Chantal Touboul

Cancer screening in France: third edition of the EDIFICE survey.

The EDIFICE programme began in 2005 and set out to provide a clearer insight over time into the participation of the French population in cancer screening. EDIFICE 3 was conducted in 2011 by phone interviews among a representative sample of 1603 individuals aged between 40 and 75 years using the quota method. The analysis focused on the target populations (50–74 years) of the national screening programmes for breast and colorectal cancer. The same populations were also assessed with respect to prostate cancer screening. In 2005, 93% of the sample population had undergone at least one mammogram in their lifetime; this figure reached 94% in 2008 and 95% in 2011. Compliance with recommended intervals improved between 2005 and 2011, and significantly so for women aged 65–74 years. In 2005, 25% of respondents reported having undergone at least one colorectal cancer screening test; this figure reached 38% in 2008 and 59% in 2011. Recommended intervals were respected by 30 and 51% in 2008 and 2011, respectively. In 2005, 2008 and 2011, a total of 36, 49 and 50% of men reported having undergone at least one prostate cancer screening test. This rate decreased significantly in men aged 50–59 years between 2008 and 2011 (44 vs. 37%, P⩽0.05). Attendance rates in national screening programmes are high and stable for breast cancer, and although currently improving for colorectal cancer, the European guideline target has not yet been reached. Despite the absence of recommendations for prostate cancer screening, participation remains constant.

Lung cancer risks, beliefs and healthcare access among the underprivileged.

One of the current goals of the French national cancer plan is to reduce healthcare inequalities. This study investigated the potential links between vulnerable social status, exposure to lung cancer risk factors and access to healthcare to highlight ways to improve lung cancer control in this population. The nationwide observational study EDIFICE 3 was carried out through phone interviews of a representative sample of 1603 individuals (age 40–75 years). The EPICES validated questionnaire was used to assess and classify vulnerable respondents. The vulnerable population identified represented 33% of the sample. Compared with nonvulnerable individuals, they had more risk factors for cancer: a higher BMI (26.0 vs. 24.8, P⩽0.01), 38% were active smokers (vs. 23%, P⩽0.01) with a heavier and longer-lasting tobacco consumption (16.0 cigarettes/day vs. 10.1, P⩽0.01 and 29.4 vs. 26.3 years of smoking, P⩽0.01) and they were less likely to undertake any physical activities (42 vs. 77%, P⩽0.01). They also presented more comorbidities (on average 2.2 vs. 1.8, P⩽0.01). Access to healthcare, however, was not discriminatory: vulnerable individuals declared consulting a general practitioner or an oncologist more often than the nonvulnerable subgroup (5.4 vs. 3.7 and 6.7 vs. 2.5 consultations in the previous 12 months, respectively, P⩽0.01). Because access to healthcare and screening attendance show no signs of discrimination against vulnerable populations, efforts to reduce inequities in lung cancer control should focus on prevention.

Social stratification, risk factor prevalence and cancer screening attendance.

This analysis aimed to assess the extent to which exposure to cancer risk factors and attendance of screening programmes are influenced by social characteristics. The validated Evaluation of deprivation and health inequalities in public health centres (EPICES) index was used to measure social deprivation. A sample of the general population (N=1603) was assessed to search for potential correlations between screening attendance, risk factors and any components of the EPICES score. In 2011, 33% of the population studied was classified as ‘vulnerable’. Sex had no significant impact on this rating (32% men, 35% women), whereas occupational status did. Vulnerable individuals were more likely already to have cancer (10 vs. 7%; nonsignificant difference; odds ratio 1.43 [0.98–2.10]). The mean BMI was 26.0 kg/m2 (SD 4.9) for the vulnerable population versus 24.8 kg/m2 (SD 3.9) in the nonvulnerable population (P<0.01). The prevalence of current smoking was higher in the vulnerable group (38 vs. 23%, odds ratio 2.03 [1.61–2.56]). In contrast, no statistically significant difference was observed between attendance rates for nationwide organized cancer screening programmes (breast and colorectal; target age group 50–74 years) by the vulnerable and nonvulnerable groups. Social indicators of vulnerable populations are associated with increased rates of risk factors for cancer, but not with screening attendance. Our data support the previously reported marked impact of organized programmes that reduce or even remove inequalities in access to cancer screening. However, although the organized programmes have indeed enabled population-wide, nonselective access to screening, primary prevention as it stands today remains inadequate in the underserved population and further improvements are warranted.

Breast cancer screening controversy: too much or not enough?

