J-F Morere

Abstract P6-09-14: Awareness of brest cancer risk factors among lay persons and physicians

Background The EDIFICE surveys have been conducted every three years since 2005. The aim of the surveys is to provide a better understanding of the participation of the French population in cancer screening programs. The breast cancer screening program is nowadays widely implemented throughout the female population aged 50-74 years; however, the question of whether it could be adapted according to breast cancer risk factors is currently under debate. This analysis focuses on awareness of the nature of breast cancer risk factors among the lay population and physicians. Methods This fourth nationwide observational survey, EDIFICE 4, was conducted by phone interviews using the quota method. A representative sample of 1602 individuals aged between 40 and 75 years old was interviewed between June 12 and July 10, 2014. A mirror survey on a representative sample of 201 general practitioners (adjusted for age and geographical area) and 100 oncologists (adjusted for type of healthcare institution and geographical area) was conducted between July 9 and August 8, 2014. Interviewees were all asked to cite five main risk factors for breast cancer. Results For lay persons (737 women with no history of cancer), the breast cancer risk factors reported were: for 54%, heredity and family history; for 29%, unhealthy lifestyle, including smoking, poor diet, stress, alcohol, physical inactivity; for 15%, exposure to exogenous hormone therapy; for 4%, air pollution; for 4%, sunburn on breasts; for 4%, late childbearing or no childbearing, and for 2%, overweight/obesity. Among physicians (70 female general practitioners and 35 female oncologists), the breast cancer risk factors reported were: for 98%, heredity and family history; for 51%, exposure to exogenous hormone therapy; for 39%, late childbearing or no childbearing; for 32%, unhealthy lifestyle, including smoking, poor diet, stress, alcohol, physical inactivity; for 22%, overweight/obesity; for 20%, age; for 22%, no breast feeding, and for 2%, air pollution. Conclusion We observed a relatively satisfactory level of understanding regarding the different risk factors for breast cancer despite the lack of indication of any qualitative ranking. Although overweight is a known risk factor for breast cancer, this fact is still not clearly understood among physicians and not widely known by the general public. On the other hand, both physicians and also half of the lay population were well aware of the fact that heredity is a risk factor for breast cancer. Citation Format: Morere J-F, Viguier J, Blay J-Y, Touboul C, Lhomel C, Eisinger F, Pivot X. Awareness of brest cancer risk factors among lay persons and physicians. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-09-14.

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.

Abstract P2-04-05: Pros and cons of breast cancer screening: Knowledge in lay women

Background: It has been more than 20 years since local initiatives were proposed and 8 years since national organized breast cancer screening (BCS) (nationwide coverage) was implemented in France. It was associated with mass media and professional information for women with the aim of increasing the participation rate. The current reported coverage rate for women aged 50-74 every other year is about 80%. However the fairness of the process had not yet been assessed. It appears that having information about the pros and cons of BCS is thus a critical issue for targeted women. Methodology: A nationwide observational study, recorded in the EDIFICE iterative surveys, with a representative sample of 451 women living in France aged 40-75 years old, was carried out in January 2013, using the quota method. The survey questionnaire was conducted using a computer-assisted telephone interviewing technique (CATI) 3 months after the beginning of a worldwide controversy spread by the mass media on BCS. Results: The vast majority of women are reassured by BCS (74% vs. 13%). However 39% reported that they were stressed by BCS, with the main reason being fear of the results (30%) rather than the examination itself (9%). The main-reported benefits consisted of early detection of BC (38%), increased cure rate (22%) and preventing breast cancer (10%). The main reported limitations are a long period between two examinations (21%), starting too late (19%) and not being reliable enough (14%). A few people spontaneously reported screening-related risks (14%); the main risk being radiation-induced cancer (6%) false positives, over diagnosis and over treatment (5%). 18% have already heard about over diagnosis. With early detection of BC, 79% of women think that they will have only loco regional treatment, 3% think they will avoid major surgery, and only 10% of them think they will still have systemic treatment. Conclusion: Overall women have a fair level of knowledge about the pros and cons of BCS. They are generally confident in BCS, but they underestimate its limitations and adverse effects, and have a lack of knowledge about the impact of BCS on therapeutic management. This appears to be a target for the next step in women: delivering honest and relevant information about BCS. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-04-05.

