4.5 years) was calculated using the Kaplan-Meier estimator. Our main objective was to investigate the effect of menopausal side effects experienced during the first six months on adherence overall and by treatment arm. All analyses were adjusted for age, Tyrer-Cuzick risk, smoking, hormone replacement therapy use, menopausal status, baseline symptoms, and treatment.
Overall, 66.8% of women were adherent for at least 4.5 years (placebo: 71.5% vs. tamoxifen: 62.1%, p<0.001). Highest drop-out rates were found within the first 12 months of follow-up, and a significant difference in adherence between treatment arms was observed thereafter (p<0.05). A low number of women experienced nausea/vomiting (5.0%) and headaches (7.0%), while higher proportions reported gynaecological symptoms (irregular bleeding/vaginal dryness/vaginal discharge, 13.8%) and hot flushes (31.5%). Women reporting nausea/vomiting (OR=1.82 [95% CI, 1.35-2.47], p<0.001) and headaches (OR=1.41 [1.08-1.84], p=0.01) were significantly more likely to be non-adherent at 4.5 years. Long-term adherence was not significantly affected for those who reported hot flushes (OR=1.10 [0.94-1.30], p=0.2) or gynaecological symptoms (OR=1.18 [0.99-1.41], p=0.07) compared with their counterparts. Nausea/vomiting was significantly associated with non-adherence in both the placebo (OR=1.82 [1.16-2.87], p=0.009) and tamoxifen (OR=1.84 [1.22-2.76], p=0.004) arms. Headaches were associated with non-adherence in the placebo arm (OR=1.70 [1.16-2.50], p=0.006), while gynaecological symptoms were only significant in the tamoxifen arm (OR=1.30 [1.05-1.63], p=0.02). The majority of side effects were of mild or moderate severity and we observed significant trends for lower adherence with increasing severity for all symptoms (p<0.05 to <0.001).
In the IBIS-I trial, we observed a significant effect of common menopausal symptoms on long-term adherence. These effects were largely similar between tamoxifen and placebo arms, suggesting women are attributing age-related menopausal symptoms to preventive therapy. To ensure women experience the full benefit of preventive therapy, interventions are required to support the management of menopausal symptoms and to promote adherence. The higher rate of drop-out in the early months of the trial suggests early intervention may be an effective way to promote long-term adherence.
Citation Format: Smith SG, Sestak I, Forbes J, Howell A, Cuzick JJ. Menopausal symptoms as predictors of long-term adherence in the International breast cancer intervention study (IBIS-1) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr S5-03.
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Affiliation(s)
- SG Smith
- Queen Mary University of London, London, United Kingdom; The University of Newcastle Australia, Newcastle, Australia; The University of Manchester, Manchester, United Kingdom
| | - I Sestak
- Queen Mary University of London, London, United Kingdom; The University of Newcastle Australia, Newcastle, Australia; The University of Manchester, Manchester, United Kingdom
| | - J Forbes
- Queen Mary University of London, London, United Kingdom; The University of Newcastle Australia, Newcastle, Australia; The University of Manchester, Manchester, United Kingdom
| | - A Howell
- Queen Mary University of London, London, United Kingdom; The University of Newcastle Australia, Newcastle, Australia; The University of Manchester, Manchester, United Kingdom
| | - JJ Cuzick
- Queen Mary University of London, London, United Kingdom; The University of Newcastle Australia, Newcastle, Australia; The University of Manchester, Manchester, United Kingdom
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Evans DG, Woodward ER, Howell SJ, Verhoef S, Howell A, Lalloo F. Risk algorithms that include pathology adjustment for HER2 amplification need to make further downward adjustments in likelihood scores. Fam Cancer 2016; 16:173-179. [PMID: 27796713 PMCID: PMC5357509 DOI: 10.1007/s10689-016-9942-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
To assess the need for adjustment in the likelihood of germline BRCA1/2 mutations in women with HER2+ breast cancers. We analysed primary mutation screens on women with breast cancer with unequivocal HER2 overexpression and assessed the likelihood of BRCA1/BRCA2 mutations by age, oestrogen receptor status and Manchester score. Of 1111 primary BRCA screens with confirmed HER2 status only 4/161 (2.5%) of women with HER2 amplification had a BRCA1 mutation identified and 5/161 (3.1%) a BRCA2 mutation. The pathology adjusted Manchester score between 10 and 19% and 20%+ thresholds resulted in a detection rate of only 6.5 and 15% respectively. BOADICEA examples appeared to make even less downward adjustment. There is a very low detection rate of BRCA1 and BRCA2 mutations in women with HER2 amplified breast cancers. The Manchester score and BOADICEA do not make sufficient downward adjustment for HER2 amplification. For unaffected women, assessment of breast cancer risk and BRCA1/2 probability should take into account the pathology of the most relevant close relative. Unaffected women undergoing mutation testing for BRCA1/2 should be advised that there is limited reassurance from a negative test result if their close relative had a HER2+ breast cancer.