The Cochrane analysis exploring the risk/benefit ratio of breast cancer screening resulted in a controversy worldwide spread by the mass media. Our survey sought to assess the impact of this controversy in terms of breast cancer screening awareness and attendance. A nationwide observational study, recorded in the EDIFICE iterative surveys, with a representative sample of 451 women aged 40–75 years, living in France, was carried out in the 3 months after the start of the controversy in January 2013. Of the 405 women with no personal history of cancer, 69 (17%) declared having heard of the controversy (aware group). Women remembering the controversy were more likely to belong to higher socioprofessional categories and to have a higher level of education. The most frequently remembered issues were overdiagnosis (38%), unreliability (16%) and radiation risk (9%). Compared with women who were unaware of the controversy, the aware group knew more about the limits of breast cancer screening (undiagnosed cancers, 20 vs. 7%, P<0.05 and risk of false positives, 20 vs. 2%, P<0. 05) and were more likely to change their opinion for the worse over the mass media debate (8.7 vs. 1.2%, P<0.05). Nevertheless, only 1% of the aware-group declared their intention to subsequently undergo screening less frequently. The low impact of the controversy on the behaviour of women with respect to screening suggests that it should not be seen as a threat to screening attendance rates, but more as an opportunity to improve awareness.

Beliefs and behavior regarding e-cigarettes in a large cross-sectional survey

Although e-cigarette use is increasing dramatically, numerous concerns persist regarding toxicity and their role in smoking cessation. We assessed beliefs and behavior regarding e-cigarettes in an adult French population. The 4th French nationwide observational survey, EDIFICE 4, was conducted among representative samples of 1602 laypersons (age, 40–75 years) from 12 June-10 July 2014, using the quota method. Profile, beliefs and behavior were assessed by phone interviews of the participating lay population with no history of cancer (N = 1463). Tobacco use, nicotine dependence (Fagerström test) and e-cigarette use were assessed. E-cigarette users represented 6% of the study lay population. E-cigarette users regarded e-cigarettes as helpful for quitting tobacco smoking and reducing the risk of lung cancer. Current dual users (e-cigarettes + cigarettes) were more likely to attempt to quit than current exclusively cigarette smokers (odds ratio, 3.15 [1.74–5.70]), and to consider themselves at higher risk for lung cancer (OR 3.85 [2.47–5.99]). They also considered e-cigarette vapor to be less toxic than tobacco smoke in terms of both active and passive exposure. Dual users typically consider themselves at higher risk for cancer and intend to quit smoking. Physicians should be made aware of this specific sub-population for whom e-cigarettes may be a useful trigger in the smoking cessation process.

1365PBREAST CANCER SCREENING CONTROVERSY: IMPACT ON OTHER CANCER SCREENING PROGRAMS

ABSTRACT Aim: The breast cancer screening (BCS) controversy following the Cochrane meta-analysis has affected womens perception and understanding of BCS. We speculated that this controversy may influence cancer screening for other locations. This analysis looks at the potential collateral effect of the BCS controversy on the populations perception of and intention to participate in colorectal and cervical cancer screening programs. Methods: A nationwide, observational study, recorded in the EDIFICE iterative surveys, on a representative sample of 451 women (age 40-75 years) living in France, was conducted in January 2013, using the method of quotas. The survey questionnaire was administered via the computer-assisted telephone interviewing technique 3 months after the start of the controversy. Attitudes toward different cancer location screening were studied. Results: Of the 405 women with no history of cancer, 69 (17%) were aware of the controversy. Among this latter group, 8% declared their intention to undergo mammograms less frequently and 9%, that the controversy would have an impact on their participation in other cancer screening programs. The concept of BCS being “more reassuring than worrying” was significantly less prevalent among women in the “aware of the controversy” group than in the group without awareness (57% vs.77%, P Conclusions: Few women were aware of the controversy, and its impact on the intention to undergo screening in the overall population of our sample is very low (1%). However, for women who are mindful of the controversy, we observed a deterioration in the level of confidence in cancer screening, and this effect was not limited to BCS but also extended to colorectal and cervical cancer screening. Disclosure: X. Pivot: Board honorarium from Roche; F. Eisinger: Board honorarium from Roche; J. Morere: Board honorarium from Roche. All other authors have declared no conflicts of interest.

