Low Serological Prevalence of SARS-CoV-2 Antibodies in Cancer Patients at a German University Oncology Center

Background Coronavirus disease 2019 (COVID-19) cases in Germany, as in most other places in Europe or worldwide, are still highly prevalent. Vaccination rates currently remain low, putting cancer patients at a continued risk of infection with SARS-CoV-2, while prevalence of SARS-CoV-2 antibodies among cancer patients in Germany remains essentially unknown. Methods Between August 2020 and February 2021, patients admitted to our hospital were prospectively enrolled in our COVID-19 biobank. Collected sera were analyzed for SARS-CoV-2-IgM/IgG using Elecsys Anti-SARS-CoV-2 assay. Results One hundred and ten patients with cancer were included in this study. With 71 (65%) patients, most had active cancer treatment, mainly chemotherapy (56%). The most frequent diagnosis was gastrointestinal cancer (54%) with pancreatic cancer being the most common cancer type (24%). Hematologic malignancies were present in 21 patients (17%). Among the cancer patients first diagnosed during the pandemic, the rate of palliative treatment situations tended to be higher (76% vs. 67%, p=0.17). A history of SARS-CoV-2 infection was documented in 15 (14%) patients, however, SARS-CoV-2 antibodies were detected in 10 (67%) patients only. Of the patients without history of SARS-CoV-2 infection, none displayed SARS-CoV-2 antibodies. Conclusion In the present single center experience, a low serological prevalence of SARS-CoV-2 antibodies among cancer patients even after SARS-CoV-2 infection was found. The results support continued strict preventive measures as well as efforts towards faster vaccination, due to a low immunity level in the population.

Breast Cancer: Treatment Effects on Fertility and Subsequent Pregnancy Outcomes

Objective: Breast cancer is the most common cancer type in women of reproductive age. Given that most women postpone childbearing, breast cancer occurrence possibly perplexes their plans for starting a family. The treatment for breast cancer can affect their fertility and have adverse effects on a pregnancy that occurs during that period. The aim of this narrative review is primarily to explore the influence of breast cancer therapy on the ability of a woman diagnosed with breast cancer to gestate. Moreover, to determine the safer timing for childbearing after being treated for breast cancer and investigate the pregnancy outcome when conception is succeeded. Childbearing after treatment for breast cancer is considered safe and pregnancy outcomes are favorable if conception happens 1 year after chemotherapy or at least 2 years after chemotherapy and radiation therapy. Counseling is of great significance and fertility preservation methods should be thoroughly discussed with women diagnosed with breast cancer, even prior to commencement of the treatment

Recent advances in Lynch syndrome

Lynch syndrome is one of the most common hereditary cancer syndromes and is characterized by the development of many cancers, such as colorectal cancer (CRC), endometrial cancer, ovarian cancer, stomach cancer and many other cancers. Lynch syndrome is caused by pathogenic germline variants in one of four DNA mismatch repair genes (MLH1, MSH2, MSH6, or PMS2) or by an EPCAM deletion. The MLH1 variant is correlated with the highest risk of CRC, while the MSH2 variant is correlated with the highest risk of other cancers. CRC is the most common cancer type that develops in individuals with Lynch syndrome, followed by endometrial cancer. Recent advances have been made to help us further understand the molecular pathogenesis of this disease and help improve diagnostic testing efficiency and surveillance strategies. Moreover, recent advances in immunotherapy provided by clinical trials also provide clinicians with more chances to better treat Lynch syndrome. This study aims to review many advances in the molecular genetics, clinical features, diagnosis, surveillance and treatment of Lynch syndrome.

Distributed Skin Lesion Analysis Across Decentralised Data Sources

Skin cancer has become the most common cancer type. Research has applied image processing and analysis tools to support and improve the diagnose process. Conventional procedures usually centralise data from various data sources to a single location and execute the analysis tasks on central servers. However, centralisation of medical data does not often comply with local data protection regulations due to its sensitive nature and the loss of sovereignty if data providers allow unlimited access to the data. The Personal Health Train (PHT) is a Distributed Analytics (DA) infrastructure bringing the algorithms to the data instead of vice versa. By following this paradigm shift, it proposes a solution for persistent privacy- related challenges. In this work, we present a feasibility study, which demonstrates the capability of the PHT to perform statistical analyses and Machine Learning on skin lesion data distributed among three Germany-wide data providers.

