Pascale Grosclaude

Cancer incidence and mortality in France over the period 1980-2005.

BACKGROUND The objective of this study was to provide updated estimates of national trends in cancer incidence and mortality for France for 1980-2005. METHODS Twenty-five cancer sites were analysed. Incidence data over the 1975-2003 period were collected from 17 registries working at the department level, covering 16% of the French population. Mortality data for 1975-2004 were provided by the Inserm. National incidence estimates were based on the use of mortality as a correlate of incidence, mortality being available at both department and national levels. Observed incidence and mortality data were modelled using an age-cohort approach, including an interaction term. Short-term predictions from that model gave estimates of new cancer cases and cancer deaths in 2005 for France. RESULTS The number of new cancer cases in 2005 was approximately 320,000. This corresponds to an 89% increase since 1980. Demographic changes were responsible for almost half of that increase. The remainder was largely explained by increases in prostate cancer incidence in men and breast cancer incidence in women. The relative increase in the world age-standardised incidence rate was 39%. The number of deaths from cancer increased from 130,000 to 146,000. This 13% increase was much lower than anticipated on the basis of demographic changes (37%). The relative decrease in the age-standardised mortality rate was 22%. This decrease was steeper over the 2000-2005 period in both men and women. Alcohol-related cancer incidence and mortality continued to decrease in men. The increasing trend of lung cancer incidence and mortality among women continued; this cancer was the second cause of cancer death among women. Breast cancer incidence increased regularly, whereas mortality has decreased slowly since the end of the 1990s. CONCLUSION This study confirmed the divergence of cancer incidence and mortality trends in France over the 1980-2005 period. This divergence can be explained by the combined effects of a decrease in the incidence of the most aggressive cancers and an increase in the incidence of less aggressive cancers, partly due to changes in medical practices leading to earlier diagnoses.

Breast Carcinoma Survival in Europe and the United States: A Population-Based Study

Breast carcinoma survival rates were found to be higher in the U.S. than in Europe.

The cancer survival gap between elderly and middle-aged patients in Europe is widening

The present study is aimed to compare survival and prognostic changes over time between elderly (70-84 years) and middle-aged cancer patients (55-69 years). We considered seven cancer sites (stomach, colon, breast, cervix and corpus uteri, ovary and prostate) and all cancers combined (but excluding prostate and non-melanoma skin cancers). Five-year relative survival was estimated for cohorts of patients diagnosed in 1988-1999 in a pool of 51 European populations covered by cancer registries. Furthermore, we applied the period-analysis method to more recent incidence data from 32 cancer registries to provide 1- and 5-year relative survival estimates for the period of follow-up 2000-2002. A significant survival improvement was observed from 1988 to 1999 for all cancers combined and for every cancer site, except cervical cancer. However, survival increased at a slower rate in the elderly, so that the gap between younger and older patients widened, particularly for prostate cancer in men and for all considered cancers except cervical cancer in women. For breast and prostate cancers, the increasing gap was likely attributable to a larger use of, respectively, mammographic screening and PSA test in middle-aged with respect to the elderly. In the period analysis of the most recent data, relative survival was much higher in middle-aged patients than in the elderly. The differences were higher for breast and gynaecological cancers, and for prostate cancer. Most of this age gap was due to a very large difference in survival after the 1st year following the diagnosis. Differences were much smaller for conditional 5-year relative survival among patients who had already survived the first year. The increase of survival in elderly men is encouraging but the lesser improvement in women and, in particular, the widening gap for breast cancer suggest that many barriers still delay access to care and that enhanced prevention and clinical management remain major issues.

