Arlette Danzon

Cancer incidence and mortality in France over the period 1980-2005.

BACKGROUND The objective of this study was to provide updated estimates of national trends in cancer incidence and mortality for France for 1980-2005. METHODS Twenty-five cancer sites were analysed. Incidence data over the 1975-2003 period were collected from 17 registries working at the department level, covering 16% of the French population. Mortality data for 1975-2004 were provided by the Inserm. National incidence estimates were based on the use of mortality as a correlate of incidence, mortality being available at both department and national levels. Observed incidence and mortality data were modelled using an age-cohort approach, including an interaction term. Short-term predictions from that model gave estimates of new cancer cases and cancer deaths in 2005 for France. RESULTS The number of new cancer cases in 2005 was approximately 320,000. This corresponds to an 89% increase since 1980. Demographic changes were responsible for almost half of that increase. The remainder was largely explained by increases in prostate cancer incidence in men and breast cancer incidence in women. The relative increase in the world age-standardised incidence rate was 39%. The number of deaths from cancer increased from 130,000 to 146,000. This 13% increase was much lower than anticipated on the basis of demographic changes (37%). The relative decrease in the age-standardised mortality rate was 22%. This decrease was steeper over the 2000-2005 period in both men and women. Alcohol-related cancer incidence and mortality continued to decrease in men. The increasing trend of lung cancer incidence and mortality among women continued; this cancer was the second cause of cancer death among women. Breast cancer incidence increased regularly, whereas mortality has decreased slowly since the end of the 1990s. CONCLUSION This study confirmed the divergence of cancer incidence and mortality trends in France over the 1980-2005 period. This divergence can be explained by the combined effects of a decrease in the incidence of the most aggressive cancers and an increase in the incidence of less aggressive cancers, partly due to changes in medical practices leading to earlier diagnoses.

Breast Carcinoma Survival in Europe and the United States: A Population-Based Study

Breast carcinoma survival rates were found to be higher in the U.S. than in Europe.

Cancer incidence among adolescents in France.

In France, cancer ranks third as the most significant cause of mortality in young people. However, the incidence, the survival, and the management of adolescent cancers have never been studied. The aim of this study is to investigate incidence rate (IR) of adolescents with cancer from data recorded in French Cancer Registries covering eight administrative areas, representing 10% of the French population, over a 10‐year period (from 1988 to 1997).

Evolution of pleural cancers and malignant pleural mesothelioma incidence in France between 1980 and 2005.

The evolution of pleural cancers and malignant pleural mesothelioma incidence in France between 1980 and 2005 was analysed using data derived from the French network of cancer registries (FRANCIM) and the French National Mesothelioma Surveillance Program (PNSM). Mesothelioma proportions in pleural cancers were calculated by diagnosis year in the 1980–2000 period. Our results suggest that the incidences of pleural cancer and mesothelioma levelled off in French men since 2000 and continued to increase in French women. A decrease of the annual pleural cancer incidence average in men was noticed (−3.4% of annual rate of change) between 2000 and 2005. The proportion of pleural cancers that were mesothelioma was unchanged between 1980 and 2003 with an average of 86%. The age standardised incidence rate of pleural mesothelioma remained relatively stable between 1998 and 2005 with a slight falling trend. For women, the age standardised incidence rate of pleural cancers and mesothelioma increased during the period 1998–2005. Additionally, the proportion of pleural cancers that were mesothelioma increased during the same period of time. Finally, the increased trend observed in the incidence of pleural mesothelioma and cancers in women is credibly due to their under diagnosis in the 1980–1997 period. The comparison between the French incidence and the American and British ones shows that the decreasing trend in incidence of mesothelioma and pleural cancers in French men since 2000 is potentially associated with a lower amphibole consumption and by the implementation of safety regulations at work from 1977.

Variations in Management of Stage I to Stage III Cutaneous Melanoma A Population-Based Study of Clinical Practices in France

OBJECTIVE To describe current management of cutaneous melanoma (CM) and identify factors accounting for disparities. DESIGN Retrospective population-based study using survey of cancer registries and pathology laboratories, and questionnaires to physicians. SETTING Five regions covering 19.2% of the French territory and including 8.2 million inhabitants. PATIENTS Incident cases of patients with stage I to stage II (hereinafter, stage I-II) tumors staged according to the American Joint Committee on Cancer Staging guidelines and nodal stage III CM in 2004. MAIN OUTCOME MEASURES Modalities of diagnosis and excision, surgical margins, sentinel lymph node biopsy, adjuvant therapies and surveillance procedures, and their variations according to age, sex, residence, location of primary CM, Breslow thickness, type of physicians, modalities of decisions, and health care patterns. RESULTS Clinical stage I-II CMs (n = 710 cases) slightly predominated in females (53%), with a lower mean Breslow thickness (1.4 mm) than in males (1.9 mm). Initial excisions were most often performed by private dermatologists and wide excisions by surgeons. Narrow margins (8%) were associated with advanced age, higher Breslow thickness, and head location. Sentinel lymph node biopsy was performed in 34% of CMs thicker than 1.0 mm, depending on geographical regions, distance from reference centers, and health care patterns. Adjuvant therapies (mainly low-dose interferon) were proposed in 53% of thick CMs (>1.5 mm), depending on the patients age and geographical region. In contrast with French recommendations, surveillance procedures frequently included systematic medical imaging. Stage III nodal CMs (n = 89 cases) predominated in males (62%). After lymphadenectomy, adjuvant therapies (including high-dose interferon in 32% of cases and chemotherapies in 24% of cases) were proposed in 68% of cases, depending on the patients age and geographical region. A complete 1-year high-dose interferon regimen was administered in less than 10% of cases. CONCLUSION Large disparities still exist in the management of CM in France, depending to a greater extent on medical and geographical environment than on the characteristics of either patients or tumors.