Abstract P3-15-06: Results of the MARS study on the management of antiangiogenics’ renovascular safety in breast cancer

Background: Anti-VEGF drugs (AVD) are widely used in cancer patients (pts). Hypertension (HTN) and proteinuria (Pu) are class-side-effects of AVD, related to the inhibition of the VEGF pathway. The MARS study has been conducted to assess the renovascular tolerance of these drugs in the clinical setting. Methods: This multicentric, prospective, observational study evaluated the renovascular safety of AVD in pts naive from any AVD, conducted in 7 centres in France, from 2009 to 2012, with a follow-up (f/u) of 1 year. Data collected included: gender, age, serum creatinine (SCr), diabetes, HTN, hematuria (Hu) and dipstick Pu, at baseline and at each visit. Results: 1124 cancer pts were included; 402 breast cancer (BC) pts received bevacizumab (1st line: 14.4%; median durations of treatment: months)). Median age at inclusion was 55 years (19-65). Visceral, bone and cerebral metastasis frequencies were 74.7, 5.1 and 2.5%, respectively. HTN prevalences: 12.4%. Baseline renal assessment retrieved: Pu 23.9%, Hu 16.2%, mean aMDRD 96.4 ml/min/1.73m2 and 14 pts with aMDRD Conclusion: These results on the renovascular safety of bevacizumab in BC pts showed that 1) TMA is rare, 2) Grade 3 Pu developed in 4.6% of pts, with no grade 4, 3) less than 17% developed HTN, and 4) aMDRD was stable. Furthermore, in case of a renovascular effect, investigators followed the recommendations from the French Society of Nephrology (Halimi JM. Nephrol Ther 2008) and no treatment withdrawal for unmanageable renovascular toxicity occurred. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-15-06.

Abstract P1-09-20: Patient navigation significantly improves vulnerability score after breast cancer. A pilot experience in an underprivileged community

BACKGROUND: We decided to evaluate the effect of patient navigation in an area (Seine-Saint-Denis, SSD) with an estimated population of 1.4 billion, which is among the poorest in France. Median household income is 68% lower than in Paris (+68%), a gap growing with time. In SSD, cancer is the leading cause of premature mortality. Whereas it is widely admitted in France that 25% of patients are faced with financial difficulties after breast cancer, this proportion reaches 40% in SSD. PATIENTS AND METHODS: Oncologie 93 is a non-profit organization whose aim is to provide supportive care, health education and individualized assistance to patients and families, and to facilitate timely access to quality medical and psychosocial care. Vulnerability was evaluated using a 11-item standardized score (EPICES) previously investigated by French Health Examination Centers. Strictly speaking this score was aimed at measuring precarity, a concept referring to a social condition assumed to face worsening. This score is more strongly related to health status than the administrative classification of poverty (Sass, Sante Publique 2006). Vulnerability was defined by a score >30 and considered as severe when >40. In SSD two thirds of the population are affected by vulnerability. Patients included in the navigation program were scored after cancer diagnosis (E1) and 1 year after the beginning of cancer therapy (E2). Psychosocial comorbidities, demographic data, and treatments received were also recorded. RESULTS: Over a 1-year period 74 breast cancer patients were included and had E1 and E2 scores, detail of therapy was available for 64 pts. The score significantly improved for the whole population (p = 0.04) but worsened in 23 pts (31%). Among all the variables studied, undergoing surgery was the only one to be significantly correlated with outcome. However, surprisingly, patients who did not undergo surgery had a significantly better evolution of the score than those who did (p = 0.04). E1 score was lower in patients eligible for surgery. CONCLUSION: We showed that patient navigation significantly improves vulnerability score during cancer therapy. It emphasizes the importance of evaluating deprivation with standardized tools in cancer patients in order to propose appropriate interventions. The only factor correlated with the evolution of the score is surgery. Patients that were not eligible for surgery had higher E1 score but significantly better evolution during the following year. We hypothesize that deprivation leads to more advanced tumors or is associated with comorbidities contraindicating breast surgery. For unclear reasons, the magnitude of the benefit seems greater in this population. About one third of patients experience worsening of the vulnerability after breast cancer therapy and the underlying mechanisms remain to be determined. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-20.

Abstract PD08-03: Barriers to Breast Reconstructive Surgery in an Underprivileged Community: Does Income Really Matter?

