Claire Roussel

Impact of organised programs on colorectal cancer screening

PurposeColorectal cancer (CRC) screening has been shown to decrease CRC mortality. Organised mass screening programs are being implemented in France. Its perception in the general population and by general practitioners is not well known.MethodsTwo nationwide observational telephone surveys were conducted in early 2005. First among a representative sample of subjects living in France and aged between 50 and 74 years that covered both geographical departments with and without implemented screening services. Second among General Practionners (Gps). Descriptive and multiple logistic regression was carried out.ResultsTwenty-five percent of the persons(N = 1509) reported having undergone at least one CRC screening, 18% of the 600 interviewed GPs reported recommending a screening test for CRC systematically to their patients aged 50–74 years. The odds ratio (OR) of having undergone a screening test using FOBT was 3.91 (95% CI: 2.49–6.16) for those living in organised departments (referent group living in departments without organised screening), almost twice as high as impact educational level (OR = 2.03; 95% CI: 1.19–3.47).ConclusionCRC screening is improved in geographical departments where it is organised by health authorities. In France, an organised screening programs decrease inequalities for CRC screening.

Organized colorectal cancer screening programmes: how to optimize efficiency in the general population.

In France, free faecal occult blood testing is offered to individuals aged between 50 and 74 years every 2 years as a method of screening for colorectal cancer (CRC). To assess how a proposed organized programme of CRC screening would be perceived among a representative sample of individuals living in France, aged between 40 and 75 years, and by a representative sample of general practitioners, two nationwide observational telephone surveys were carried out in 2005 (EDIFICE 1; 1601 individuals) and 2008 (EDIFICE 2; 1801 individuals). In 2008, 38% of individuals aged between 50 and 74 years reported undergoing screening for CRC; this corresponded to a statistically significant 13% increase in CRC screening rate compared with 2005 (P=0.01). When asked whether it was possible to screen for CRC, 94% of individuals who had undergone screening (N=350) responded positively compared with 87% of individuals who had not been screened. The main reason for individuals not to undergo screening was a lack of awareness (35% of men and 37% of women, P=not significant); the second reason was lack of advice and referral from their general practitioner (21% of women versus 15% of men, P=0.03). The French population is aware of the potential benefit of CRC screening; however, many do not undergo regular screening. It is therefore important to identify the hurdles associated with CRC screening.

Mammography utilization in women aged 40-49 years: the French EDIFICE survey.

In France, mammography screening is offered to women aged between 50 and 74 years. EDIFICE, the iterative nationwide survey, collected data on a national level aboutconsumers utilization of available cancer screening procedures. This analysis compared data from a subset of241 women aged between 40 and 50 years with that of488 women aged between 50 and 74 years. Multivariate analysis showed the following significant factors to be linked with screening attendance for women younger than50 years: age, with a threshold value at 44 years; awareness of the recommended screening period (2years); consultation within the last 12 months with ageneral practitioner or a gynaecologist; and long standinglocal programme for colon cancer screening. Notwithstanding the debate on risk/benefit of breast cancer screening for women in their 40s, we observed more differences with regard to attendance between women aged 40–45 years versus that of 46–74 years than between women aged 40–49 years versus that of 50–74 years. The issue that is unanswered as yet is, do women make a kind of heuristic for starting breast cancer screening, leading them to a threshold choice of 45 years or alternatively to a collective answer of standard age minus 5 years!

Impact of awareness of cancer among acquaintances on cancer screening attendance.

Two nationwide observational surveys were carried out in France in 2005 and 2008 with the aim of assessing the impact on attitudes towards cancer screening of a positive history of cancer among a persons close circle of acquaintances (relatives, friends or colleagues). In 2005, 67% (993/1482) of people interviewed reported having someone in their close circle of acquaintances affected bycancer and in 2008, the rate was 80% (1158/1454). In2008, having someone within a persons close circle of acquaintances affected by cancer did not increase the rate of screening for breast cancer (already high at >80%). However, it did increase the rate of screening for colorectal cancer [odds ratio (OR)=2.3; 95% confidence interval (CI)=1.6–3.3] and prostate cancer (OR=2.2; 95% CI=1.4–3.5). Knowing someone affected by cancer within the close circle of acquaintances clearly increases awareness, and thus could be an incentive for undergoing cancer screening. With regard to cancer types, such as prostate cancer, for which there is no national programme or media communication, this awareness might be the main source of information and motivation. The impact of awareness on screening behaviour seems to be greatest for the same cancer location as that in the affected acquaintance, as opposed to cancers at other sites. Increased awareness as observed in our survey, which may be attributable to less social stigma associated with a diagnosis of cancer, might increase the rate of screening attendance in the general population.

