Cancer In France Research Articles

Évaluation de la qualité des données chaînées nationales du cancer colorectal

Epidemiologic data concerning colorectal cancer in France mainly comes from local registries that cover about 15% of the population. The Programme of medicalisation of information systems (PMSI) database records and archives the diagnosis and treatment provided during a patient's hospital stay. In France, the chaining of different hospital stays for a given patient recently became possible and permits epidemiological studies to be carried out any given pathologies at the national level. However, evaluation of the quality of chained data has been limited to local experiences. This study hence aimed to evaluate the quality of chained data for colorectal cancer patients for the purpose of conducting epidemiological studies. All hospital stays, totalling 556,206, at the national level for the year 2003 of patients diagnosed with colorectal cancer (principal or secondary) were obtained and analysed. Chaining was defective for 6.47% of the stays. Those which were not chained came exclusively from public hospitals. The number of stays without a principal diagnosis was 134 (0.2%); 82 were from public hospitals (61.2%) and 52 from private ones (38.8%). Stays with at least one error totalled 6.58%. The chained data appears reliable; nevertheless, due to the stays which are not chained, the data should be used with caution.

Chimiothérapie des cancers des voies aérodigestives supérieures

Tumours of the upper aerodigestive tract represent the sixth most frequent kind of cancer in France and throughout the world. If the localised forms may be controlled in the long run in two thirds of cases by surgery or radiotherapy, only one third of locally advanced forms are accessible to a cure after association from radiotherapy and chemotherapy. Besides, with a median of survival less than six months, metastatic tumours present a catastrophic spontaneous prognosis among patients with a medical ground that is often heavily deteriorated by prolonged exposure to alcohol and tobacco. Thus, there is a necessity to implement adapted therapeutic strategies to each patient and based on satisfactory proof levels of effectiveness. Optimisation of existing chemotherapy protocols and development of new therapies, in particular of targeted therapies, remain an important objective in the hope to improve results of treatments in locally advanced and metastatic cancers of the oral cavity.

The frequency of cancer in France: mortality trends since 1950 and summary of the report on the causes of cancer

In 2005, a total number of 149,000 cancer deaths were observed in France, 89,000 in the male population and 60,000 in the female population. Age-standardised mortality rates are decreasing for most cancer sites, at least in recent years, the main exception being lung cancer in the female population which has become the second cause of cancer deaths after breast cancer. The report on the attributable causes of cancer in France from the International Agency for Research on Cancer, the French Science and Medical Academies and the Fédération Nationale des Centres de Lutte Contre le Cancer shows the importance of tobacco alcohol and infections. They are the most important causes of cancer in France, leading respectively to 24 %, 7 % and 4 % of cancer deaths. Cancer prevention is possible as demonstrated by the decrease in tobacco and alcohol consumption in the male population leading to a reduction in the risk of cancer.

Childhood cancer survival in France, 1990–1999

The aim of this study was to describe the overall survival after childhood cancer in France using follow-up data from regional population-based registries. The survival of children (aged under 15 years) diagnosed with a cancer during 1990–1999 was analysed. For all cancers, the survivals were, respectively, 90.3% [89.4–91.3] at 1-year, 75.2% [73.8–76.6] at 5 years and 72.2% [70.7–73.7] at 10 years. During the 1990s, the average improvement in the 5-year survival was +1.2% per year. Adjusted for gender, age, area of residence and stage, children with cancer diagnosed between 1995 and 1999 had a 0.80 reduced risk of dying compared with those whose cancer had been diagnosed between 1990 and 1994. The increase of survival at the population level reflects a global improvement in childhood cancer care. The Paediatric Registries, in association with the French Society of Childhood Cancer, are now collecting data to quantify on a national basis the other events, at least relapse and second cancers.

Cost of care of colorectal cancers according to health care patterns and stage at diagnosis in France

Little is known about the economic burden associated with colorectal cancer in France. The aim of this study was to evaluate the effects of age, stage at diagnosis, health care pattern and level of comorbidities on the mean cost of the management of colorectal cancers, using data from a population-based registry and the French health care system. We estimated the direct costs of medical care for 384 colorectal cancers diagnosed in 2004, using the three main databases of the National Health Insurance. The cost of management was defined as the sum of all health expenditures over the 12 months following the date of diagnosis. The mean cost for first-year management was 24,966 euro (SE 1,195 euro). There was no significant difference in overall costs in relation to sex, age, Charlson index score, cancer location or health care pattern. Costs increased significantly with cancer extension from 17,596 euro for stage I to 35,059 euro for stage IV. Hospitalisation charges represented the greatest economic burden (55.2%), followed by medical purchases (24.4%), outpatient care (17.8%) and transportation (2.5%). These results confirm the major economic burden of colorectal cancer and indicate that total costs depend mainly on the stage at diagnosis. By improving stage at diagnosis, mass screening could contribute to decreasing the cost of managing colorectal cancers.

