M. Boussac-Zarebska

French colorectal cancer screening pilot programme: results of the first round

Objectives In France, a national pilot population-based screening programme on colorectal cancer was set up in 2002. In 2006, 23 French districts were included, targeting a population of more than five million people. This programme offers biennial screening using the fecal occult blood test (FOBT) to average risk subjects aged between 50 and 74 years. People receive a letter inviting them to consult their GPs, who in turn provide the FOBT. People with a positive test result are proposed a full colonoscopy. The results of the programmes first-round performance indicators are presented. Methods The monitoring centre collected data from GPs and gastroenterologists on follow-up and colonoscopy results for people who were screened positive. Data were transferred to the French Institute for Public Health Surveillance (InVS) for the analysis. Results The overall participation rate for the 19 districts having completed a first screening round reached 42%. The overall positive test rate was 2.7%. In the eight districts with comprehensive follow-up data for the first round, 86% of colonoscopies were completed after a positive test. A total of 1615 people were diagnosed with cancer, and 4612 people with adenoma. The cancer detection rate reached 2.3%, it was higher in men than in women (3.4% versus 1.4%), and increased with age. Forty-three percent of invasive detected cancers were stage I, 24% stage II, 23% had lymph node involvement and 10% presented with distant metastasis. Conclusion These results suggest that indicators are consistent with international references. During 2007–2008, the programme coverage will be progressively extended, and all 99 French districts should be actively involved in its implementation.

Are breast cancer screening practices associated with sociodemographic status and healthcare access? Analysis of a French cross-sectional study.

The aim of this study was to analyse the role of womens sociodemographic and healthcare access characteristics according to breast cancer screening practices (organized, individual or no screening). A cross-sectional study was set up in seven French districts using a self-administered postal questionnaire. Randomization was stratified proportionally on age and urban/rural status in each district separately among attendees and nonattendees to the organized breast cancer screening programme (OS). A total of 5638 women aged 50–74 years returned their questionnaires: 1480 in the attendee OS group and 4158 in the nonattendee group. Among them, 3537 declared having undergone a recent mammography outside the organized programme (individual, IS group) and 621 declared never having undergone a mammography or having done so more than 2 years ago (NS group). Analyses showed a gradient between the three groups (IS, OS and NS, respectively) in their association with breast cancer screening practices considering three factors: an increasing gradient was observed for renunciation of basic healthcare for financial reasons, a decreasing gradient in the regular visit to a medical gynaecologist and having had a Pap smear in the last 3 years. Three other variables that showed a decreasing gradient are: living with a partner, current use of hormone replacement therapy and having had a check-up in the last 5 years. In conclusion, the main differences between breast cancer screening practices were largely associated with difficulties in healthcare access, considering regular gynaecological visits in particular.

Parkinson disease male-to-female ratios increase with age: French nationwide study and meta-analysis

Background Parkinson’s disease (PD) is 1.5 times more frequent in men than women. Whether age modifies this ratio is unclear. We examined whether male-to-female (M–F) ratios change with age through a French nationwide prevalence/incidence study (2010) and a meta-analysis of incidence studies. Methods We used French national drug claims databases to identify PD cases using a validated algorithm. We computed M–F prevalence/incidence ratios overall and by age using Poisson regression. Ratios were regressed on age to estimate their annual change. We identified all PD incidence studies with age/sex-specific data, and performed a meta-analysis of M–F ratios. Results On the basis of 149 672 prevalent (50% women) and 25 438 incident (49% women) cases, age-standardised rates were higher in men (prevalence=2.865/1000; incidence=0.490/1000 person-years) than women (prevalence=1.934/1000; incidence=0.328/1000 person-years). The overall M–F ratio was 1.48 for prevalence and 1.49 for incidence. Prevalence and incidence M–F ratios increased by 0.05 and 0.14, respectively, per 10 years of age. Incidence was similar in men and women under 50 years (M–F ratio <1.2, p>0.20), and over 1.6 (p<0.001) times higher in men than women above 80 years (p trend <0.001). A meta-analysis of 22 incidence studies (14 126 cases, 46% women) confirmed that M– F ratios increased with age (0.26 per 10 years, p trend=0.005). Conclusions Age-increasing M–F ratios suggest that PD aetiology changes with age. Sex-related risk/protective factors may play a different role across the continuum of age at onset. This finding may inform aetiological PD research.

Cancer incidence estimation at a district level without a national registry: A validation study for 24 cancer sites using French health insurance and registry data

BACKGROUND District-level cancer incidence estimation is an important issue in countries without a national cancer registry. This study aims to both evaluate the validity of district-level estimations in France for 24 cancer sites, using health insurance data (ALD demands--Affection de Longue Durée) and to provide estimations when considered valid. Incidence is estimated at a district-level by applying the ratio between the number of first ALD demands and incident cases (ALD/I ratio), observed in those districts with cancer registries, to the number of first ALD demands available in all districts. These district-level estimations are valid if the ratio does not vary greatly across the districts or if variations remain moderate compared with variations in incidence rates. METHODS Validation was performed in the districts covered by cancer registries over the period 2000-2005. The district variability of the ALD/I ratio was studied, adjusted for age (mixed-effects Poisson model), and compared with the district variability in incidence rate. The epidemiological context is also considered in addition to statistical analyses. RESULTS District-level estimation using the ALD/I ratio was considered valid for eight cancer sites out of the 24 studied (lip-oral cavity-pharynx, oesophagus, stomach, colon-rectum, lung, breast, ovary and testis) and incidence maps were provided for these cancer sites. CONCLUSION Estimating cancer incidence at a sub-national level remains a difficult task without a national registry and there are few studies on this topic. Our validation approach may be applied in other countries, using health insurance or hospital discharge data as correlate of incidence.

L’état du dépistage du cancer colorectal en France en 2009

Connaitre les resultats disponibles en 2009 de la premiere campagne; Connaitre les facteurs de reussite et d’echec.