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.
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
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.
is irrespective of whether or not they are
treated by breast cancer specialists.” 
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
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, 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
“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.
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
to the combination of a lack of awareness
and a lack of resources.
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
 Gillis CR and Hole DJ.
outcome of care by specialist surgeons in
breast cancer: a study of 3786 patients
in the west of Scotland. BMJ. 1996 Jan
 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
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
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
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
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
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,
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.
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.
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
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
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
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