The global burden of breast cancer

The global burden of breast cancer remains immense in 2013, with over 1.6 million new cases being diagnosed annually. This burden has been increasing at a rate of 3.1% per year, and while the majority of new cases are diagnosed among women in developed countries, the 450,000 deaths per year from the disease are now equally divided between the developing and developed world, the 9th European Breast Cancer conference (EBCC-9) was told on 19 March 2014.

Professor Peter Boyle, Director of the University of Strathclyde Institute of Global Public Health at the International Prevention Research Institute (iPRI) in Lyon, France, will tell the conference that in Scotland the death rate from breast cancer is now at its lowest level in over 100 years.

“This positive situation has been brought about by contributions from a variety of sources including the development and availability of effective treatments, increased awareness among women, the national NHS Breast Screening programme, and free access for all women to high-quality diagnostic and treatment facilities.

While this is very positive, not all women worldwide have been able to benefit from these advances and the contrast between the situation in rich and poor countries is staggering.” “But even here in Scotland there are considerable differences due to lifestyle and social class; for example, Professor Gillis has shown that, in Glasgow, two women with breast cancer of the same age, presenting for the same treatment at the same time, and with the same tumour characteristic, may have a ten point percentage difference in five-year survival simply because one comes from an affluent area of the city and the other from a deprived area.

This is irrespective of whether or not they are treated by breast cancer specialists.” [1] Eliminating these differences is a matter of urgency, Professor Boyle will say. “We need to make a reduction in the number of women developing and dying from breast cancer a global priority.”

Women in low income countries, and particularly in Africa, tend to seek medical attention for their disease only once it is at an advanced stage and has spread to other parts of the body, and by this stage the only option is palliation, which is often itself not available or, at best, not optimal. The World Breast Cancer Report 2012[2], published by the iPRI, collected data about groups of breast cancer patients from institutes throughout the world in order to develop a clearer picture of the current situation.

“We found that in high income countries, such as the United Kingdom and Australia, there were very few women who were diagnosed initially with stage III or IV (advanced and metastatic) disease,” Prof Boyle will say, “whereas in countries such as Kenya and Uganda almost all women with breast cancer presented at Stage III or IV.

“Given that the difference in survival when going from a stage I to a stage II breast cancer is approximately 12 percentage points, and from a stage III to a stage IV around 30 percentage points, it is clear that our first priority should be to do all we can to encourage women in low-income countries to present to their doctor before their breast cancer is at such advanced stage that cure is no longer possible.”

An increasing population size, longer life expectancy, a decrease in the stigma attached to a diagnosis of breast cancer, increases in awareness, and the introduction of early detection programmes in lower resource countries will inevitably lead to an increase in the numbers of new cases being diagnosed.

“What we need to ensure is that appropriate treatment facilities are available, and this is often not the case,” Prof Boyle will say. For example, in many low-income countries, radiotherapy facilities are either unavailable or present on such a limited scale that they can barely make a difference, and, for women with late-stage terminal cancer who are often in great pain, opioid medications to control pain are frequently lacking.

“It is not as though breast cancer is a new disease – it has been around for thousands of years – or as though it cannot be treated effectively,” Prof Boyle will conclude.

“While there is plenty of good news to report, at least in the developed world, what is particularly alarming is that there are still so many preventable deaths due to the combination of a lack of awareness and a lack of resources.

Epidemiology has a vital role to play both in elucidating the current situation and in bringing it to the notice of those who are able to do something about it.” [1] Gillis CR and Hole DJ.

Survival outcome of care by specialist surgeons in breast cancer: a study of 3786 patients in the west of Scotland. BMJ. 1996 Jan 20;312(7024):145-8. [2] The World Breast Cancer Report 2012 was funded by an unrestricted grant from the Susan G. Komen for the Cure as well as from the iPRI’s own resources.

China reduces TB prevalence by half in 20 years

Over the last 20 years, China has more than halved its tuberculosis (TB) prevalence, with rates falling from 170 to 59 per 100 000 population.

This unrivalled success has been driven by a massive scale-up of the directly observed, short-course (DOTS) strategy, from half the population in the 1990s to the entire country after 2000, according to findings from a 20-year-long analysis of national survey data, published in The Lancet.

“One of the key global TB targets set by the Stop TB Partnership aims to reduce tuberculosis prevalence by 50% between 1990 and 2015. This study in China is the first to show the feasibility of achieving such a target, and China achieved this 5 years earlier than the target date”, says study leader Dr Yu Wang from the Chinese Center for Disease Control and Prevention in Beijing, China.

“Huge improvements in TB treatment, driven by a major shift in treatment from hospitals to local public health centres implementing the DOTS strategy, were largely responsible for this success.”

