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While much current research on Disney princesses focuses on the harmful impact of unrealistic ideals on young viewers’ self-esteem, there is a critical need to shift attention towards the health risks faced by the princesses themselves, Sanne H B van Dijk and colleagues argue

PurposeFollow-up for breast cancer survivors consists of after care and surveillance. The benefits of routine surveillance visits remain debatable. In this study we compared the severity of locoregional recurrences (LRRs) and the subsequent risk of a distant metastasis (DM) between LRRs detected at routine and interval visits.MethodsWomen diagnosed with early breast cancer between 2003 and 2008 in one of the 15 participating hospitals, and who developed a LRR as first event after primary treatment, were selected from the Netherlands Cancer Registry (Cohort A). Chi-squared tests were used to compare the severity of routine- and interval-detected local recurrences (LRs) and regional recurrences (RRs), using tumor size, tumor grade, and number of positive lymph nodes. Data on the development of a subsequent DM after a LRR were available for a subset of patients (Cohort B). Cohort B was used to estimate the association between way of LRR-detection and risk of a DM.ResultsCohort A consisted of 109 routine- and 113 interval-LRR patients. The severity of routine-detected LRs or RRs and interval-detected LRs or RRs did not significantly differ. Cohort B consisted of 66 routine- and 61 interval-LRR patients. Sixteen routine- (24%) and 17 (28%) interval-LRR patients developed a DM. After adjustment, way of LRR-detection was not significantly associated with the risk of a DM (hazard ratio: 1.22; 95% confidence interval: 0.49–3.06).ConclusionThe current study showed that routine visits did not lead to less severe LRRs and did not decrease the risk of a subsequent DM.

Background The onset of the COVID-19 pandemic forced the Dutch national screening program to a halt and increased the burden on health care services, necessitating the introduction of specific breast cancer treatment recommendations from week 12 of 2020. We aimed to investigate the impact of COVID-19 on the diagnosis, stage and initial treatment of breast cancer. Methods Women included in the Netherlands Cancer Registry and diagnosed during four periods in weeks 2–17 of 2020 were compared with reference data from 2018/2019 (averaged). Weekly incidence was calculated by age group and tumor stage. The number of women receiving initial treatment within 3 months of diagnosis was calculated by period, initial treatment, age, and stage. Initial treatment, stratified by tumor behavior (ductal carcinoma in situ [DCIS] or invasive), was analyzed by logistic regression and adjusted for age, socioeconomic status, stage, subtype, and region. Factors influencing time to treatment were analyzed by Cox regression. Results Incidence declined across all age groups and tumor stages (except stage IV) from 2018/2019 to 2020, particularly for DCIS and stage I disease ( p  < 0.05). DCIS was less likely to be treated within 3 months (odds ratio [OR] wks2–8 : 2.04, OR wks9–11 : 2.18). Invasive tumors were less likely to be treated initially by mastectomy with immediate reconstruction (OR wks12–13 : 0.52) or by breast conserving surgery (OR wks14–17 : 0.75). Chemotherapy was less likely for tumors diagnosed in the beginning of the study period (OR wks9–11 : 0.59, OR wks12–13 : 0.66), but more likely for those diagnosed at the end (OR wks14–17 : 1.31). Primary hormonal treatment was more common (OR wks2–8 : 1.23, OR wks9–11 : 1.92, OR wks12–13 : 3.01). Only women diagnosed in weeks 2–8 of 2020 experienced treatment delays. Conclusion The incidence of breast cancer fell in early 2020, and treatment approaches adapted rapidly. Clarification is needed on how this has affected stage migration and outcomes.

PurposeWe aimed to compare (1) treatments and time intervals between treatments of breast cancer patients diagnosed during and before the COVID-19 pandemic, and (2) the number of treatments started during and before the pandemic.MethodsWomen were selected from the Netherlands Cancer Registry. For aim one, odds ratios (OR) and 95% confidence intervals (95%CI) were calculated to compare the treatment of women diagnosed within four periods of 2020: pre-COVID (weeks 1–8), transition (weeks 9–12), lockdown (weeks 13–17), and care restart (weeks 18–26), with data from 2018/2019 as reference. Wilcoxon rank-sums test was used to compare treatment intervals, using a two-sided p-value < 0.05. For aim two, number of treatments started per week in 2020 was compared with 2018/2019.ResultsWe selected 34,097 women for aim one. Compared to 2018/2019, neo-adjuvant chemotherapy was less likely for stage I (OR 0.24, 95%CI 0.11–0.53), stage II (OR 0.63, 95%CI 0.47–0.86), and hormone receptor+/HER2− tumors (OR 0.55, 95%CI 0.41–0.75) diagnosed during transition. Time between diagnosis and first treatment decreased for patients diagnosed during lockdown with a stage I (p < 0.01), II (p < 0.01) or III tumor (p = 0.01). We selected 30,002 women for aim two. The number of neo-adjuvant endocrine therapies and surgeries starting in week 14, 2020, increased by 339% and 18%, respectively. The number of adjuvant chemotherapies decreased by 42% in week 15 and increased by 44% in week 22.ConclusionThe pandemic and subsequently altered treatment recommendations affected multiple aspects of the breast cancer treatment strategy and the number of treatments started per week.

