Germline BRCA1 and BRCA2 testing for breast cancer survivors.

Background For patients with early breast cancer, knowledge of germline BRCA1/2 status increasingly influences management as well as informing future cancer risk for patients and their families. As access to germline testing expands, it is important that this benefit is extended to survivors as well as to the newly diagnosed. Methods In collaboration with our breast unit colleagues and by embedding a Senior Genetic Counsellor in the virtual multidisciplinary meeting, we identified patients suitable for genetics review 5 years after their breast cancer diagnosis. Results Between May 2015 and December 2018, 2044 patients were discussed, of whom 769 patients were identified for notes review by Genetics. Of these, 275 had already undergone testing and 47 had confirmed germline pathogenic variants in BRCA1/2 A further 463 were recommended for referral. One hundred and eighty patients were subsequently offered testing with 161 accepting (161/180, 89%). Nine patients were found to harbour pathogenic variants in either BRCA1 or BRCA2 (9/161, 6%). Of the initial 2044 patients reviewed, 2.7% (56/2044) are now known to carry germline pathogenic variants. Conclusion The survivorship setting provides an opportunity for genetic review underpinned by collaborative working between cancer specialists and the genetics team.

Valorization of lignin in polymer and composite systems for advanced engineering applications - A review.

As fossil fuel resources dwindle and new regulations for a cleaner and safer environment come on stream, there is growing interest in developing new sustainable feedstocks for future fuels, chemicals, polymers and fibers. Therefore materials research is ever more focused on the production of green or bio-based materials and their composites. Lignocellulosic biomass has become the feedstock of choice for these new materials as cellulose and lignin are the most abundant biopolymers on the planet. Lignin is a phenolic macromolecule, the principal biological source of aromatic structures, with a complex structure which varies depending on plant species and its isolation process. Despite its high carbon content and its potential as a raw material, lignin remains underutilised. Between 40 and 50 million tons of lignin are produced worldwide per year; while some is being used for low- and medium-value applications, most is currently treated as a non-commercialized by-product or as low value fuel to produce energy. However, with the emergence of biorefinery projects larger amounts of lignin with the potential for valorisation are being produced. Here, we summarise some of the latest developments in the field.

The prevalence of unmet needs in 625 women living beyond a diagnosis of early breast cancer.

BACKGROUND: There are over half a million women with a previous breast cancer diagnosis living in the UK. It is important to establish their level of unmet physical and psychosocial needs, as many are not routinely seen for follow-up under current models of care. METHODS: We conducted a retrospective analysis of early breast cancer survivors entering an Open Access Follow-Up (OAFU) programme in 2015. Unmet needs were assessed using the Holistic Needs Assessment (HNA) or extracted directly from the electronic patient record (EPR), when the HNA had not been completed. RESULTS: Six hundred and twenty-five patients were eligible. Sixty-one per cent of the survivors had at least one unmet need and 18% had ⩾5 needs. Consistently higher levels of unmet needs were identified using the formal HNA checklist as opposed to extraction from EPR (P<0.001). Physical and emotional needs were the most frequently reported (55 and 24% respectively). Patients receiving endocrine therapy and those who had received chemotherapy were more likely to report unmet needs (both P<0.001). CONCLUSIONS: Unmet physical and emotional needs are common in breast cancer survivors. It is vital that the services are available for these patients as they transition from hospital-based follow-up to patient-led self-management models of care.