Human papillomavirus (HPV) genotype distribution in invasive cervical cancers in France: EDITH study

Invasive cervical cancer (ICC) remains a significant cause of morbidity and mortality in France. Since human papillomavirus (HPV) is the necessary cause of ICC, the aim of this study was to assess the type-specific prevalence of HPV in ICC in France in order to locally evaluate the potential benefit of an HPV 16/18 L1 virus-like particles (VLP) vaccination. A total of 516 histological specimens collected in 15 centers were analyzed. Among them, 86% had a diagnosis of squamous cell carcinoma (SCC) whereas 14% were adenocarcinomas (ADC). HPV genotyping was performed using the INNO-LiPA assay allowing the specific detection of 24 HPV genotypes both high risk (HR) and low risk (LR). The overall HPV prevalence in ICC was 97%. The most prevalent genotypes were HPV 16 (73%) and HPV 18 (19%) followed by HPV 31 (7%), 33, 68, 45, 52 and 58 (4.1-2.3%). HPV 16 and/or 18 were associated with 82% of ICC, 10% being HPV 16 and 18 coinfections. While HPV 16 was the most prevalent type in both SCC (74%) and ADC (64%), HPV 18 was by far more prevalent in ADC (37%) compared to SCC (16%; p < 0.001). Multiple infections with at least two different HR HPV genotypes were observed in 22% of ICC. Given the high HPV 16/18 prevalence and taking into account possible production of crossneutralizing antibodies against other HPV types, HPV 16/18 L1 VLP vaccination would be expected to significantly reduce the burden of ICC in France.

Sino-nasal cancer and exposure to leather dust

In 1987, the International Agency for Research into Cancer classified shoemaking and cobbling as a definite human carcinogen. However, there are 10 times fewer articles published on Medline compared to wood dust which also induces sino-nasal cancer. To improve the medical, technical and social management of this type of cancer in the shoe trades. A literature review was conducted by two independent experts to identify articles describing epidemiological studies of this link (with no stipulated time frame). The search resulted in 14 studies, including one meta-analysis of case-control studies: four out of five of the case-control studies found an excess risk associated with exposure to leather dust. Of five cohort mortality studies, excess risk was found in all studies conducted in the shoe trades but not in the tanning industry. The four studies of the incidence of sino-nasal cancer confirm the excess risk in shoemaking. In the shoe trades, there is an excess risk of sino-nasal cancer, especially among those working in shining, finishing and shoe repair. Incidence levels among employees are estimated at 1-7/100,000 depending on the specific job. The risk fraction which can be attributed to this type of exposure for this cancer in France is estimated at 3%. In the light of these findings, all involved should be made aware of the link and motivated (as has already been done in the wood industries) to get this occupational disease recognized as such for the shoe trades.

P1-194: Individual screening of lung cancer in france: results of EDIFICE study

P1-194: Individual screening of lung cancer in france: results of EDIFICE study

Organized cervical cancer screening for underpriviledged women

Individual cervical screening with pap-smears is the major cause of the decrease in incidence and mortality of cervical cancer in France since more than 30 years. But, for the last ten years, the decrease in mortality is limited due to the persistence of poor prognostic cases and the insufficiency of treatment efficacy in such patients. These cases are mostly observed in women who did not participate to regular screening. They are generally from low socioeconomic levels or migrant populations, or both. Such an observation leads us to organize 3 successive pilot campaigns (2001, 2003, 2005) in the Northern part of Marseille city where the rate of such poor population is high (37 to 45%). The women without a pap-smear indexed in the National Insurance Register for the last 3-2 years were invited by individual mailing to perform, free of charge, a pap-smear. The evaluation of each campaign helps us to improve the next one. The major changes from the 1st one to the 3rd one were to increase the number of free screening services, to send a second invitation to the non responders, and to organize local meetings with social workers and nurses to explain to the women the importance of performing regular screening tests. The final results after the 3 campaigns showed : out of the eligible women the participation rates are dramatically low evolving from 1,56 % to 2,48% and 6,87% of pap-smears done along the 3 campaigns ; the selection of women "without pap-smear" from the national Insurance register was not good, a great number of missing data was identified, explaining partly the extremely low rate of participation ; the factors increasing a little the participation are the second mailing of invitation (39 % of pap-smears realised) ; the total gratuitous of the screening (both sampling and reading) ; the oral information delivered locally by social workers and the proximity of the places to perform the test ; the quality of the pap-smears collected by gynecologists was good but insufficient for other health professionals, requiring a specific training for cervical cell collection. The organization of such pilot projects need to be followed to find better solutions to increase the participation to cervical screening of such populations who are at high risk of poor prognosis cervical cancers.