Abstract 4447: In search of the ideal cancer screening test

Background: The success of a cancer screening program partly depends on the compliance level of the screened population for the proposed screening procedure. Since 2005, EDIFICE surveys on cancer screening behaviours are carried out in France in the general population for breast, colon and prostate cancers. In the third edition of the EDIFICE surveys, subjects were questioned on what could be improved on screening tests. Methods: This third nationwide observational study, EDIFICE 3, was conducted through phone interviews among a representative sample of 1603 subjects aged between 40 and 75 years, using the quota method, from July 8th to July 28th, 2011. The question concerning subjects’ expectations for a screening test was: “If scientific progress were made, what kind of cancer screening test would you wish to be proposed?” Results: For breast cancer screening, among 669 women never treated for cancer, the main expectations were: a more reliable imaging or radiological test for 43% of the subjects, a blood test for 32% and no preference for 17% of the subjects. For colon cancer screening, among 1469 subjects never treated for cancer, the main expectations were: a blood test for 35% of the subjects, no preference for 22% and a more reliable imaging or radiological test for 21% of the subjects. Results show a low level of satisfaction for the fecal occult blood test with 9% of the subjects looking for a more reliable fecal test. For prostate cancer screening, among 711 men never treated for cancer, the main expectations were: a blood test for 43% of the subjects, a more reliable imaging or radiological test for 21% and no preference for 21 % of the subjects. Conclusions: For breast cancer and prostate cancer, screening procedures are well accepted by the population. The vast majority prefers a blood test for cancer screening, even if they seem to accept radiological tests. In contrast, the population seems reluctant with fecal occult blood tests. This suggests the need to think over colon cancer screening tests to improve their results. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4447. doi:1538-7445.AM2012-4447

Cancer screening: reaching the limits or terra incognita? Lessons from the EDIFICE surveys.

The main lessons from the EDIFICE surveys can be summed up in five points. (i) Evidence talks but very quietly: cancer-screening practices in the French general population do not match scientific evidence; (ii) Give time to time: the rate of appropriation of screening behaviour isslow; (iii) Where there is a will there is a way: the organization of screening decreases inequalities for cancer screening; (iv) Do not aim only at the target: although monitoring of adhesion and compliance for the targeted population is mandatory, monitoring the utilization of screening resources, particularly in countries such as France that have no financial constraints (screening outside the official range is still almost fully reimbursed) is also useful; and (v) Trees do not reach the sky: we have observed a ceiling effect for breast cancer with 90–95% of women who have had a mammogram in their lifetime and 80–85% of women from the targeted population who had a mammogram within the previous 2 years. For colorectal cancer, even with the longstanding programme, the ceiling level observed in France is close to 60%.

Increasing Coverage Rates for Mammographic Screening in France in Older Women––16 Years of Follow‐Up

To the Editor: For breast cancer screening, an older age has commonly been associated with lower attendance, for example, in the USA, Australia, Canada, Italy, the Netherlands, Switzerland, Spain, Iran, and in France. Two generations are and were concerned by breast cancer screening: the so-called ‘‘Silent generation’’ (birth years 1925–1942) and the so-called ‘‘Baby boomers generation’’ (birth years 1943–1960) (1). In the 1990s, the silent generation represented 100% of the targeted population, but by 2007, this proportion had decreased to 35.2%. Karl Mannheim pointed out that generation refers to individuals exposed to a common range of historical events and socio-cultural factors, which lead to common values and world view (‘‘Weltanschauung’’). The aim of this publication was to investigate the increasing coverage rates in older women observed in France, and to test the extent to which lower attendance for breast cancer screening by

Uptake of breast cancer screening in women aged over 75 years: a controversy to come?