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Affiliation(s)
- D G Evans
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Sciences Centre (MAHSC), Institute of Human Development, University of Manchester, Manchester, M13 9WL, UK. .,Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, M23 9LT, UK. .,Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Sciences Centre (MAHSC), Central Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK. .,Manchester Breast Centre, School of Molecular and Clinical Cancer Sciences, The University of Manchester, Manchester, M20 4BX, UK.
| | - E R Woodward
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Sciences Centre (MAHSC), Institute of Human Development, University of Manchester, Manchester, M13 9WL, UK.,Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Sciences Centre (MAHSC), Central Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK
| | - S J Howell
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, M23 9LT, UK.,Manchester Breast Centre, School of Molecular and Clinical Cancer Sciences, The University of Manchester, Manchester, M20 4BX, UK.,Department of Medical Oncology, The Christie, Manchester, M20 4BX, UK
| | - S Verhoef
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Sciences Centre (MAHSC), Central Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK
| | - A Howell
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, M23 9LT, UK.,Manchester Breast Centre, School of Molecular and Clinical Cancer Sciences, The University of Manchester, Manchester, M20 4BX, UK
| | - F Lalloo
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester Academic Health Sciences Centre (MAHSC), Central Manchester University Hospitals NHS Foundation Trust, Manchester, M13 9WL, UK
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Howell A, Parker S, Tsitskaris K, Oddy MJ. The burden of bone, native joint and soft tissue infections on orthopaedic emergency referrals in a city hospital. Ann R Coll Surg Engl 2016; 98:34-9. [PMID: 26688397 DOI: 10.1308/rcsann.2015.0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Bone, native joint and soft tissue infections are frequently referred to orthopaedic units although their volume as a proportion of the total emergency workload has not been reported previously. Geographic and socioeconomic variation may influence their presentation. The aim of this study was to quantify the burden of such infections on the orthopaedic department in an inner city hospital, determine patient demographics and associated risk factors, and review our current utilisation of specialist services. Methods All cases involving bone, native joint and soft tissue infections admitted under or referred to the orthopaedic team throughout 2012 were reviewed retrospectively. Prosthetic joint infections were excluded. Results Almost 15% of emergency admissions and referrals were associated with bone, native joint or soft tissue infection or suspected infection. The cohort consisted of 169 patients with a mean age of 43 years (range: 1-91 years). The most common diagnosis was cellulitis/other soft tissue infection and the mean length of stay was 13 days. Two-thirds of patients (n=112, 66%) underwent an operation. Fifteen per cent of patients were carrying at least one blood borne virus, eleven per cent were alcohol dependent, fifteen per cent were using or had been using intravenous drugs and nine per cent were homeless or vulnerably housed. Conclusions This study has shown that a significant number of patients are admitted for orthopaedic care as a result of infection. These patients are relatively young, with multiple complex medical and social co-morbidities, and a long length of stay.
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Affiliation(s)
- A Howell
- University College London Hospitals NHS Foundation Trust , UK
| | - S Parker
- University College London Hospitals NHS Foundation Trust , UK
| | - K Tsitskaris
- University College London Hospitals NHS Foundation Trust , UK
| | - M J Oddy
- University College London Hospitals NHS Foundation Trust , UK
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Evans DG, Harkness EF, Howell A, Wilson M, Hurley E, Holmen MM, Tharmaratnam KU, Hagen AI, Lim Y, Maxwell AJ, Moller P. Intensive breast screening in BRCA2 mutation carriers is associated with reduced breast cancer specific and all cause mortality. Hered Cancer Clin Pract 2016; 14:8. [PMID: 27087880 PMCID: PMC4832454 DOI: 10.1186/s13053-016-0048-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/05/2016] [Indexed: 11/13/2022] Open
Abstract
Background The addition of annual MRI screening to mammography has heightened optimism that intensive screening along with improved treatments may substantially improve life expectancy of women at high risk of breast cancer. However, survival data from BRCA2 mutation carriers undergoing intensive combined breast screening are scarce. Methods We have collated the results of screening with either annual mammography or mammography with MRI in female BRCA2 mutation carriers in Manchester and Oslo and use a Manchester control group of BRCA2 mutation carriers who had their first breast cancer diagnosed without intensive screening. Results Eighty-seven BRCA2 mutation carriers had undergone combined (n = 34) or mammography (n = 53) screening compared to 274 without such intensive screening. Ten year breast cancer specific survival was 100 % in the combined group (95 % CI 82.5–100 %) and 85.5 % (95 % CI 72.6–98.4 %) in the mammography group compared to 74.6 % (95 % CI 66.6–82.6 %) in the control group. Better survival was driven by lymph node status (negative in 67 % of screened vs 39 % of unscreened women; p < 0.001) and a significantly greater proportion of intensively screened women had invasive breast cancers <2 cm at diagnosis (74.6 % vs 50.4 %; p = 0.002). Conclusion Intensive combined breast cancer screening with annual MRI and mammography appears to improve survival from breast cancer in BRCA2 mutation carriers. Data from larger groups are required to confirm the effectiveness of combined screening in BRCA2 carriers.