China is a major contributor to the TB pandemic, with 1 million new TB cases every year, accounting for 11% of all new cases globally. Two national surveys of tuberculosis prevalence in 1990 and 2000 showed that levels of TB were reduced by around 30% in the 13 provinces where the DOTS programme was adopted.

However, national TB prevalence fell by just 19% over the decade. Another survey was done in 2010 to reevaluate the national TB burden, providing an opportunity to assess the effect of the nationwide expansion of the DOTS programme.

Nearly 253 000 individuals aged 15 years and older were surveyed in 2010 at 176 investigation points chosen from all 31 mainland provinces. The results show that between 2000 and 2010, national TB prevalence fell by 57% – tripling the reduction of the previous decade.

During this time, 87% of the total decrease in prevalence was among cases already diagnosed with TB before the survey. The increase of known TB cases treated using DOTS rose from 15% in 2000 to 66% in 2010, and contributed to lower proportions of treatment default (from 43% to 22%) and retreatment (from 84% to 31%).

More than 100 dead from Ebola virus in West Africa

Guinea - According to a statement from the WHO, as of April 14, the Ministry of Health of Guinea has reported a cumulative total of 168 clinically compatible cases of Ebola virus disease (EVD), including 108 deaths.

The detailed situation report is available as at 11 April, describing 159 clinically compatible cases of Ebola virus disease (EVD), including 106 deaths. Laboratory investigations continue at the Institut Pasteur (IP) Dakar laboratory in Conakry and at the European Union Mobile Laboratory (EMLab) team in Guekedou.

A total of 71 clinical cases have been laboratory confirmed (45%), while 34 of the remaining clinical cases are classified as probable cases and 54 as suspected cases. Forty-two of the 106 deaths (40%) have been laboratory confirmed.

Eleven patients were still hospitalised on 10 April while 37 have been discharged from care. A total 941 contacts have been identified since the beginning of the outbreak. Medical observation is continuing for 396 contacts while 545 have been discharged from follow-up.

Doctors at the Donka Hospital isolation facility in Conakry are investigating a cluster of cases who had funeral contact with a relative who died on 1 April with suspected malaria. Two contacts of this patient were admitted on 12 April and tested positive. One doctor, an internal medicine physician who tested positive on a post mortem sample, had cared for this patient and is also linked to this chain of transmission.

He developed an illness with features of EVD but without signs of bleeding. Liberia - As of 11 April, the Ministry of Health and Social Welfare (MOHSW) of Liberia has reported a cumulative total of 26 clinical cases of EVD (6 laboratory confirmed, and 20 probable and suspected cases of EVD), including 13 deaths.

The most recent clinical case was identified on 11 April while the date of admission of the most recent laboratory confirmed case is 4 April. Mali - As of 14 April, the Ministry of Health (MOH) of Mali reports a cumulative total of 6 suspected cases, all of whom remained under medical observation – 3 in the capital city of Bamako, 2 in Kourémalé and 1 in Bankoumana.

The Ebola virus can cause severe viral haemorrhagic fever (VHF) outbreaks in humans with a case fatality rate of up to 90%. Ebola first appeared in 1976 in two simultaneous outbreaks, in Nzara, Sudan, and in Yambuku, Democratic Republic of Congo (DRC). The latter was in a village situated near the Ebola River, from which the disease takes its name.

The Ebola virus is comprised of five distinct species: Bundibugyo, Ivory Coast, Reston, Sudan and Zaire. Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals. In Africa, infection has been documented through the handling of infected chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found dead or ill in the rainforest.

Later Ebola spreads in the community through human-to-human transmission, resulting from close contact with the blood, secretions, organs or other bodily fluids of infected people. Burial ceremonies where mourners have direct contact with the body of the deceased person can also play a role in the transmission of Ebola.

GSK and Novartis in major partnership agreement

GlaxoSmithKline announced April 22 that it has entered into a major 3-part partnership with Novartis to create a new world-leading consumer healthcare business with revenues of £6.5 billion (about US$10.9bn).

GSK will have majority control with an equity interest of 63.5%. GSK will acquire Novartis’ global Vaccines business (excluding influenza vaccines) for an initial cash consideration of $5.25 billion with subsequent potential milestone payments of up to $1.8 billion and ongoing royalties GSK will divest its marketed Oncology portfolio, related R&D activities and rights to its AKT inhibitor and also grant of commercialisation partner rights for future oncology products to Novartis for an aggregate cash consideration of $16 billion (of which up to $1.5 billion depends on the results of the COMBI-d trial) Sir Andrew Witty, Chief Executive Officer, GSK said: “The Novartis OTC portfolio is highly complementary to GSK’s and has many well-known, widely recommended brands such as Voltaren, Excedrin, Otrivin, and Theraflu.