The influence of socio-economic and surveillance characteristics on breast cancer survival : a French population-based study

Survival data on female invasive breast cancer with 9-year follow-up from five French cancer registries were analysed by logistic regression for prognostic factors of cancer stage. The Kaplan–Meier method and log-rank test were used to estimate and compare the overall survival probability at 5 and 7 years, and at the endpoint. The Cox regression model was used for multivariate analysis. County of residence, age group, occupational status, mammographic surveillance, gynaecological prevention consultations and the diagnosis mammography, whether within a screening framework or not, were independent prognostic factors of survival. Moreover, for the same age group, and only for cancers T2 and/or N+ (whether 1, 2 or 3) and M0, the prognosis was significantly better when the diagnosis mammography was done within the framework of screening. Socio-economic and surveillance characteristics are independent prognostic factors of both breast cancer stage at diagnosis and of survival. Screening mammography is an independent prognostic factor of survival.

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

AIM 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. METHODS 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. RESULTS 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. CONCLUSION 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.

Trends in incidence of digestive cancers in France.

The objective of this study was to analyse trends in the incidence of digestive cancers in France. Observed incidence and mortality data in the population covered by cancer registries were modelled using age-cohort models. An estimation of the incidence/mortality ratio was obtained from these models and was applied to the mortality rates predicted from an age-cohort model for the entire French population. Site-specific standardized-incidence rates by 1-year intervals and cumulative rate 0–74 years by birth cohort were estimated. On average, age-standardized incidence rates of large bowel cancers increased by 1.0% per year in men and 0.8% in women from 1980 to 2000. The estimated cumulative rate increased from 4.0% for men born in 1913 to 4.8% for those born in 1953. The corresponding values in women were 2.5 and 2.9%. The most striking increase in incidence was seen for primary liver cancer with an increase from 2000 incident cases in 1980 to nearly 6000 in 2000. The estimated cumulative rate was 0.5% for men born in 1913 and 2.9% for those born in 1953. The increase in incidence was lower for pancreas cancer. A decrease in the incidence of stomach cancer was observed for both sexes and of oesophageal cancer in men by slightly more than 2%. The study showed large changes in the cancer burden in France between 1980 and 2000.

Primary cutaneous lymphomas: A population-based descriptive study of 71 consecutive cases diagnosed between 1980 and 2003

Although primary cutaneous lymphomas (PCL) are the second most common group of extra-nodal non-Hodgkin lymphomas, few epidemiological data are available in the literature, and most of them are provided by large databases from population-based cancer registries in the US or patients attending a single institution. We conducted this study to investigate the epidemiological and clinical features of PCL diagnosed in the département of Doubs from 1980 to 2003. Data were collected from the Doubs cancer registry from 1980 to 2003. Seventy-one patients with PCL were investigated. 82% were cutaneous T-cell lymphoma (CTCL) and 18% were cutaneous B-cell lymphoma (CBCL). Among CTCL, mycosis fungoides (MF) represented 58% and Sezary syndrome 10%. The standardised incidence rate of PCL was 0.42 for 100 000 person-years and significantly increased from 0.21 in 1980–1984 to 0.70 in 2000–2003 (p <0.05). The incidence rate of CTCL was 0.34 for 100 000 person-year and significantly increased from 0.2 to 0.57 (p <0.05). For MF and CBCL, the incidence rates were 0.20 and 0.08, respectively and did not vary significantly from 1980–1984 to 2000–2003. Five-year survival was 64.5% for PCL patients similar to MF patients. Our results provide updated data on the incidence of PCL in France.

Age-period-cohort modelling of non-Hodgkin's lymphoma incidence in a French region: a period effect compatible with an environmental exposure

BackgroundThe incidence of non-Hodgkins lymphoma (NHL) has risen steadily during the last few decades in all geographic regions covered by cancer registration for reasons that remain unknown. The aims of this study were to assess the relative contributions of age, period and cohort effects to NHL incidence patterns and therefore to provide clues to explain the increasing incidence.MethodsPopulation and NHL incidence data were provided for the Doubs region (France) during the 1980-2005 period. NHL counts and person-years were tabulated into one-year classes by age (from 20 to 89) and calendar time period. Age-period-cohort models with parametric smooth functions (natural splines) were fitted to the data by assuming a Poisson distribution for the observed number of NHL cases.ResultsThe age-standardised incidence rate increased from 4.7 in 1980 to 11.9 per 100,000 person-years at risk in 1992 (corresponding to a 2.5-fold increase) and stabilised afterwards (11.1 per 100,000 in 2005). Age effects showed a steadily increasing slope up to the age of 80 and levelled off for older ages. Large period curvature effects, both adjusted for cohort effects and non-adjusted (p < 10-4 and p < 10-5, respectively), showed departure from linear periodic trends; period effects jumped markedly in 1983 and stabilised in 1992 after a 2.4-fold increase (compared to the 1980 period). In both the age-period-cohort model and the age-cohort model, cohort curvature effects were not statistically significant (p = 0.46 and p = 0.08, respectively).ConclusionsThe increased NHL incidence in the Doubs region is mostly dependent on factors associated with age and calendar periods instead of cohorts. We found evidence for a levelling off in both incidence rates and period effects beginning in 1992. It is unlikely that the changes in classification (which occurred after 1995) and the improvements of diagnostic accuracy could largely account for the 1983-1992 period-effect increase, giving way to an increased exposure to widely distributed risk factors including persistent organic pollutants and pesticides. Continued NHL incidence and careful analysis of period effects are of utmost importance to elucidate the enigmatic epidemiology of NHL.