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Featured researches published by M. Smans.


British Journal of Cancer | 2012

Diabetes and breast cancer risk: a meta-analysis

Peter Boyle; M. Boniol; Alice Koechlin; Chris Robertson; Valentini F; Coppens K; Fairley Ll; Tongzhang Zheng; Yawei Zhang; Markus Pasterk; M. Smans; Maria Paula Curado; Patrick Mullie; Sara Gandini; Maria Bota; Geremia B. Bolli; Julio Rosenstock; Philippe Autier

Background:The potential of an increased risk of breast cancer in women with diabetes has been the subject of a great deal of recent research.Methods:A meta-analysis was undertaken using a random effects model to investigate the association between diabetes and breast cancer risk.Results:Thirty-nine independent risk estimates were available from observational epidemiological studies. The summary relative risk (SRR) for breast cancer in women with diabetes was 1.27 (95% confidence interval (CI), 1.16–1.39) with no evidence of publication bias. Prospective studies showed a lower risk (SRR 1.23 (95% CI, 1.12–1.35)) than retrospective studies (SRR 1.36 (95% CI, 1.13–1.63)). Type 1 diabetes, or diabetes in pre-menopausal women, were not associated with risk of breast cancer (SRR 1.00 (95% CI, 0.74–1.35) and SRR 0.86 (95% CI, 0.66–1.12), respectively). Studies adjusting for body mass index (BMI) showed lower estimates (SRR 1.16 (95% CI, 1.08–1.24)) as compared with those studies that were not adjusted for BMI (SRR 1.33 (95% CI, 1.18–1.51)).Conclusion:The risk of breast cancer in women with type 2 diabetes is increased by 27%, a figure that decreased to 16% after adjustment for BMI. No increased risk was seen for women at pre-menopausal ages or with type 1 diabetes.


European Journal of Cancer and Clinical Oncology | 1991

Smoking and cancer with emphasis on Europe.

C. La Vecchia; Peter Boyle; Silvia Franceschi; Fabio Levi; Patrick Maisonneuve; E. Negri; F. Lucchini; M. Smans

A summary of smoking and cancer in various European countries is presented Important points are the tobacco/alcohol interaction in the elevated mortality rates from upper digestive and respiratory tract neoplasms in France and other southern European countries, the delay in the lung cancer epidemic in females compared with the situation in North America (with the major exception of the United Kingdom) and the different pattern of lung cancer rates in younger compared with older generations (which suggests that eastern and southern European countries will have the highest lung cancer rates at the beginning of the next century in the absence of urgent intervention). The efficacy of anti-smoking policies in Scandinavian countries which now have the lowest lung cancer rates in Europe and the persisting importance of high-tar dark-tobacco cigarettes in eastern and southern Europe in enhancing the risk not only of cancer of the lung but also of upper digestive and respiratory and bladder neoplasms are also discussed.


Journal of the National Cancer Institute | 2012

Mammography Screening and Breast Cancer Mortality in Sweden

Philippe Autier; Alice Koechlin; M. Smans; Lars J. Vatten; Mathieu Boniol

BACKGROUND Swedish women aged 40-69 years were gradually offered regular mammography screening since 1974, and nationwide coverage was achieved in 1997. We hypothesized that this gradual implementation of breast cancer screening would be reflected in county-specific mortality patterns during the last 20 years. METHODS Using data from the Swedish Board of Health and Welfare from 1960 to 2009, we used joinpoint regression to analyze breast cancer mortality trends in women aged 40 years and older (1,286,000 women in 1995-1996). Poisson regression models were used to compare observed mortality trends with expected trends if screening had resulted in breast cancer mortality reductions of 10%, 20%, or 30% among women screened during 18 years of follow-up after the introduction of screening. All statistical tests were two-sided. RESULTS From 1972 to 2009, breast cancer mortality rates in Swedish women aged 40 years and older declined by 0.98% annually, from 68.4 to 42.8 per 100,000, and it continuously declined in 14 of the 21 Swedish counties. In three counties, breast cancer mortality declined sharply during or soon after the implementation of screening; in two counties, a steep decline started at least 5 years after screening was introduced; and in two counties, breast cancer mortality increased after screening started. In counties in which screening started in 1974-1978, mortality trends during the next 18 years were similar to those before screening started, and in counties in which screening started in 1986-1987, mortality increased by approximately 12% (P = .007) after the introduction of screening compared with previous trends. In counties in which screening started in 1987-1988 and in 1989-1990, mortality declined by approximately 5% (P = .001) and 8% (P < .001), respectively, after the introduction of screening. Conclusion County-specific mortality statistics in Sweden are consistent with studies that have reported limited or no impact of screening on mortality from breast cancer.