Place of multidisciplinary consulting meetings and clinical trials in the management of colorectal cancer in France in 2000

The 1998 consensus conference dealing with colon cancer, and the 2003 Cancer Plan underlined the need for multidisciplinary meetings and for including patients in therapeutic trials. The aim of this study, which pooled data from the French Cancer Registries operating within the Francim network, was to report on diagnostic and therapeutic practices in the general French population before implementation of the Cancer Plan. The study population was composed of 2935 patients with colorectal cancer diagnosed in 2000 in twelve French administrative districts accounting for 15% of the geographical area of France. Data were collected using a standardized procedure. Three categories of place of diagnosis were defined: public university hospitals, public non-university hospitals, and private clinics. Overall, multidisciplinary meeting was conducted for 32.2% of patients with colorectal cancer. This proportion varied from 6.4% to 76.9%, depending on the geographical area (P<0.001). The place of diagnosis affected this practice: 52% in public university hospitals, 31% in public non-university hospitals and 29% in private clinics (P<0.001). In multivariate analysis, age (OR(>75 years): 0.71, P<0.001), site (OR(rectum): 1.80, P<0.001) and health care facilities (OR(public non-university vs public university): 0.36, P<0.001, OR(private vs public university): 0.40, P<0.001) affected the use of multidisciplinary meeting. Overall, 4.3% of patients were included in a therapeutic trial. This concerned 6.2% of patients aged under 75 and 1.0% of those aged over 75 (P<0.001). The proportion of inclusions, taking into account the trials proposed in 2000 and 2001, varied from 0.7% to 16.4% according to geographical area (P<0.001). This proportion was 10.3% if there had been multidisciplinary meeting and 5.1% if not (P<0.001). Neither cancer site, gender, nor healthcare facility responsible for diagnosis influenced trial inclusion. This population-based study underlines geographical variations in the management of colorectal cancer in France. In 2000, multidisciplinary meeting was conducted for an insufficient proportion of patients, and an insufficient number of patients were included in therapeutic trials. Repeating the same survey in 2005 will provide information on the effects of the Cancer Plan and the diffusion of these recommendations.

Analyzing the aging population and cancer in France to identify healthcare needs

L’approche geographique de la demographie permet d’accompagner les reflexions sur l’organisation et l’anticipation des besoins de soins des personnes âgees en matiere cancerologique. L’augmentation de l’esperance de vie et la diminution de la fecondite dans les societes europeennes accroissent le poids demographique des personnes âgees dans la population. L’analyse geographique des evolutions spatiotemporelles des populations âgees permet de montrer qu’elles ne sont pas homogenes sur l’ensemble du territoire: differences numeriques entre zones urbaines et zones rurales, et au sein des ensembles urbains, part importante des femmes, ainsi que disparites entre regions d’emigration et d’immigration. Ces dynamiques spatiales s’accompagnent de changements significatifs des conditions de vie des personnes âgees (seules ou en collectivite).

Evaluation of a combined screening programme for breast, cervical and colorectal cancers in France

A combined breast, cervical and colorectal cancer screening programme was set up in 1990 in Isère, for women aged 50-69 years (target population 100,000) comprising an initial medical visit. The programme was evaluated in 1997. The evaluation covered uptake results, sensitivity, specificity, two opinion surveys among 1025 physicians and 400 women to measure the impact, and three surveys regarding radiologists', gastroenterologists' and pathologists' attitudes. Sensitivity and specificity rates were 74 and 87% for breast, 83 and 99% for cervical and 43 and 97% for colorectal screening. The number of cervical smears completed by women aged 60-69 years doubled with the programme. Acceptability of the faecal occult blood test was 88%. Eighty percent of physicians were in favour of the programme but 67% said that they often prescribed outside the programme. Overall, 71% of the interviewed women said they had had a breast screen, 69% a Pap smear and 53% a faecal occult blood test when only 25-35% of the target population was actually recorded in the programme. This programme increased the uptake of women not previously screened both within and outside the programme. It showed discrepancies between beliefs and practices of physicians. Protocol changes were implemented after this evaluation.

