Objective To evaluate the implementation of non‐invasive prenatal testing (NIPT) on pregnant women's choices in a national NHS antenatal screening programme for Down's syndrome, Edwards' syndrome and Patau's syndrome. Method An observational study of all pregnant women with a singleton pregnancy and higher chance (≤1:150) combined or quadruple screening result from 30 April 2018 to 25 September 2020 in Wales, UK. Pregnant women's journey through the pathway was determined including uptake of NIPT, performance of NIPT in a non‐research setting and invasive procedures performed. Results Of the 1273 women with a higher chance initial screening, 1073 (84%) chose NIPT contingent test, 174 (14%) no further testing and 26 (2%) invasive procedure. There were 1001 (93%) low chance NIPT results; 11 (1%) failed results and 61 (6%) high chance results. Average annual incidence of 27 invasive procedures undertaken compared to 229 pre‐NIPT implementation, a nearly ninefold reduction. Down's syndrome annual live birth rate remained unchanged across the implementation period. Discussion This study demonstrates that NIPT contingent screening was highly acceptable to women with a resulting reduction in invasive procedures performed. Conclusion The high uptake of NIPT in NHS antenatal screening pathway conditions should inform planning for other national screening programmes.

SARS-CoV-2 vaccine uptake in pregnant women is believed to be low and lags behind the general population contributing to increased hospital admissions, and poor maternal and fetal outcomes. However, there is a paucity of information on the SARS-CoV-2 serostatus of pregnant women to help inform policy planning and assess impact of interventions to improve vaccine uptake in this at-risk group. We analyzed 8,683 residual, anonymized newborn screening dried bloodspot (DBS) specimens during a 15-month period (October 2020 to December 2021) in Wales (UK) for SARS-CoV-2 IgG-antibodies. We compared newborn DBS antibody-positive rates to the percentage number of pregnant women vaccinated and the percentage number of antibody-positive adults. In December 2021, 47.8% of women in Wales had received two doses of the vaccine by their delivery date; however, only 41.1% of DBS specimens had high antibody concentrations. Results indicate that a proportion of pregnant women remain at higher-risk of COVID complications, particularly given the reduction in antibody neutralization of Omicron versus the Delta variant. Our study demonstrates the utility of newborn screening DBS specimens to monitor SARS-CoV-2 serostatus in pregnant women representing maternal vaccination and natural infection in almost real-time, defining the immunity gap and impact of any interventions.

AimDiabetic eye screening is important for the early detection of diabetic retinopathy, to prevent sight loss. The COVID-19 pandemic may have resulted in additional factors influencing whether individuals with diabetes choose to attend their appointment. This study aimed to explore the barriers and facilitators to attending diabetic eye screening during the COVID-19 pandemic. MethodEleven semi-structured interviews were conducted between 7th April 2021 and 9th July 2021. Participants included those with type 1 or type 2 diabetes who were in a retinopathy priority group. Interviews were conducted via Microsoft Teams either as video or telephone interviews. Central questions included topics such as thoughts and feelings on COVID-19 and how participants felt about diabetic eye screening. Data were analysed via reflexive thematic analysis. ResultsTwo themes were developed: “Keeping safe from COVID-19 at appointments” and “The importance of protecting their eyesight”. Participants explained barriers and facilitators to keeping safe from COVID-19 at their appointment. These included increased confidence from the vaccine, the perceived risk of catching COVID-19 in certain environments, and trusting the NHS to keep them safe. Participants also discussed the importance of their eyesight and their identity as an attender, which facilitated attendance. Overall, participants considered the benefits of attending screening against the perceived risk of catching COVID-19.ConclusionsThe results indicated several barriers and facilitators participants experienced when deciding whether to attend an eye screening appointment since the COVID-19 pandemic. Service communications must address these as the pandemic continues, and for other future outbreaks of infectious disease.

Introduction: Women with B5a (non-invasive) preoperative core biopsies upgraded to invasive disease at surgery have a high chance of needing further surgery. The average B5a upgrade rate across UK breast screening programmes is around 20%. Through this Scottish review, we aim to identify factors affecting upgrade rates and ways to improve our performance. Methods: This was a retrospective analysis of 1,252 cases of B5a biopsies from the Scottish Breast Screening Programme between 2004 and 2012. Final surgical pathology was correlated with radiological and biopsy factors. Results: B5a upgrade rates for the units ranged from 19.2 to 29.2%, with average of 23.6%. Mean sizes of invasive tumours were small (3 to 11 mm). Upgrade rate was significantly higher for cases where the main mammographic abnormality was mass, distortion or asymmetry, compared with microcalcification alone (33.2% vs. 21.7%) (P = 0.0004). The upgrade rate was significantly lower with use of large-volume vacuum-assisted biopsy (VAB) devices than 14-gauge core needles (19.9% vs. 26%) (P = 0.013). The upgrade Introduction: MRI is a common method for detecting breast cancer in women at high risk [1,2] These women may instead be diagnosed mammographically or present symptomatically. The aim of this study was to investigate how breast cancer is diagnosed in high-risk women and determine whether there are specific characteristics related to the type of presentation. Methods: A total of 125 high-risk patients with 134 breast cancers (69 BRCA, 65 family history) were managed at the Royal Marsden Hospital from 1994 to 2013. Following ethical approval, data were collected retrospectively for each presentation of breast cancer: method of presentation/diagnosis (MRI, mammography, symptomatic), age at diagnosis, cancer type, grade, size, presence of DCIS, lymphovascular invasion (LVI), nodal status and tumour subtype. Chi-squared and ANOVA analyses determined any association between the parameters, P < 0.05 was significant. Results: Ten breast cancers were MRI detected, 43 mammography detected and 81 symptomatic (mean age 41, 51, and 45 years (P = 0.008); mean size 17, 29, and 34 mm (P = 0.076) respectively).The majority of cancers were high-grade (68%) invasive ductal carcinomas (78%) without LVI (76%). MRIdetected cancers were triple negative in 60% (P = 0.03), node negative in 100% (P = 0.005) with DCIS in 70% (P = 0.007). Mammography-detected cancers were luminal in 77% (P = 0.03), node negative in 77% (P = 0.005), with DCIS in 81% (P = 0.007). Symptomatic cancers were luminal in 54%, triple negative in 41%, node negative in 56% and DCIS positive in 51%. Conclusion: In this high-risk cohort, MRI detects small, triple-negative, node-negative cancers in younger women, while mammography detects larger, luminal, cancers in older women that may be node positive. Introduction: Anisotropy is the directional dependence of the measurement of a property. As breast tissue structure and some breast diseases (DCIS) are anisotropic in structure, we aimed to establish ...

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