Pathway use and concordance in affiliated academic and community oncology practices.

e18639 Background: Clinical oncology pathways (COP) provide treatment (Rx) decision support and allow detailed quality oversight. There are limited data on use of COP and the proportion of patients receiving COP recommended Rx (concordant / “On Pathway” Rx – OnP) and on the reasons for COP non-concordant “Off Pathway” Rx (OffP). Methods: COP concordance and reasons for OffP Rx were evaluated and compared at an NCI-designated cancer center (Roswell Park Comprehensive Cancer Center – RP) and its 5 affiliated community practice sites (Roswell Park Care Network – RPCN) for COP Rx decisions from 10/1/19 – 9/30/20. Elsevier ClinicalPath Oncology COPs (formerly Via Oncology) were implemented in 2018 at RP and RPCN and are completed at initiation of any systemic Rx. COPs cover about 85% of cancers, excluding most hematologic cancers. COP Rx decisions are classified as OnP (including Rx on a clinical trial) or OffP. All OffP decisions are reviewed retrospectively to identify the reasons for OffP Rx. Differences in OnP rates at RP and RPCN were compared by chi square test or Fisher’s test overall and for 7 cancer type groups and for adjuvant Rx (ADJ) and metastatic disease (MET). ADJ/MET comparison excluded gynecologic cancer (GYN), myeloma and myelodysplastic syndrome (MDS) because COPs do not classify ADJ vs MET for these. Results: At RP there were 4,291 Rx decisions for 3,361 patients and at RPCN 1,349 Rx decisions for 1,198 patients. Breast cancer was the most common cancer type (18% of patients at RP and 36% at RPCN). Proportions of patients with GYN, melanoma, sarcoma, and GU cancers were higher at RP and similar for GI, thoracic and myeloma/MDS. Among 3,153 ADJ and MET Rx decisions at RP, 55% were for METS vs. 36% of 1,096 decisions in the RPCN. Pathway decision concordance (OnP) rates overall were 85% at RP and 89% at RPCN (p < 0.01- Table). OnP rates for ADJ Rx were 89% at RP and 92% at RPCN (p = 0.05), and for MET 84% at RP and 86% at RPCN (p = 0.53). Most OffP Rx was for medically valid reasons including comorbidity, new/targeted therapies, and prior Rx precluding COP recommended Rx. Conclusions: COP concordance was slightly higher in community practice, potentially because newer therapies, patients with greater morbidities and more complex cancers are in the academic practice. RP had a higher proportion of MET cases consistent with the tertiary practice treating more advanced cancer. OffP Rx was higher with MET, likely related to the nuances of Rx of MET cancer and new therapies not yet in pathways. OffP Rx was fully justified in most cases.[Table: see text]

The politicians’ perspectives on participation in mammographic screening: an interview-based study from a region in Sweden

Background Breast cancer is the most common cancer type among women globally. To facilitate early detection, all 40–74-year-old female residents of Sweden are invited to participate in a population-based mammographic screening programme. Approximately 20% of all invited women decline the offer, and if this is due to systematic differences that can be adjusted, it can indicate inequity in healthcare. Assessment of and being updated about the health and healthcare of the residents are largely the responsibilities of the self-governed regions in Sweden. The understanding of the residents’ health serves as a basis for decision making and priority setting. This study aims to describe how politicians representing a region in Sweden perceive women’s participation in mammographic screening and the politicians’ own possibility to promote such participation. Methods Qualitative thematic analysis was conducted on the data obtained from individual semi-structured interviews held in 2019. The interviewees comprised ten politicians (six women and four men, 38–71 years old) representing a sub-committee focusing on public health and healthcare issues. Results Two main themes have been identified: 1) expected actions and 2) expected conditions for acting, including a total of four sub-themes. According to the politicians, the expected actions, such as obtaining information and being updated about matters regarding mammographic screening, concern both the women invited to the screening and the politicians themselves. Additionally, for both the individual and the healthcare organisation, here represented by the politicians, expected actions entail a shared commitment to maintain health. The expected conditions for acting refer to the politician’s awareness of the factors influencing the women’s decision to undergo or refuse the screening and having the resources to enable taking actions to facilitate participation. Conclusions Expected actions and expected conditions for acting are tightly connected and entail some form of prioritisation by the politicians. Setting the priorities can be based on information about the purpose of the screening and an understanding of social determinants’ impacts on women’s decision to refrain from mammographic screening, as well as available resources.

BRAFnon-V600E more frequently co-occurs with IDH1/2 mutation in adult patients with gliomas than patients harboring BRAFV600E, but without survival advantage