Together, we will create the world’s premier OTC business with clear opportunities to accelerate revenue growth. “The acquisition of Novartis’ Vaccines business will significantly enhance the breadth of our vaccines portfolio and pipeline, notably in meningitis, with the addition of Bexsero, an exciting new vaccine for prevention of meningitis B.

The acquisition will also strengthen our manufacturing network and reduce supply costs. “The third part of this transaction would see divestment of our Oncology portfolio to Novartis. Over the last six years we have made excellent progress to develop a series of innovative medicines.

This transaction provides us with a unique opportunity to crystallise an attractive value for this portfolio and allow these medicines to benefit from Novartis’ global scale in this area. “Very importantly, this transaction strengthens GSK’s offering to patients and consumers.

We will expand our portfolio to both help treat illness and prevent disease, and we will broaden our scope to improve human health with the acquired R&D and innovation expertise.” The acquisition of Novartis’ global Vaccines business (excluding influenza vaccines) further improves GSK’s position as the world’s leading global vaccines supplier.

Demand for vaccination remains significant with the global vaccine market projected to grow approximately 10% per annum over the next 10 years. The combination is geographically well-matched. Novartis’ portfolio has had relatively limited exposure to high growth emerging markets and this presents multiple new growth opportunities for several major brands and innovations, notably Voltaren, Excedrin and Otrivin.

Similarly, GSK’s brands would benefit from exposure to Novartis’ highly successful CIS, Central and Eastern European business. Emma Walmsley has been appointed as Chief Executive Officer Designate of the new business and will be a member of its Board. Sir Andrew Witty will be Chairman of the Board. The Board will comprise directors from both GSK and Novartis.

Roche and Hitachi renew partnership in diagnostics

Roche and Hitachi High-Technologies Corporation have renewed their 10-year contract for the joint development and manufacture of the next generation of instruments and workflow automation solutions for medical laboratories.

The renewed alliance marks a significant milestone towards new platform solutions in Roche’s immunochemistry and clinical chemistry business that will help laboratories meet future needs. The agreement follows a successful 36- year partnership that yielded a number of industry-first innovations in modular designed analyser platforms and workflow automation instruments for the laboratory’s serum work area.

This resulted in more than 55,000 installations in immunodiagnostics and clinical chemistry worldwide. “The new agreement is an important new chapter for us as we’re entering a new generation of modular laboratory solutions over the next few years.

Thanks to an ideal combination of both parties’ expertise, our diagnostics solutions allow customers to choose from the broadest set of instruments available for each laboratory setting. Apart from that, we enjoy a competitive advantage from an expanding selection of over 100 different tests in immunochemistry alone, the benchmark in the industry for a consolidated instrument series,” Jean-Claude Gottraux, Head of Roche Professional Diagnostics, said.

“Concurrent with our future platform strategy, Hitachi High-Tech is contributing to Roche’s concept of addressing the various needs of healthcare professionals with customised and modular solutions that help consolidate and integrate complex laboratory workflows across the whole work chain. The renewed agreement allows both companies to apply their strengths more effectively, and we expect the result to be continuing success for all of us,” Yasukuni Koga, Head of the Medical Systems Sales and Marketing Division, Hitachi High- Technologies Corporation, said.

Collaboration began in 1978, when the two companies teamed up on the sale and development of automated analysers for the clinical laboratory testing of body fluids. Since then, a new generation of laboratory solutions has paved the way for a sequence of industry-first innovations under the ‘cobas’ name.

Today, cobas instruments represent the industry benchmark owing to the flexibility, accuracy, speed and medical value they provide for clinical decisionmaking worldwide. Combined with the ‘Elecsys’ electroluminescence (ECL) testing technology, they augment the powerhouse of Roche’s immunochemistry line-up.

New consensus reached to help tackle drug-resistant TB

New consensus statements have been developed to help tackle the growing threat of multidrug-resistant tuberculosis (TB) and extensively drug-resistant tuberculosis (TB). Published online 24 March 2014 in the European Respiratory Journal¸ the statements mark the first time that physicians who treat patients with multidrug- and extensively drug-resistant TB have reached a consensus on important areas of patient management where scientific evidence is inconclusive.

The World Health Organization (WHO) estimates that currently 450,000 new cases with MDR-TB occur each year. The majority of affected patients live in the WHO European Region.

As the emergence of these forms of the disease is fairly recent, clinical evidence is lacking and could be for many years to come. To help bridge this gap in knowledge, experts from the European-based TBNET network have provided harmonised answers to the key questions for the prevention, diagnosis, treatment and management of multidrug- and extensively drug-resistant TB.

Although some guidelines are available for the treatment of people with multidrugand extensivel