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Affiliation(s)
- D G Evans
- Genesis Breast Cancer Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT UK ; Genomic Medicine, St Mary's Hospital, Oxford Road, Manchester Academic Health Sciences Centre, University of Manchester Institute of Human Development, Central, Manchester Foundation Trust, Manchester, M13 9WL UK
| | - E F Harkness
- Genesis Breast Cancer Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT UK ; Centre for Imaging Sciences, Institute of Population Health, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - A Howell
- Genesis Breast Cancer Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT UK
| | - M Wilson
- Genesis Breast Cancer Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT UK
| | - E Hurley
- Genesis Breast Cancer Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT UK
| | - M M Holmen
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - K U Tharmaratnam
- Department of Mathematics, University of Oslo, Blindern, Oslo, Norway
| | - A I Hagen
- Department of Breast and Endocrine Surgery, Trondheim University Hospital, Trondheim, Norway ; Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Y Lim
- Genesis Breast Cancer Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT UK
| | - A J Maxwell
- Genesis Breast Cancer Prevention Centre and Nightingale Breast Screening Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9LT UK
| | - P Moller
- Inherited Cancer Research Group, The Norwegian Radium Hospital, Department for Medical Genetics, Oslo University Hospital, Oslo, Norway ; Department of Tumour Biology, Institute of Cancer Research, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway ; Department of Human Medicine, Universität Witten/Herdecke, Witten, Germany
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Chughtai B, Forde J, Howell A. 64: Variability of commercial cranberry products for the prevention of uropathogenic bacterial adhesion. Am J Obstet Gynecol 2016. [DOI: 10.1016/j.ajog.2016.01.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cuzick J, Forbes JF, Sestak I, Howell A, Bonanni B, Bundred N, Levy C, von Minckwitz G, Eiermann W, Neven P, Stierer M, Holcombe C, Coleman RE, Jones LJ, Ellis I. Abstract S6-03: Anastrozole versus tamoxifen for the prevention of loco-regional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in-situ (IBIS-II DCIS). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-s6-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Third generation aromatase inhibitors are a more effective treatment option than tamoxifen for hormone receptor positive invasive breast cancer in postmenopausal women. However, it is not known whether anastrozole is more effective than tamoxifen in preventing the recurrence of breast cancer in women with hormone receptor (HR) positive ductal carcinoma in situ (DCIS). Here, we compare the efficacy of anastrozole versus tamoxifen in postmenopausal women with HR positive DCIS.
Methods: A multi-centre randomised placebo-controlled trial of 1mg/day anastrozole (oral) vs. 20mg/day tamoxifen (oral) for five years was conducted in 2980 postmenopausal women with locally excised HR positive DCIS. The primary endpoint was to determine if anastrozole is at least as effective as tamoxifen in loco-regional control and prevention of contralateral disease. Secondary endpoints included breast cancer mortality, other cancers, cardiovascular disease, fractures, adverse events and non-breast cancer deaths. All analyses were done on an intention-to-treat basis and Cox proportional hazard were used to compute hazard ratios and corresponding confidence intervals for recurrence.
Results: Between 2003 and 2012, a total of 2980 postmenopausal women were recruited into the IBIS-II DCIS trial. 1471 women were randomly assigned to receive anastrozole and 1509 women tamoxifen. Median follow-up for this first analysis is 6.8 years and 131 breast cancer recurrences have been recorded. Median age was 60.3 years (56.1-64.6), median BMI was 26.7 (23.6-30.7), and 45.6% of women had used hormone replacement therapy (HRT) before joining the trial. Of the 131 women with recurrent disease, 77 had a loco-regional recurrence and 51 reported contralateral disease. A total of 61 deaths were recorded. We will present a comprehensive analysis of the efficacy of anastrozole and tamoxifen for preventing loco-regional/contralateral breast cancer and major adverse events by intention to treat (ITT).
Conclusions: To follow.