Background The effect of BRAFnon−V600E and BRAFV600E on the outcome and the molecular characteristics in adult glioma patients is unknown and needs to be explored, although BRAFV600E has been extensively studied in pediatric glioma. Methods Co-occurring mutations and copy number alterations of associated genes in the MAPK and p53 pathways were retrieved and investigated using the cBioPortal. The prognosis of available adult glioma cohorts with BRAFV600E and BRAFnon−V600E mutations was also investigated. Results Glioblastoma multiform was the most common cancer type with BRAF non−V600E and BRAFV600E. TP53 (56.00% vs. 7.41%), IDH1/2 (36.00% vs. 3.70%), and ATRX (32.00% vs. 7.41%) exhibited more mutations in BRAFnon−V600E than in BRAFV600E, and TP53 was the independent risk factor (56.00% vs. 7.41%). Both BRAFnon−V600E and BRAFV600E frequently overlapped with CDKN2A/2B homozygous deletions (HD), whereas there was no significant difference. Survival analysis showed no difference between BRAF non−V600E and BRAFV600E cohorts, even excluded the effects of IDH1/2 mutations, and concerned the BRAFnon−V600E mutations in the glycine-rich loop (G-loop) and in the activation segment. The estimated mean survival of BRAFnon−V600E and IDH1/2WT with mutations in the G-loop groups was the shortest. Conclusions BRAF non−V600E exhibited a higher association with IDH1/2 mutation than BRAFV600E, but no survival advantage was found.

Towards a Complete Pipeline for Segmenting Nuclei in Feulgen-Stained Images

Cervical cancer is the second most common cancer type in womenaround the world. In some countries, due to non-existent or inadequatescreening, it is often detected at late stages, making standardtreatment options often absent or unaffordable. It is a deadlydisease that could benefit from early detection approaches. It isusually done by cytological exams which consist of visually inspectingthe nuclei searching for morphological alteration. Since itis done by humans, naturally, some subjectivity is introduced. Computationalmethods could be used to reduce this, where the firststage of the process would be the nuclei segmentation. In this context,we present a complete pipeline for the segmentation of nucleiin Feulgen-stained images using Convolutional Neural Networks.Here we show the entire process of segmentation, since the collectionof the samples, passing through pre-processing, training thenetwork, post-processing and results evaluation. We achieved anoverall IoU of 0.78, showing the affordability of the approach of nucleisegmentation on Feulgen-stained images. The code is availablein: https://github.com/luizbuschetto/feulgen_nuclei_segmentation

Analysis of the Most Viewed First 50 Videos on YouTube about Breast Cancer

Objective. Breast cancer is the most common cancer type among women worldwide. Today, health consumers search the Internet to gain health information about many diseases including breast cancer. YouTube™ is the second most commonly used website on the Internet. However, the quality and accuracy of health-related YouTube™ videos are controversial. The objective of this study was to investigate the quality and accuracy of breast cancer-related videos on YouTube™. Material and Methods. “Breast cancer” keyword was entered into YouTube™ search bar, and after excluding advertisement, duplicate, and non-English videos, the first most viewed 50 videos were analyzed. Videos’ length, the number of views, comments, likes, and dislikes were recorded. DISCERN and JAMA scores and Video Power Index (VPI) values of the videos were calculated. All videos were evaluated by two independent radiologists experienced on breast cancer. The correlation between the two observers was also analyzed. Results. Of all videos, 14% were uploaded by physicians, 26% by health channels, 20% by patients, 10% by news channels, 2% by herbalists, 2% by blog channels, and 2% by nonprofit activism channels. The mean DISCERN score was calculated as 26.70±10.99 and the mean JAMA score as 2.23±0.97. The mean VPI value, which was calculated to determine the popularity of the videos, was found as 94.10±4.48. A strong statistically significant correlation was found between the two observers in terms of both DISCERN and JAMA scores. There was an excellent agreement between the two observers. Conclusion. The overall quality of the viewed videos was found as poor. Healthcare professionals should be encouraged to upload breast cancer-related videos with accurate information to promote patients for screening and direct them appropriately.

Sphingolipids in Non-Alcoholic Fatty Liver Disease and Hepatocellular Carcinoma: Ceramide Turnover

Non-alcoholic fatty liver disease (NAFLD) has emerged as one of the main causes of chronic liver disease worldwide. NAFLD comprises a group of conditions characterized by the accumulation of hepatic lipids that can eventually lead to non-alcoholic steatohepatitis (NASH), fibrosis, cirrhosis, and hepatocellular carcinoma (HCC), the fifth most common cancer type with a poor survival rate. In this context, several works have pointed out perturbations in lipid metabolism and, particularly, changes in bioactive sphingolipids, as a hallmark of NAFLD and derived HCC. In the present work, we have reviewed existing literature about sphingolipids and the development of NAFLD and NAFLD-derived HCC. During metabolic syndrome, considered a risk factor for steatosis development, an increase in ceramide and sphigosine-1-phosphate (S1P) have been reported. Likewise, other reports have highlighted that increased sphingomyelin and ceramide content is observed during steatosis and NASH. Ceramide also plays a role in liver fibrosis and cirrhosis, acting synergistically with S1P. Finally, during HCC, metabolic fluxes are redirected to reduce cellular ceramide levels whilst increasing S1P to support tumor growth.