Journal of the Royal Society of Medicine | 2015

Statistical analyses in Swedish randomised trials on mammography screening and in other randomised trials on cancer screening: a systematic review

Philippe Autier; Mathieu Boniol; M. Smans; Richard Sullivan; Peter Boyle

Objectives We compared calculations of relative risks of cancer death in Swedish mammography trials and in other cancer screening trials. Participants Men and women from 30 to 74 years of age. Setting Randomised trials on cancer screening. Design For each trial, we identified the intervention period, when screening was offered to screening groups and not to control groups, and the post-intervention period, when screening (or absence of screening) was the same in screening and control groups. We then examined which cancer deaths had been used for the computation of relative risk of cancer death. Main outcome measures Relative risk of cancer death. Results In 17 non-breast screening trials, deaths due to cancers diagnosed during the intervention and post-intervention periods were used for relative risk calculations. In the five Swedish trials, relative risk calculations used deaths due to breast cancers found during intervention periods, but deaths due to breast cancer found at first screening of control groups were added to these groups. After reallocation of the added breast cancer deaths to post-intervention periods of control groups, relative risks of 0.86 (0.76; 0.97) were obtained for cancers found during intervention periods and 0.83 (0.71; 0.97) for cancers found during post-intervention periods, indicating constant reduction in the risk of breast cancer death during follow-up, irrespective of screening. Conclusions The use of unconventional statistical methods in Swedish trials has led to overestimation of risk reduction in breast cancer death attributable to mammography screening. The constant risk reduction observed in screening groups was probably due to the trial design that optimised awareness and medical management of women allocated to screening groups.


PLOS ONE | 2016

Observed and Predicted Risk of Breast Cancer Death in Randomized Trials on Breast Cancer Screening

Philippe Autier; Mathieu Boniol; M. Smans; Richard Sullivan; Peter Boyle

Background The role of breast screening in breast cancer mortality declines is debated. Screening impacts cancer mortality through decreasing the number of advanced cancers with poor diagnosis, while cancer treatment works through decreasing the case-fatality rate. Hence, reductions in cancer death rates thanks to screening should directly reflect reductions in advanced cancer rates. We verified whether in breast screening trials, the observed reductions in the risk of breast cancer death could be predicted from reductions of advanced breast cancer rates. Patients and Methods The Greater New York Health Insurance Plan trial (HIP) is the only breast screening trial that reported stage-specific cancer fatality for the screening and for the control group separately. The Swedish Two-County trial (TCT)) reported size-specific fatalities for cancer patients in both screening and control groups. We computed predicted numbers of breast cancer deaths, from which we calculated predicted relative risks (RR) and (95% confidence intervals). The Age trial in England performed its own calculations of predicted relative risk. Results The observed and predicted RR of breast cancer death were 0.72 (0.56–0.94) and 0.98 (0.77–1.24) in the HIP trial, and 0.79 (0.78–1.01) and 0.90 (0.80–1.01) in the Age trial. In the TCT, the observed RR was 0.73 (0.62–0.87), while the predicted RR was 0.89 (0.75–1.05) if overdiagnosis was assumed to be negligible and 0.83 (0.70–0.97) if extra cancers were excluded. Conclusions In breast screening trials, factors other than screening have contributed to reductions in the risk of breast cancer death most probably by reducing the fatality of advanced cancers in screening groups. These factors were the better management of breast cancer patients and the underreporting of breast cancer as the underlying cause of death. Breast screening trials should publish stage-specific fatalities observed in each group.