Citation Format: Cuzick J, Forbes JF, Sestak I, Howell A, Bonanni B, Bundred N, Levy C, von Minckwitz G, Eiermann W, Neven P, Stierer M, Holcombe C, Coleman RE, Jones LJ, Ellis I. Anastrozole versus tamoxifen for the prevention of loco-regional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in-situ (IBIS-II DCIS). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr S6-03.
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Affiliation(s)
- J Cuzick
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - JF Forbes
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - I Sestak
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - A Howell
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - B Bonanni
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - N Bundred
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - C Levy
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - G von Minckwitz
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - W Eiermann
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - P Neven
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - M Stierer
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - C Holcombe
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - RE Coleman
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - LJ Jones
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
| | - I Ellis
- University of Newcastle, Calvary Mater Hospital, Australia New Zealand Breast Cancer Trials Group Newcastle, Newcastle, Australia; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University London, London, United Kingdom; Genesis Breast Cancer Prevention Centre, Manchester, United Kingdom; Instituto Europeo di Oncologia, Milan, Italy; South Manchester University Hospital, Manchester, United Kingdom; Centre François Baclesse, Caen, France; German Breast Group, Neu-Isenburg, Germany; Interdisciplinary Oncology Center Mnchen, Munich, Germany; UZ Gasthuisberg Ziekenhuis, Leuven, Belgium; Vienna International Health Centre, Vienna, Austria; Royal Liverpool University Hospital, Liverpool, United Kingdom; Weston Park Hospital, Sheffield, United Kingdom; Barts Cancer Institute, John Vane Science Centre, London, United Kingdom; University of Nottingham, Molecular Medical Sciences, Nottingham, United Kingdom
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Zucchini G, Armstrong AC, Wardley AM, Wilson G, Misra V, Seif M, Ryder WD, Cope J, Blowers E, Howell A, Palmieri C, Howell SJ. A phase II trial of low-dose estradiol in postmenopausal women with advanced breast cancer and acquired resistance to aromatase inhibition. Eur J Cancer 2015; 51:2725-31. [PMID: 26597446 DOI: 10.1016/j.ejca.2015.08.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/26/2015] [Accepted: 08/29/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND High-dose oestrogen (HDE) is effective but toxic in postmenopausal women with advanced breast cancer (ABC). Prolonged oestrogen deprivation sensitises BC cell lines to estrogen and we hypothesised that third-generation aromatase inhibitors (AIs) would sensitise BCs to low-dose estradiol (LDE). METHODS A single-arm phase II study of LDE (2 mg estradiol valerate daily) in postmenopausal women with estrogen receptor-positive (ER+) ABC. The primary end-point was clinical benefit (CB) rate. If LDE was ineffective, HDE was offered. If LDE was effective, retreatment with the pre-LDE AI was offered on progression. RESULTS Twenty-one patients were recruited before the trial was closed early due to slow accrual; 19 were assessable for efficacy and toxicity. CB was seen in 5 in 19 patients (26%; 95% confidence interval 9.1-51.2%), all with prolonged SD (median duration 16.8 months; range 11.0-29.6). Treatment was discontinued for toxicity in 4 in 19 patients (21%) and 8 in 11 women without hysterectomy experienced vaginal bleeding (VB). After primary LDE failure, three patients received HDE and one achieved a partial response (PR). Following CB on LDE, four patients restarted pre-LDE AI and three achieved CB including one PR. Those with CB to LDE had a significantly longer duration of first-line endocrine therapy for ABC than those without (54.9 versus 16.8 months; p < 0.01) CONCLUSION: LDE is an effective endocrine option in women with evidence of prolonged sensitivity to AI therapy. LDE is reasonably well tolerated although VB is an issue. Re-challenge with the pre-LDE AI following progression confirms re-sensitisation as a true phenomenon.
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Affiliation(s)
| | - A C Armstrong
- The Christie NHS Foundation Trust, UK; The University of Manchester, UK
| | - A M Wardley
- The Christie NHS Foundation Trust, UK; The University of Manchester, UK
| | - G Wilson
- The Christie NHS Foundation Trust, UK
| | - V Misra
- The Christie NHS Foundation Trust, UK
| | - M Seif
- Central Manchester NHS Foundation Trust, UK
| | - W D Ryder
- The Christie NHS Foundation Trust, UK
| | - J Cope
- The Christie NHS Foundation Trust, UK
| | - E Blowers
- The Christie NHS Foundation Trust, UK
| | - A Howell
- The Christie NHS Foundation Trust, UK; The University of Manchester, UK
| | | | - S J Howell
- The Christie NHS Foundation Trust, UK; The University of Manchester, UK.