Comparing the impact of the COVID-19 pandemic on the incidence of newly diagnosed breast tumors and their tumor stage between the Netherlands and Norway will help us understand the effect of differences in governmental and social reactions towards the pandemic. Women newly diagnosed with breast cancer in 2017–2021 were selected from the Netherlands Cancer Registry and the Cancer Registry of Norway. The crude breast cancer incidence rate (tumors per 100,000 women) during the first (March-September 2020), second (October 2020-April 2021), and Delta COVID-19 wave (May-December 2021) was compared with the incidence rate in the corresponding periods in 2017, 2018, and 2019. Incidence rates were stratified by age group, method of detection, and clinical tumor stage. During the first wave breast cancer incidence declined to a larger extent in the Netherlands than in Norway (27.7% vs. 17.2% decrease, respectively). In both countries, incidence decreased in women eligible for screening. In the Netherlands, incidence also decreased in women not eligible for screening. During the second wave an increase in the incidence of stage IV tumors in women aged 50–69 years was seen in the Netherlands. During the Delta wave an increase in overall incidence and incidence of stage I tumors was seen in Norway. Alterations in breast cancer incidence and tumor stage seem related to a combined effect of the suspension of the screening program, health care avoidance due to the severity of the pandemic, and other unknown factors. •No stage shift was seen in Norway up till December 31st, 2021.•The incidence of stage IV breast tumors temporarily increased in the Netherlands.•Suspending the screening program shortly might safely ease the healthcare burden.•A low COVID-19 burden might have prevented a decrease in breast cancer diagnosis.

•Both the Dutch Healthy Diet index 2015 (DHD15-index) and the Dietary Approaches to Stop Hypertension (DASH) score are inversely associated with colorectal cancer risk in the general population.•The DHD15-index and the DASH score were not associated with colorectal tumor risk in persons with Lynch Syndrome (LS).•Further studies should investigate the association between diet quality and mechanisms leading to the development of LS-associated tumors. Persons with Lynch syndrome (LS) have an increased risk of developing colorectal tumors (CRTs). Adherence to diet quality indices associated with colorectal cancer (CRC) risk in the general population has not been studied before in LS. Dietary habits of 490 participants with LS from a prospective cohort study was collected using a food frequency questionnaire. The Dutch Healthy Diet index 2015 (DHD15-index) and Dietary Approaches to Stop Hypertension (DASH) were used to score food-based diet quality. Diet quality scores were divided into tertiles where a higher tertile reflects a higher diet quality. Multivariable Cox proportional hazard regression models were used to estimate the association between the DHD15-index, DASH score and CRT risk. During a median follow-up time of 53.4 months, 210 participants (42.9%) developed CRTs. The DHD-index and DASH score were not associated with CRT risk; hazard ratios for highest vs. lowest tertile were 1.00 (95% Confidence Interval (CI): 0.67-1.48) and 1.11 (95% CI: 0.74-1.69), respectively. No linear trends across the DHD-index and DASH score tertiles were observed (P-trend = 0.97 and 0.83 respectively). In contrast to observations in the general population, no evidence for an association between the food-based DHD15-index or DASH score and CRT risk was observed in persons with LS. Further studies are needed investigating the association between diet quality and mechanisms leading to the development of LS-associated tumors.

Background This study investigated the implementation of ultra-hypofractionated radiotherapy (i.e. 5 fractions) in DCIS and early-stage breast cancer, factors associated with its use, and variation across radiotherapy institutes. Methods Registry and questionnaire data were used. Registry data included data from the Netherlands Cancer Registry and the NABON Breast Cancer Audit-Radiotherapy (NBCA-R). Women eligible for 5 fractions were included. Trends and variation were visualised using trendlines and case-mix adjusted boxplots. Logistic regression was applied to investigate which factors were associated with the use of 5 fractions. In April 2024 a questionnaire was distributed among radiotherapy institutes to identify facilitators and barriers for implementation. Results The current study included 16,115 women. In 2020, 18.5% of the eligible women received 5 fractions, compared to 60.8% in 2023. The lowest variation between radiotherapy institutes was found in 2023 (median: 60.4%, interquartile range: 53.3–70.6%). Age, tumour grade, multifocality, (y)pT, (y)pN, radiotherapy target volume, type of radiotherapy institute, and start year of radiation were associated with the chance of receiving 5 fractions. Sixteen out of the 19 radiotherapy institutes completed the questionnaire, showing variation in age and radiotherapy target volume for which the schedule was used. Most institutes mentioned no barriers for using 5 fractions. Questionnaire data confirmed the trendline finding that national consensus meetings were essential for largescale implementation. Conclusions The use of ultra-hypofractionated radiotherapy has increased during the past four years, with reduced variation across Dutch institutes. Registry and questionnaire data indicated that national consensus meetings were instrumental in driving implementation.