BACKGROUND: Although breast reconstruction is associated with multiple benefits, several barriers have been described including age, stage of disease or economic status. In an US study conducted in low-income patients, 37% have completed breast reconstructive surgery (BRS) (Maly, Cancer 2009). In universal healthcare systems however, little is known about the effect of these factors: in Canada (NS), the rate of BRS remains lower than in the USA (3.8%) without any influence of household income (Barnsley, Can J Surg 2008). We decided to evaluate barriers to BRS in an area (Seine-Saint-Denis, SSD) with an estimated population of 1.4 billion, which is among the poorest in France. Median household income is 68% lower than in Paris (+68%), a gap growing with time. In SSD, cancer is the leading cause of premature mortality. Yet, the area has no more than one academic cancer center. PATIENTS AND METHODS: Oncologie 93 is a non-profit organization whose aim is to provide supportive care, health education and counseling to cancer patients treated in various cancer centers in SSD. A phone survey was conducted using semi-structured interviews. All pts completed their chemotherapy 1 year ago. Vulnerability was evaluated using a 11-item standardized score (EPICES) previously investigated by French Health Examination Centers. Strictly speaking this score was aimed at measuring “precarity”, a concept referring to a social condition assumed to face worsening. This score is more strongly related to health status than the administrative classification of poverty (Sass, Sante Publique 2006). Vulnerability was defined by a score ≥30 and considered as severe when ≥40. RESULTS: Among 99 pts screened over a 10 months period, 42 underwent a mastectomy. Mean age was 54 but only 27% stayed professionally active, 30% were retired. A majority (60%) had a partner. The EPICES score was ≥30 in 45% of pts, and ≥40 in 35%, ie 2.5 fold higher than average. One year after therapy, only 5 pts (12%) had BRS but 17 (46%) of the remaining 37 pts were considering BRS. Only 3 of them (8%) already got an appointment with a plastic surgeon. Other patients (n = 19) were still undecided (51%). Main reasons invoked were: fear of a new surgical procedure (n = 10, 27%) or feeling unprepared to BRS (n = 9, 24%). Five patients (13%) considered BRS as “useless”: 4 of them were ≥65 and age was the main factor in their choice. Vulnerability was not correlated with the decisions about BRS, neither was marital status. Of note, for all patients but one financial difficulties were not regarded as a critical issue and all pts were aware that BRS can be reimbursed by the public health insurance; none of them, however, knew that extra fees were the rule when BRS is performed outside of public hospitals. CONCLUSIONS: In an universal healthcare system, only a minority of low-income or vulnerable patients choose BRS. Although BRS funding is usually not regarded as a problem, numerous barriers to BRS still exist, mainly related to irrational grounds or wrong beliefs. Whether these barriers can be overcome by improved patient-doctor communication or better information remains an issue. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD08-03.

Renal Insufficiency in Breast Cancer Patients: High Prevalence and Reduced Survival.

Background The IRMA-1 study was the first to report on the high prevalence of renal insufficiency (RI) in 1898 breast cancer patients. The IRMA-2 study was started one year later, in another cohort of patients, and consisted of 2 phases: a cross-sectional study, similar to IRMA-1, and a 2-year retrospective follow-up of the patients to evaluate the impact of RI on survival. Data from the phase 1 of IRMA-2 were compared to the results of IRMA-1 in terms of RI prevalence and the potential association between RI and cancer survival was evaluated. We present here the results for IRMA-2 patients with breast cancer. Methods: The IRMA-1 and IRMA-2 studies included 4684 and 4945 patients, respectively, among which 1898 in IRMA-1 and 1816 in IRMA-2 had breast cancer (no dialysis). Sex, age, weight, serum creatinine (SCR), metastasis (bone and/or visceral), and anticancer drugs were collected. GFR was estimated with the aMDRD formula. RI was defined as aMDRD Results: Median age 56.0 ( vs. 55.0 in IRMA-1), mean weight 64.3 ( vs. 64.2) and 19 men ( vs. 20). The prevalence of an elevated SCR (SCR>110µmol/l) was 2.0% ( vs. 1.6% in IRMA-1), that of a GFR vs. 50.8%) and that of a GFR =60, respectively, when analysing all patients.When the same analysis was performed for non-metastatic patients (n=918), by definition with a better prognosis, RI at inclusion was still associated with mortality (Log Rank test, p=0.01) with mean survivals of 21.2 and 22.9 months for patients with GFR =60, respectively.At inclusion, 81.2% of treated patients (n=1572) were receiving at least one drug needing dosage adjustment and 75.9% received at least one nephrotoxic drug ( vs. 90.4 and 76.7%, respectively). Conclusion: The results of IRMA-2 and IRMA-1 confirm the high prevalence of RI in breast cancer patients, on 2 cohorts of nearly 2000 breast cancer patients each. Furthermore, patients with aMDRD Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2054.

Evolution of breast cancer screening in France from 2005 to 2008: results of the EDIFICE survey.

Abstract #5010 Background: In 2005, a first EDIFICE survey was aimed to provide a better understanding of population s adherence to the screening tests available in France and results pertaining to breast cancer are reported (Int. J. Med. Sci. 2008, 5: 106-112). In 2008, EDIFICE survey is performed again to assess the evolution 3 years later. Taking into account that the Implementation of breast cancer screening has been generalized in France since 2003: All women aged between 50 and 74 years are systematically invited to perform a mammography every two years.
 Methods: This second nationwide observational survey was carried out from December 12, 2007 to January 07, 2008 among a representative samples of 1802 French people aged between 40 and 85 years and 600 general practitioners (GPs). Information collected included socio-demographic characteristics, attitude towards cancer screening and actual experience of cancer screening, as well as GPs practice regarding screening. The precision of the results is 4.3% for a 95% confidence interval.
 Results: In EDIFICE–1 and -2, 501 and 488 participating women aged between 50 and 74 years are assessed, respectively.
 In EDIFICE-2, there was a significant relationship (p Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5010.