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Lee E, Clark R, Buelow M, Patel K, Cook C, Morgan B, Howell A, Menatti A, Bryant A, Suhr J. C-78Malingered Attention Deficit Hyperactivity Disorder on the Conners Adult Attention Rating Scale: Do Reasons for Malingering Matter? Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Patel K, Bryant A, Menatti A, Howell A, Morgan B, Cook C, Lee E, Buelow M, Clark R, Suhr J. C-77Minnesota Multiphasic Personality Inventory-2-Restructured Format Profiles in Malingered Attention Deficit Hyperactivity Disorder: Does Reason for Malingering Matter? Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bryant A, Lee E, Howell A, Morgan B, Cook C, Patel K, Menatti A, Clark R, Buelow M, Suhr J. C-79Malingered Functional Impairment in the Context of Attention Deficit Hyperactivity Disorder Evaluation: A Simulator Study. Arch Clin Neuropsychol 2015. [DOI: 10.1093/arclin/acv047.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Basu NN, Ingham S, Hodson J, Lalloo F, Bulman M, Howell A, Evans DG. Risk of contralateral breast cancer in BRCA1 and BRCA2 mutation carriers: a 30-year semi-prospective analysis. Fam Cancer 2015; 14:531-8. [DOI: 10.1007/s10689-015-9825-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Evans DG, Thomas S, Caunt J, Roberts L, Howell A, Wilson M, Fox R, Sibbering DM, Moss S, Wallis MG, Eccles DM, Duffy S. Mammographic surveillance in women aged 35-39 at enhanced familial risk of breast cancer (FH02). Fam Cancer 2015; 13:13-21. [PMID: 23733252 DOI: 10.1007/s10689-013-9661-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although there have been encouraging recent studies showing a potential benefit from annual mammography in women aged 40-49 years of age with an elevated breast cancer risk due to family history there is little evidence of efficacy in women aged <40 years of age. A prospective study (FH02) has been developed to assess the efficacy of mammography screening in women aged 35-39 years of age with a lifetime breast cancer risk of ≥ 17 % who are not receiving MRI screening. Retrospective analyses from five centres with robust recall systems identified 47 breast cancers (n = 12 in situ) with an interval cancer rate of 15/47 (32%). Invasive tumour size, lymph node status and current vital status were all significantly better than in two control groups of unscreened women (including those with a family history) recruited to the POSH study. Further evaluation of the prospective arm of FH02 is required to assess the potential added value of digital mammography and the cancer incidence rates in moderate and high risk women in order to inform cost effectiveness analyses.
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Affiliation(s)
- D G Evans
- Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester NHS Trust, Wythenshawe, Manchester, M23 9LT, UK,
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Holliday R, Venugopal S, Howell A, Keys W. Operator's ability at assessing a high-speed (air turbine) handpiece before use: an audit. Br Dent J 2015; 218:E3. [DOI: 10.1038/sj.bdj.2015.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 11/09/2022]
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Sivagnanam L, Hufton A, Berks M, Harkness E, Lim Y, Maxwell A, Wilson M, Bydder M, Gadde S, Evans DG, Howell A, Stavrinos P, Astley S. PB.23. Breast density in previous screening mammograms of women with and without breast cancer. Breast Cancer Res 2014. [PMCID: PMC4244072 DOI: 10.1186/bcr3717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Otsuka M, Harkness E, Chen X, Moschidis E, Bydder M, Gadde S, Lim Y, Maxwell A, Evans DG, Howell A, Stavrinos P, Wilson M, Astley S. Local breast density at lesion sites in diagnostic and previous screening mammograms. Breast Cancer Res 2014. [PMCID: PMC4243105 DOI: 10.1186/bcr3699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Daniels J, Harkness E, Lim Y, Maxwell A, Morris J, Stavrinos P, Wilson M, Bydder M, Evans DG, Howell A. PB.24. How does volumetric breast density change with time? Breast Cancer Res 2014. [PMCID: PMC4243094 DOI: 10.1186/bcr3729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Donnelly LS, Evans DG, Wiseman J, Fox J, Greenhalgh R, Affen J, Juraskova I, Stavrinos P, Dawe S, Cuzick J, Howell A. Uptake of tamoxifen in consecutive premenopausal women under surveillance in a high-risk breast cancer clinic. Br J Cancer 2014; 110:1681-7. [PMID: 24594998 PMCID: PMC3974072 DOI: 10.1038/bjc.2014.109] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 01/31/2014] [Accepted: 02/01/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Randomised trials of tamoxifen versus placebo indicate that tamoxifen reduces breast cancer risk by approximately 33%, yet uptake is low. Approximately 10% of women in our clinic entered the IBIS-I prevention trial. We assess the uptake of tamoxifen in a consecutive series of premenopausal women not in a trial and explore the reasons for uptake through interviews. METHODS All eligible women between 33 and 46 years at ≥17% lifetime risk of breast cancer and undergoing annual mammography in our service were invited to take a 5-year course of tamoxifen. Reasons for accepting (n=15) or declining (n=15) were explored using semi-structured interviews. RESULTS Of 1279 eligible women, 136 (10.6%) decided to take tamoxifen. Women >40 years (74 out of 553 (13.4%)) and those at higher non-BRCA-associated risk were more likely to accept tamoxifen (129 out of 1109 (11.6%)). Interviews highlighted four themes surrounding decision making: perceived impact of side effects, the impact of others' experience on beliefs about tamoxifen, tamoxifen as a 'cancer drug', and daily reminder of cancer risk. CONCLUSIONS Tamoxifen uptake was similar to previously ascertained uptake in a randomised controlled trial (IBIS-I). Concerns were similar in women who did or did not accept tamoxifen. Decision making appeared to be embedded in the experience of significant others.