The frequency of cancer in France: all ages and under age 15, mortality in 2003 and trends since 1968

In 2003, there was 147,000 deaths attributed to cancer in France, 88,000 in men and 59,000 in women. Cancer mortality rates have been decreasing since 1987 in the male population and since the late 60's in the female population, the decrease is larger for the male population. This decrease is observed for most sites of cancer at least in recent years, however lung and bladder cancer mortality are increasing in the female population, pancreatic and skin cancer mortality are increasing both for men and for women, and myeloma is more or less stable. Among children aged 0 to 14, the incidence of cancer is stable and the mortality is decreasing markedly, the decrease being largest for leukaemia and lymphoma because of chemotherapy.

Social determinants of access to reference care centres for patients with colorectal cancer – A multilevel analysis

Background Although social disparities in survival for patients with cancer are documented in an increasing number of papers, knowledge on the underlying mechanisms concerning screening, diagnosis, treatment or follow-up, is relatively poor. Our study was aimed at investigating the social determinants of access to reference cancer care centres for surgery for colorectal cancer in France. Methods Retrospective analysis was conducted on population-based data from a specialised cancer registry (County of Calvados, France). The population consisted of 5156 patients with surgical treatment for colorectal cancer recorded between January 1st 1981 and December 31st 2000. Results The probability of being cared for in a reference care centre was 1.3-fold lower for people living in a deprived district (mean income < 15000€) and 3-fold lower for people living in a district where more than 7% of houses were devoid of bath and shower in comparison with districts where this rate was under 2%. After adjustment for distance from reference care centre, the probability of being cared for in a reference care centre was still over one third lower for people living in a district with more than 7% of houses devoid of bath and shower. Social disparities in management of patients with colorectal cancer have increased in the last decade. The reduction of access to reference care with distance was stronger in elderly patients. Conclusions There is a social and geographical determination of type of treatment centre for care management of colorectal cancer in France. Special attention needs to be paid to the high quality of care management in non-specialised care centres in order to avoid an increased social gradient in cancer mortality in France.

Socioeconomic and geographic determinants of survival of patients with digestive cancer in France.

Using a multilevel Cox model, the association between socioeconomic and geographical aggregate variables and survival was investigated in 81 268 patients with digestive tract cancer diagnosed in the years 1980–1997 and registered in 12 registries in the French Network of Cancer Registries. This association differed according to cancer site: it was clear for colon (relative risk (RR)=1.10 (1.04–1.16), 1.10 (1.04–1.16) and 1.14 (1.05–1.23), respectively, for distances to nearest reference cancer care centre between 10 and 30, 30 and 50 and more than 90 km, in comparison with distance of less than 10 km; P-trend=0.003) and rectal cancer (RR=1.09 (1.03–1.15), RR=1.08 (1.02–1.14) and RR=1.12 (1.05–1.19), respectively, for distances between 10 and 30 km, 30 and 50 km and 50 and 70 km, P-trend=0.024) (n=28 010 and n=18 080, respectively) but was not significant for gall bladder and biliary tract cancer (n=2893) or small intestine cancer (n=1038). Even though the influence of socioeconomic status on prognosis is modest compared to clinical prognostic factors such as histology or stage at diagnosis, socioeconomic deprivation and distance to nearest cancer centre need to be considered as potential survival predictors in digestive tract cancer.

Excess risk of cancer in renal transplant patients

Cancer data were reviewed in 488 patients who underwent renal transplantation and received cyclosporine at our centre from January 1985 to December 1995. Incidence of nonmelanoma skin cancer (NMSC) was standardized on the age and sex distribution of the French population. For cancer other than NMSC, we calculated the ratio of observed to expected numbers of cancer cases in the RT population, based on age- and sex-specific incidence for cancer in France. Standardized incidence ratios (SIR) were calculated for all cancers and for specific cancer types encountered. Over 4,638 patient-years of exposure, 51 (10.4%) transplant recipients developed a first NMSC which was significantly associated with older age at transplantation (P < 0.0001) and the 1991-1995 transplantation period (P = 0.0008). Fifty-six recipients developed cancer other than NMSC over the period. The SIR for all cancer was 2.2 (1.5-3.0) in males and 3.0 (1.9-4.6) in females. The SIR for specific cancer types revealed significant excess for native kidneys [13.0 (5.2-26.8)] prostate cancer [3.6 (1.5-3.0)] and post-transplant lymphoproliferative disorder (PTLD) [9.5 (3.1-22.1)] in males, and cervical cancer [25.3 (9.3-55.0)], native kidneys [26.4 (5.4-77.2)] and PTLD [28.9 (9.4-67.6)] in females. Incidence of NMSC and some types of other cancer is high in cyclosporine-treated patients. Optimizing monitoring practice might be useful to identify subjects with significant excess risk for specific types of solid tumours.