1363PSCREENING FOR BREAST CANCER. FEAR AND REASSURANCE: IMPACT OF THE RECENT CONTROVERSY

ABSTRACT Aim: Early detection is one of the essential tools of cancer control. Once a population has been adequately informed, primary prevention and screening are reliant upon individual behavior. There is thus, a complex interaction between knowledge, belief and psychological characteristics, which defines actual behavior. Using data from the population survey EDIFICE, we analyzed the subtle balance between fear and reassurance associated with breast cancer screening (BCS) and the impact of the recent controversy triggered by the Cochrane analysis of effectiveness and usefulness of population-based screening Methods: A nationwide observational study, recorded in the EDIFICE iterative surveys, on a representative sample of 451 women (aged 40-75 years) living in France, was conducted in January 2013, using the quota method. The survey questionnaire was given via the computer-assisted telephone interviewing (CATI) technique 3 months after the beginning of the controversy. Our analysis focused on women with no history of cancer, and took into account individual awareness of the controversy. Results: Although the vast majority of women are reassured by BCS (299/405 [74%]), 160/405 (39%) declared it worried them. Interestingly, the rate of women who declared being both worried and reassured was high (105/405 [25.8%]). This ambiguity was less frequent in the group aware of the breast cancer controversy: 10/69 (15.2%) vs 93/334 (27.9%) for those who were not aware of it, P Conclusions: For one out of four women, BCS is both worrying and reassuring. The perceived balance between fear and reassurance among those who were aware of the controversy is less favorable to screening since the recent media coverage. Communication around BCS should make allowances for womens potentially ambiguous feelings. A more subtle, less forthright approach may prove more appropriate and more relevant. Disclosure: F. Eisinger: Board honorarium from Roche; J. Morere: Board honorarium from Roche X. Pivot: Board honorarium from Roche. All other authors have declared no conflicts of interest.

Knowledge of the French population on colorectal cancer screening: Data from the EDIFICE 3 survey.

352 Background: In France, following a pilot population-based screening program in 2002-2003, a national organized program targeting 17 million people was progressively implemented from 2005 to 2009. EDIFICE surveys are iterative polls focusing on cancer screening behavior. The EDIFICE 3 survey was conducted in 2011 and partly dedicated to knowledge of the colorectal cancer screening process. Methods: This third nationwide observational study, EDIFICE 3, was conducted via phone interviews among a representative sample of 946 subjects aged between 50 and 74 years, who had never been treated for cancer. 59% of the population declared having undergone colorectal cancer screening (fecal test or colonoscopy). Results: Interviewed about the screening process, 510/946 (54%) of the French population were unaware of the procedure after a positive fecal test and 782/946 (83%) were unaware of how soon a new test should be performed after a negative result. Only 79/946 (8%) were aware of what to do after either a pos...

Abstract B03: Perceived causality of cancer and screening behaviors

Cancer is a complex disease and the accountability for being affected is a scientific, symbolic and even a political issue. Beliefs in specific causative factors may also impact on cancer screening behaviors. Taking advantage of the EDIFICE iterative national health surveys on cancer screening we investigated how lay people perceive the cause(s) of cancer occurrence. Three causality classifications were used. Firstly, “external” (exogenous model) versus “internal” (endogenous) causes were assessed. Then we asked the interviewed persons to choose 2 from the following list of five causes: lifestyle, external pollution, heredity, increased life span, random (bad luck). Lastly, based on that classification and corresponding answers we created two categories (not including the overall sample): Under control: solely for lifestyle as an answer versus Out of control: for any other answers except lifestyle. Screening behaviors were assessed according to the declared rate of cancer screening for breast, colorectal and prostate cancer (within the last two years for breast and colorectal cancer). External causes and internal causes were almost equally divided (47% (759/1603) and 44% (704/1603) respectively with 9% (140/1603) having no idea). Women more often than men attributed cancer to an internal cause (49% (402/829) versus 39% (302/774); OR 1.47 [1.21 – 1.80]). As age increased, the rate of the undecided group increased from 6% (31/521) for the 40-49 years old to 15% (25/168) for the 70-75 years old (p<0.01). Interestingly there was no impact of personal history of cancer, nor if a friend or a relative had been affected by cancer, on the distribution of external/internal causes. Among the five proposed cancer causes, 57% (911/1603) of our sample quoted lifestyle, 54% (861/1603) external pollution, 43% (688/1603) heredity, 15% increased life span (243/1603) and 14% (218/1603) random (bad luck). The younger population (40 to 49) blamed pollution more often than older people (50 to 74) (59% (305/521) versus 52% (551/1061), p<0.05). It is widely assumed that causation belief impacts on preventive behaviors. In contrast in our survey, despite differences in causation beliefs, we found no significant impact of perceived causality on screening behaviors. Indeed, we compared the rate of screening attendance for breast, colorectal and prostate cancer between persons who thought cancer risks might be under control versus out of control and those who thought cancer risks originate in the body (internal) versus external causation. None of these 6 comparisons was statistically significant. Compliance to cancer screening recommendations thus appears to be independent of perceived cancer causality. Citation Format: François Eisinger, Jean-François Morère, Chantal Touboul, Xavier Pivot, Yvan Coscas, Jean-Yves Blay, Christine Lhomel, Jérôme Viguier. Perceived causality of cancer and screening behaviors. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr B03.