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Affiliation(s)
- L S Donnelly
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - D G Evans
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
- Department of Genomic Medicine, MAHSC, St Mary's Hospital, Manchester M13 9WL, UK
| | - J Wiseman
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - J Fox
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - R Greenhalgh
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - J Affen
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - I Juraskova
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED), School of Psychology, University of Sydney, Sydney, NSW 2006, Australia
| | - P Stavrinos
- Manchester Academic Health Science Centre, University Hospital of South Manchester, University of Manchester, Manchester M23 9LT, UK
| | - S Dawe
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
| | - A Howell
- Nightingale and Genesis Breast Cancer Prevention Centre, University Hospital of South Manchester, Manchester M23 9LT, UK
- Department of Medical Oncology, Christie Hospital, Manchester M20 4BX, UK
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Evans G, Stavrinos P, Dawe S, Harvie M, Wilson M, Maxwell A, Brentnall A, Cuzick J, Astley S, Howell A. 8LBA Assessing individual breast cancer risk within the UK National Health Service Breast Screening Programme: First prospective results from PROCAS. Eur J Cancer 2014. [DOI: 10.1016/s0959-8049(14)70116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cuzick J, Sestak I, Forbes JF, Dowsett M, Knox J, Cawthorn S, Saunders C, Roche N, Mansel RE, von Minckwitz G, Bonanni B, Palva T, Howell A. Abstract S3-01: Breast cancer prevention using anastrozole in postmenopausal women at high risk. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-s3-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Third generation aromatase inhibitors are the most effective endocrine treatment for hormone receptor positive breast cancer in postmenopausal women. Here, we assess the efficacy of anastrozole in postmenopausal women who do not have breast cancer, but are at high risk of developing the disease.
Methods: A multi-centre randomised placebo-controlled trial of 1mg/day oral anastrozole vs. matching placebo for five years was conducted in 3864 postmenopausal women at increased risk of breast cancer. The primary endpoint was the incidence of breast cancer (including ductal carcinoma in-situ (DCIS) and differences were assessed by the proportional hazards model. Detailed information on adverse events was collected.
Results: After a median follow up of 5.03 years, 125 breast cancers were recorded. A 53% reduction (95% CI (32-68%), P<0.0001) was seen in the anastrozole arm. Significant reductions were seen for all invasive (50%), oestrogen receptor positive invasive (58%) and in situ tumours (70%). Fractures were non-significantly higher (8.5% vs. 7.7%, P = 0.3) and musculoskeletal events were significantly higher in the anastrozole arm (1226 vs. 1124, RR = 1.10 (1.05-1.16)) but were very common in both arms (63.9% vs. 57.8%). Vasomotor symptoms were also increased with anastrozole (RR = 1.15 (1.08-1.22)). Cancers at other sites were significantly decreased (40 vs. 70, RR = 0.58 (0.39-0.85)). Deaths from breast cancer and other causes were similar in both arms.
Conclusions: Anastrozole is an effective agent for reducing breast cancer incidence in postmenopausal women at high risk. Anastrozole was well tolerated and side effects associated with oestrogen deprivation were only slightly higher than for placebo.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S3-01.