Estimation of Annual Incidence of Lung Cancer Associated with Work Place Exposure to Passive Smoking in France

This study attempted to estimate the number of annual new cases of lung cancer from workplace exposure to Environmental Tobacco Smoke (ETS) in France. The number of new lung cancer cases attributable to workplace ETS exposure in France was estimated with regard to the following factors: excess risk of lung cancer from workplace ETS exposure, incidence of lung cancer in non-exposed non-smokers, and number of French workers exposed to passive smoking. The excess risk of lung cancer from workplace ETS exposure was estimated as from 0.12 to 0.39 by different references. The French workforce, regularly exposed to ETS in their workplace is about 3.2 millions. The incidence of lung cancer of non-smokers without exposure to ETS is between 3.7 to 10 per hundred thousand. If these three factors are combined, it is estimated that exposure to workplace passive smoking causes around 14 to 125 new cases of lung cancer each year in France. New lung cancer cases from workplace exposure to ETS represent a few percent of all occupational lung cancers, and a minuscule number in regards to the whole lung cancer annual incidence (14 to 125 for 23,000 lung cancers in France=0.06% to 0.54%).

Comparison of IHC and FISH techniques to determine HER2 status of metastatic breast cancer in France: interim analysis of the FISH 2002 study

The protein tyrosine kinase focal adhesion kinase (FAK) and Src in association with phosphorylation of the adapter protein paxillin are essential in tumor metastasis formation. Elevated levels of FAK, Src and paxillin may increase the metastatic potential of colorectal tumor cells. The aim of the current study was to examine the expression of FAK, Src, and paxillin using immunohistochemistry in the context of disease progression and to evaluate its clinical significance as a prognostic factor.The relationship between FAK, Src and paxillin levels and colorectal cancer progression was evaluated by immunohistochemistry in 104 colorectal cancer specimens with clinical follow up. In addition, FAK, Src and paxillin expression levels were quantified in 68 colorectal tumors and corresponding liver metastases.FAK and paxillin expression individually did not significantly impact time to recurrence (p = 0.09, and p = 0.89 respectively). Src expression was associated with tumor recurrence p = 0.03. However, tumors that expressed both high FAK and Src levels had a significant shorter time to recurrence (p = 0.004, hazard ratio: 2.98, 95% CI 1.14–6.31). FAK, Src and paxillin showed equivalent levels in corresponding liver metastases compared to the primary tumors (p = 0.67, p = 0.28 and p = 0.34 respectively).These findings show that high levels of FAK and Src combined were predictive for recurrence of colorectal cancer. In addition, expression of FAK, Src and paxillin in colorectal cancer were maintained in corresponding distant metastases.

Cancers ORL et génomique

ENT cancers in France - with the fourth rank after the breast, colon and prostate localizations - represent on important problem of public health. Survival at five years reaches a maximum in spite of undeniable therapeutic progress, in particular with the targeted treatments associated to conventional cytotoxic drugs. The studies in progress still make it possible to hope for new predictive and prognostic biological markers, but the complexity of these parameters, as well as the needs for heavy and expensive equipment to explore them, require a unification of the efforts and means. It is the major objective of the cooperative program PACOR.

The Cost of Lung Cancer Management in France from the Payor???s Perspective

We assessed the average management cost per case of lung cancer in France according to the histological type and stage at diagnosis, together with the cost of each component of different treatment strategies. The sample was drawn from public and private hospitals that were treating large numbers of patients. The study covered the period from 1 July 1998 to 30 June 1999 and was based on medical chart review. A Markov model with six decision trees (two for small cell lung cancer [SCLC] and four for non-small cell lung cancer [NSCLC]) was used for the cost analysis. Treatment was broken down into first-line and second-line strategies, surveillance, and terminal care (TC). The average management costs were €22 006 (€10 631–36 296) for 1 year and €25 643 (€10 631–41 191) for 2 years. The 2-year average costs were €22 420 for disseminated SCLC and €27 098 for localized SCLC. The costs of NSCLC ranged from €19 543 for nonsurgical stages to €30 024 for surgical stages and €24 383 for stage IV. The weight of the different components of each strategy differed markedly according to the diagnostic subgroup: the cost of diagnosis ranged from 7.4% to 14% of total management costs, and that of TC from 11.5% to 31.1%. The principal cost component was first-line chemotherapy (32–58.5%). Sensitivity analyses showed that, whatever the type of lung cancer, the percentage of actively treated patients was the main cost determinant. TC and chemotherapeutic lines also had important economic implications. The model developed here enables the component costs of different lung cancer management strategies in France to be assessed and the economic consequences of new treatment modalities to be predicted.