Recent results in cancer research | 1989

Cancer Mortality Atlas of the European Economic Community

M. Smans; Peter Boyle; C. S. Muir

Recent years have seen the publication of many national cancer atlases, both outside and inside Europe. Unfortunately, as they lack uniform presentation, a picture of the cancer situation in the EEC cannot be readily constructed. The International Agency for Research on Cancer (IARC), believing that cancer patterns are not likely to follow national boundaries, embarked on the production of a mortality atlas for the EEC countries, which is to be published later this year.


Ecancermedicalscience | 2016

Maps and atlases of cancer mortality: a review of a useful tool to trigger new questions

Alberto d'Onofrio; Chiara Mazzetta; Chris Robertson; M. Smans; Peter Boyle; Mathieu Boniol

In this review we illustrate our view on the epidemiological relevance of geographically mapping cancer mortality. In the first part of this work, after delineating the history of cancer mapping with a view on interpretation of Cancer Mortality Atlases, we briefly illustrate the ‘art’ of cancer mapping. Later we summarise in a non-mathematical way basic methods of spatial statistics. In the second part of this paper, we employ the ‘Atlas of Cancer Mortality in the European Union and the European Economic Area 1993–1997’ in order to illustrate spatial aspects of cancer mortality in Europe. In particular, we focus on the cancer related to tobacco and alcohol epidemics and on breast cancer which is of particular interest in cancer mapping. Here we suggest and reiterate two key concepts. The first is that a cancer atlas is not only a visual tool, but it also contain appropriate spatial statistical analyses that quantify the qualitative visual impressions to the readers even though at times revealing fallacy. The second is that a cancer atlas is by no means a book where answers to questions can be found. On the contrary, it ought to be considered as a tool to trigger new questions.


Journal of the Royal Society of Medicine | 2015

Screening mammography: Authors’ response to Nyström and Tabar and colleagues

Philippe Autier; Mathieu Boniol; M. Smans; Richard Sullivan; Peter Boyle

the control group’s closure screen somehow invalidates the design and analysis. The PSP screen is a prevalent screen, whereas at that time, the ASP is in incident screen mode. The appropriate comparison is with the prevalent screen of the ASP, which was published in 1992 and shows similar results to the PSP closure screen. The criticism of the Swedish Two-County Trial on the grounds of imbalances in missing values is inaccurate, not only are we unable to verify these figures from the trial data, we cannot find them in the paper that Autier et al cite as the source. The issue of potential bias in cause of death has been examined time and again and shown to be a red herring. Indeed, the Swedish overview has published the excess mortality analysis which does not require classification of cause of death and found essentially the same mortality reduction as in the cause-specific analysis. The paper does not contribute to the debate on the value of mammographic screening, but confuses the discussion due to fatal errors that negate their conclusions.


Recent results in cancer research | 1989

Italian Atlas of Cancer Mortality

Cesare Cislaghi; A. Decarli; C. La Vecchia; Guerrino Mezzanotte; M. Smans

Analyses of the geographical variation of cancer death certification between the 95 Italian provinces based on published data for the early 1970s showed substantial variations in mortality, higher rates being generally registered in northern areas, and marked gradients for most common neoplasms (Cislaghi et al. 1978). Originally, it was suspected that this pattern might have been influenced by under-certification of cancer deaths in southern regions. However, subsequent checks both of internal (e. g., between various age groups) and external (e. g., between death certification and cancer registration data) data reliability (Zanetti et al. 1982) showed a satisfactory degree of reliability of Italian cancer death certification, with the exception of a few selected problem areas of diagnosis and certification (i. e., cancers of liver, prostate, and brain, and the distinctions between colon and rectum or corpus and cervix uteri), which are probably also found in data from most other developed countries.


International Journal of Cancer | 1985

Descriptive epidemiology of colorectal cancer

Peter Boyle; D. G. Zaiudze; M. Smans

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Peter Boyle

University of Strathclyde

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Mathieu Boniol

Académie Nationale de Médecine

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Philippe Autier

Université libre de Bruxelles

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Alice Koechlin

University of Strathclyde

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Chris Robertson

University of Strathclyde

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Peter Boyle

University of Strathclyde

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Philippe Autier

Université libre de Bruxelles

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Alberto d'Onofrio

European Institute of Oncology

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