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Affiliation(s)
- J Cuzick
- Centre for Cancer Prevention, Queen Mary University, London, United Kingdom; Newcastle Mater Hospital, Newcastle, Australia; Breast Care Centre, Southmead Hospital, Bristol, United Kingdom; Royal Marsden Hospital, London, United Kingdom; University of Wales College of Medicine, Cardiff, United Kingdom; German Breast Group, Frankfurt, Neu-Isenburg, Germany; European Institute of Oncology, Milan, Italy; Pirkanmaa Cancer Society, Tampere, Finland; Paterson Institute for Cancer Research, Manchester, United Kingdom; The University of Western Australia, Australia
| | - I Sestak
- Centre for Cancer Prevention, Queen Mary University, London, United Kingdom; Newcastle Mater Hospital, Newcastle, Australia; Breast Care Centre, Southmead Hospital, Bristol, United Kingdom; Royal Marsden Hospital, London, United Kingdom; University of Wales College of Medicine, Cardiff, United Kingdom; German Breast Group, Frankfurt, Neu-Isenburg, Germany; European Institute of Oncology, Milan, Italy; Pirkanmaa Cancer Society, Tampere, Finland; Paterson Institute for Cancer Research, Manchester, United Kingdom; The University of Western Australia, Australia
| | - JF Forbes
- Centre for Cancer Prevention, Queen Mary University, London, United Kingdom; Newcastle Mater Hospital, Newcastle, Australia; Breast Care Centre, Southmead Hospital, Bristol, United Kingdom; Royal Marsden Hospital, London, United Kingdom; University of Wales College of Medicine, Cardiff, United Kingdom; German Breast Group, Frankfurt, Neu-Isenburg, Germany; European Institute of Oncology, Milan, Italy; Pirkanmaa Cancer Society, Tampere, Finland; Paterson Institute for Cancer Research, Manchester, United Kingdom; The University of Western Australia, Australia
| | - M Dowsett
- Centre for Cancer Prevention, Queen Mary University, London, United Kingdom; Newcastle Mater Hospital, Newcastle, Australia; Breast Care Centre, Southmead Hospital, Bristol, United Kingdom; Royal Marsden Hospital, London, United Kingdom; University of Wales College of Medicine, Cardiff, United Kingdom; German Breast Group, Frankfurt, Neu-Isenburg, Germany; European Institute of Oncology, Milan, Italy; Pirkanmaa Cancer Society, Tampere, Finland; Paterson Institute for Cancer Research, Manchester, United Kingdom; The University of Western Australia, Australia
| | - J Knox
- Centre for Cancer Prevention, Queen Mary University, London, United Kingdom; Newcastle Mater Hospital, Newcastle, Australia; Breast Care Centre, Southmead Hospital, Bristol, United Kingdom; Royal Marsden Hospital, London, United Kingdom; University of Wales College of Medicine, Cardiff, United Kingdom; German Breast Group, Frankfurt, Neu-Isenburg, Germany; European Institute of Oncology, Milan, Italy; Pirkanmaa Cancer Society, Tampere, Finland; Paterson Institute for Cancer Research, Manchester, United Kingdom; The University of Western Australia, Australia
| | - S Cawthorn
- Centre for Cancer Prevention, Queen Mary University, London, United Kingdom; Newcastle Mater Hospital, Newcastle, Australia; Breast Care Centre, Southmead Hospital, Bristol, United Kingdom; Royal Marsden Hospital, London, United Kingdom; University of Wales College of Medicine, Cardiff, United Kingdom; German Breast Group, Frankfurt, Neu-Isenburg, Germany; European Institute of Oncology, Milan, Italy; Pirkanmaa Cancer Society, Tampere, Finland; Paterson Institute for Cancer Research, Manchester, United Kingdom; The University of Western Australia, Australia
| | - C Saunders
- Centre for Cancer Prevention, Queen Mary University, London, United Kingdom; Newcastle Mater Hospital, Newcastle, Australia; Breast Care Centre, Southmead Hospital, Bristol, United Kingdom; Royal Marsden Hospital, London, United Kingdom; University of Wales College of Medicine, Cardiff, United Kingdom; German Breast Group, Frankfurt, Neu-Isenburg, Germany; European Institute of Oncology, Milan, Italy; Pirkanmaa Cancer Society, Tampere, Finland; Paterson Institute for Cancer Research, Manchester, United Kingdom; The University of Western Australia, Australia
| | - N Roche
- Centre for Cancer Prevention, Queen Mary University, London, United Kingdom; Newcastle Mater Hospital, Newcastle, Australia; Breast Care Centre, Southmead Hospital, Bristol, United Kingdom; Royal Marsden Hospital, London, United Kingdom; University of Wales College of Medicine, Cardiff, United Kingdom; German Breast Group, Frankfurt, Neu-Isenburg, Germany; European Institute of Oncology, Milan, Italy; Pirkanmaa Cancer Society, Tampere, Finland; Paterson Institute for Cancer Research, Manchester, United Kingdom; The University of Western Australia, Australia