In France, the age range for organized screening for breast cancer is 50–74 years. From a laypersons perspective, thepublic health message focusing on a specific target population may be difficult to understand. The aim of this study is to assess how women aged over 75 years deal with this absence of screening recommendations for their age group. The population-based survey, EDIFICE, was carried out by telephone in 2008. Women were interviewed with regard to their behaviour, and in particular relating tobreast cancer screening. For 136 breast cancer-free women, aged 75 and above and who had undergone at least one mammography in their lifetime, the test had been done within the last 2 years for only 62 (51%) of them. Inamultiregression analysis, only one item (i.e. already having undergone at least five mammographies) was statistically associated with a higher rate of attendance (odds ratio=3.3, 95% confidence interval=1.03–11.1). According to our data, for women aged 75 and above, anestimated 17 000 000 Euros are spent each year on breast cancer screening in France, the net benefit of which is still unknown.

Abstract B33: Cancer survivors as messengers

Using data from the iterative EDIFICE surveys carried out in France on cancer screening behaviours in the general population, survivors were asked whether they had or not urged their relatives or friends to undergo cancer screening tests. Among our representative sample of 1564 individuals, aged 40–74 years old, 110 were cancer survivors (7%). Among the survivors, 76 (69%) declared having made positive advices for cancer screening. Interestingly 6% (7 survivors out of 110) declared that following their intervention, a cancer was found in friends or relatives after a screening test. Since there are currently 2 000 000 survivors living in France, one could consider that more than 84 000 cancers have been discovered after survivors had urged friends and/or relatives to undergo a cancer screening. For colorectal cancer, attendance rate for screening is only about 40% of the targeted population. For a screening test like FOBT, the tumour detection rate is close to 1.25% of tested individuals. If 50% of current survivors could convince one reluctant person to undergo a screening test, every other year, then 12 500 colorectal tumours could be detected at an early stage. Stories and personal communication are by far more effective than mass media campaign in risk management communication. For survivors who wish to be involved in cancer control, it could be hypothesized that their efficiency and impact could even be increased using inexpensive process and tools such as, communication aids such as flyers (facts and data) and/or training. The increasing number of survivors and their strong commitment could be used to convey preventive counselling and advices on cancer screening, particularly for colorectal cancer which is still underperformed. Citation Information: Cancer Prev Res 2011;4(10 Suppl):B33.

Abstract A88: Cancer awareness through close circle experience of the disease: An increasing trend

In a Cartesian perspective, knowing a threat is the first mandatory step for risk management. Cancer awareness is a strong momentum for risk mitigation. We have used the EDIFICE program, an iterative nationwide survey collecting data on people use of cancer screening procedures and its explicative factors, to analyze the trend for cancer awareness and its impact on cancer screening. Materials and Methods: Two nationwide observational studies were carried out in France: EDIFICE 1 was conducted from 18 January 2005 to 2 February 2005 among a representative sample of 1504 subjects aged between 40 and 75 years. EDIFICE 2 was conducted from 12 December 2007 to 7 January 2008 among a representative sample of 1802 subjects aged between 40 and 75 years. Two questions focused on awareness/experiential perspectives. Do you know someone affected with a cancer in your close circle of friends and family? Which location? Results: In 2005, 67% (993/1482) of people interviewed declared having someone in their close circle affected with a cancer. In 2008, the figure was 80% (1158/1454). Interestingly the increasing awareness is much more important for the close circle of friends and colleagues rising from 24% to 42% rather than for relatives (from 56% to 61%). The OR for close circle of friends is 2.3 (IC 95% 2.0–2.7) and for relatives 1.2 (IC 95% 1.1–1.4) With regard to location, three types of cancer exhibit a significant increase: breast from 25% in 2005 to 36% in 2008, prostate from 6% to 13% and colorectal from 7% to 12%, while for other locations (as a whole) no change occurred: 31% in 2005 and 30% in 2008. In our survey, having someone in its close circle affected with a cancer does not increase the rate of screening for breast cancer (already high at above 80%). Nevertheless, it does increase the rate of screening for colorectal cancer OR=2.3 (IC 95% 1.6–3.3) and prostate cancer OR=2.2 (IC 95% 1.4–3.5). The increase is more important for specific location (prostate cancer in its close circle increases prostate cancer screening), but it is also significant without taking into account the anatomical location of affected people in their close circle. For breast cancer, the mean age for the 1 st mammogram carried out is 45.6 years (sd:9.6) for women with no one affected in their close circle of friends and family compared to 43.4 years (sd=9.2) for women with at least one known case p Comment and Conclusion: We observed a significant increase in awareness through experience of cancer in close circle, probably related to less social stigma on cancer. This increased awareness through experience impacts on cancer screening behaviors with a higher rate of declared attendance. Citation Information: Cancer Prev Res 2010;3(1 Suppl):A88.