Evelyne Fournier

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.

Trends in invasive breast cancer incidence among French women not exposed to organized mammography screening: An age-period-cohort analysis

BACKGROUND The long tenure of the Doubs cancer registry (France) and the late implementation of a mass screening program provide a unique opportunity to assess the relative contributions of age, period and cohort effects to the increase in female invasive breast cancer incidence, while avoiding the influence of an organized screening program. METHODS Population and incidence data were provided for the Doubs region during the 1978-2003 period. Breast cancer counts and person-years were tabulated into 1-year classes by age and time period. Age-period-cohort models with parametric smooth functions were fitted to the data, assuming a Poisson distribution for the number of observed cases. RESULTS A total of 5688 incident cases of invasive breast cancer in women were diagnosed in women aged 30-84 years in the Doubs region between 1978 and 2003. The annual percentage increase in incidence is 2.09%. Age effects rise dramatically until age 50, and at a slower pace afterwards. Large cohort curvature effects (p<10(-6)), show departure from linear trends, with a significant peak for women born around 1940. Period curvature effects are lower in magnitude (p=0.01). CONCLUSION Both cohort and period effects are involved in the marked increase in breast cancer incidence over a 25-year period in the Doubs region. Although the future trend for breast cancer incidence is difficult to predict, the introduction of an organized screening program, and the sharp decline in hormone replacement therapy use will likely contribute to period effects in future analyses.

Rare skin cancer: a population-based cancer registry descriptive study of 151 consecutive cases diagnosed between 1980 and 2004.

Background. There are few epidemiological data available on rare skin cancer, including Merkel cell carcinoma, Pagets disease, adnexal carcinoma, and sarcoma. We conducted this study to investigate the epidemiological of rare skin cancer diagnosed in the département of Doubs from 1980 to 2004. Methods. Data were collected from a population-based cancer registry from 1980 to 2004. Diagnosis was based on the 3rd edition of the International Classification of Diseases for Oncology. The incidence rates were standardized on world population. Results. One hundred and fifty one patients were investigated (88 women and 63 men). Median age for the diagnosed disease was 63 years. The standardized incidence rate was 0.82/100 000 person-year (95% CI = 0.68–0.96) and increased from 0.25 in 1980–1984 to 1.50 in 2000–2004. Fifty nine cases (39%) were sarcomas, 35 (23%) adnexal carcinomas, 27 (18%) Merkel cell carcinoma and 27 (18%) Pagets disease. The standardized incidence rates were 0.37/100 000 (0.27–0.47) for sarcomas, 0.16 (0.10–0.22) for adnexal tumors, 0.13 (0.08–0.18) for Merkel cell carcinoma, and 0.15 (0.09–0.21) for Pagets disease. Conclusions. Our results based on a population-based cancer registry showed an increase of the standardized incidence rate for all types of rare skin tumors. These results may be useful when considering the growing interest in rare diseases in identifying risk factors and planning scientific research programmes.

Kaposi's sarcoma: a population‐based cancer registry descriptive study of 57 consecutive cases diagnosed between 1977 and 2009

There are few epidemiological data available on rare skin cancer, including Kaposis sarcoma (KS), which is a multifocal illness affecting the skin, mucosa, and viscera. Four different types of KS have been described: classic, AIDS‐associated, iatrogenic, and African. The purpose of this study was to describe the epidemiology and evolution of the different types of KS in the Doubs region of France.