| | - RE Mansel
- Centre for Cancer Prevention, Queen Mary University, London, United Kingdom; Newcastle Mater Hospital, Newcastle, Australia; Breast Care Centre, Southmead Hospital, Bristol, United Kingdom; Royal Marsden Hospital, London, United Kingdom; University of Wales College of Medicine, Cardiff, United Kingdom; German Breast Group, Frankfurt, Neu-Isenburg, Germany; European Institute of Oncology, Milan, Italy; Pirkanmaa Cancer Society, Tampere, Finland; Paterson Institute for Cancer Research, Manchester, United Kingdom; The University of Western Australia, Australia
| | - G von Minckwitz
- Centre for Cancer Prevention, Queen Mary University, London, United Kingdom; Newcastle Mater Hospital, Newcastle, Australia; Breast Care Centre, Southmead Hospital, Bristol, United Kingdom; Royal Marsden Hospital, London, United Kingdom; University of Wales College of Medicine, Cardiff, United Kingdom; German Breast Group, Frankfurt, Neu-Isenburg, Germany; European Institute of Oncology, Milan, Italy; Pirkanmaa Cancer Society, Tampere, Finland; Paterson Institute for Cancer Research, Manchester, United Kingdom; The University of Western Australia, Australia
| | - B Bonanni
- Centre for Cancer Prevention, Queen Mary University, London, United Kingdom; Newcastle Mater Hospital, Newcastle, Australia; Breast Care Centre, Southmead Hospital, Bristol, United Kingdom; Royal Marsden Hospital, London, United Kingdom; University of Wales College of Medicine, Cardiff, United Kingdom; German Breast Group, Frankfurt, Neu-Isenburg, Germany; European Institute of Oncology, Milan, Italy; Pirkanmaa Cancer Society, Tampere, Finland; Paterson Institute for Cancer Research, Manchester, United Kingdom; The University of Western Australia, Australia
| | - T Palva
- Centre for Cancer Prevention, Queen Mary University, London, United Kingdom; Newcastle Mater Hospital, Newcastle, Australia; Breast Care Centre, Southmead Hospital, Bristol, United Kingdom; Royal Marsden Hospital, London, United Kingdom; University of Wales College of Medicine, Cardiff, United Kingdom; German Breast Group, Frankfurt, Neu-Isenburg, Germany; European Institute of Oncology, Milan, Italy; Pirkanmaa Cancer Society, Tampere, Finland; Paterson Institute for Cancer Research, Manchester, United Kingdom; The University of Western Australia, Australia
| | - A Howell
- Centre for Cancer Prevention, Queen Mary University, London, United Kingdom; Newcastle Mater Hospital, Newcastle, Australia; Breast Care Centre, Southmead Hospital, Bristol, United Kingdom; Royal Marsden Hospital, London, United Kingdom; University of Wales College of Medicine, Cardiff, United Kingdom; German Breast Group, Frankfurt, Neu-Isenburg, Germany; European Institute of Oncology, Milan, Italy; Pirkanmaa Cancer Society, Tampere, Finland; Paterson Institute for Cancer Research, Manchester, United Kingdom; The University of Western Australia, Australia
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Sergeant JC, Wilson M, Barr N, Beetles U, Boggis C, Bundred S, Bydder M, Gadde S, Hurley E, Jain A, Lim Y, Lord L, Reece V, Evans DG, Howell A, Astley SM. PB.17: Inter-observer agreement in visual analogue scale assessment of percentage breast density. Breast Cancer Res 2013. [PMCID: PMC3980893 DOI: 10.1186/bcr3517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Sergeant JC, Sperrin M, Bardwell L, Buchan I, Evans DG, Howell A, Astley SM. PB.11: Identifying women at high risk of developing breast cancer: implications of adjusting for inter-observer variability in visual analogue scale assessment of percentage breast density. Breast Cancer Res 2013. [PMCID: PMC3980277 DOI: 10.1186/bcr3512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Dunn R, Astley S, Bydder M, Evans DG, Howell A, Sergeant J, Maxwell AJ. PB.44: Audit of interval cancers from family history breast screening. Breast Cancer Res 2013. [PMCID: PMC3980311 DOI: 10.1186/bcr3544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Beattie L, Bydder M, Sergeant JC, Maxwell A, Barr N, Beetles U, Boggis CRM, Bundred S, Gadde S, Hurley E, Jain A, Lord E, Reece V, Wilson M, Stavrinos P, Evans DG, Howell A, Astley SM. PB.18: Factors affecting breast density assessment. Breast Cancer Res 2013. [PMCID: PMC3981048 DOI: 10.1186/bcr3518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Johnson PF, Sergeant JC, Bydder M, Maxwell A, Whiteside S, Stavrinos P, Wilson M, Evans DG, Howell A, Astley SM. PB.25: Relationship between volumetric breast density, age and hormonal factors. Breast Cancer Res 2013. [PMCID: PMC3980887 DOI: 10.1186/bcr3525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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