Incidence of gastrointestinal cancers in France

AIM Monitoring cancer incidence and time trends is essential for cancer research and health care planning. The aim of the study was to compare the incidence of gastrointestinal cancers in twelve administrative area in France to estimate the national cancer incidence during 2000 compared with the preceding 20 years. METHODS Incidence data was provided by cancer registries and mortality data by the French national medical research institute (INSERM). The two data sets were modeled separately over the period 1988-1997 using age-cohort models. The incidence/mortality ratio obtained from these models was applied to the mortality rates of an age-cohort model of the entire population. RESULTS The estimated number of new cases of gastrointestinal cancer was 61,465 in 2000. Colorectal cancer was the leading localization with 36,257 cases. The incidence of gastrointestinal cancers was slightly higher in northern than in southern area. Incidence of esophageal cancer was three times that of liver cancer. Variations in incidence were less marked for other localizations. The incidence of gastric and esophageal cancer in the male population decreased between 1980 and 2000, on average by slightly more than 2% per year. Incidence of other cancers increased. The number of new cases of colorectal cancer increased by 50%. The rise in the incidence of liver cancer was particularly striking, with an increase from 2000 incident cases in 1980 to nearly 6000 in 2000. CONCLUSION For most localizations, incidence of gastrointestinal cancers displays few geographical differences in France, but there has been a striking change in incidence trends over the past 20 years.

Cancer incidence and mortality in France in 1975-95

The aims of the European Network of Cancer Registries (ENCR) are to improve the quality, comparability and availability of cancer registry data in Europe. This paper on cancer incidence and mortality in France presents the most recent available data, with short-term projections to 1995, and a commentary based, where possible, on epidemiological research carried out in France. Cancer incidence in men in France increased throughout the study period 1975 to 1995, from 92,000 new cases in 1975 to about 135,000 in 1995. This increase was partly due to the ageing of the French population, but incidence rates have also increased, particularly from 1975 to 1985. The trend appears to be levelling off in the 1990s, with an incidence rate in 1995 of about 482 per 100,000 (this and subsequent rates quoted are standardized to the European Standard Population). Among women, the all-cancer incidence rates also increased during the 1970s and 1980s. Although the rate of increase was less pronounced than in men, the trend is continuing in the 1990s. The estimated age standardized rate in 1995 was 309 per 100,000, representing 104,000 new cases. The main components of these changes in the last decade were, for men, increases in large bowel and prostate cancer, which have been partly compensated for by decreases in oral cavity, larynx and stomach cancer. For women the trend was dominated by the continuing increase in breast cancer with increases also in large bowel and lung cancers. Of the numerically important cancers in women, only stomach cancer has shown a clear decline. The situation in 1995 was that breast cancer remained the predominant cancer affecting women in France, accounting for almost one third of all new cases of cancer diagnosed and one fifth of cancer deaths. The next most frequent cancers in women were those of the large bowel. Regrettably, incidence rates of both breast and bowel cancer are increasing in women. For men in France the most frequent cancers in 1995 were those of the prostate, large bowel and lung, all of which increased in incidence since 1975. Although it is estimated that there will be more newly diagnosed cases of prostate cancer than lung cancer in 1995, the latter will cause many more deaths, particularly of young men.

Treatment and prognosis of hepatocellular carcinoma: A population based study in France

Few data are available from population‐based statistics on hepatocellular carcinoma (HCC). The aim of this study was to report on their management and their prognosis in a French population.

Breast cancer survival in the US and Europe: A CONCORD high-resolution study.

Breast cancer survival is reportedly higher in the US than in Europe. The first worldwide study (CONCORD) found wide international differences in age‐standardized survival. The aim of this study is to explain these survival differences. Population‐based data on stage at diagnosis, diagnostic procedures, treatment and follow‐up were collected for about 20,000 women diagnosed with breast cancer aged 15–99 years during 1996–98 in 7 US states and 12 European countries. Age‐standardized net survival and the excess hazard of death up to 5 years after diagnosis were estimated by jurisdiction (registry, country, European region), age and stage with flexible parametric models. Breast cancers were generally less advanced in the US than in Europe. Stage also varied less between US states than between European jurisdictions. Early, node‐negative tumors were more frequent in the US (39%) than in Europe (32%), while locally advanced tumors were twice as frequent in Europe (8%), and metastatic tumors of similar frequency (5–6%). Net survival in Northern, Western and Southern Europe (81–84%) was similar to that in the US (84%), but lower in Eastern Europe (69%). For the first 3 years after diagnosis the mean excess hazard was higher in Eastern Europe than elsewhere: the difference was most marked for women aged 70–99 years, and mainly confined to women with locally advanced or metastatic tumors. Differences in breast cancer survival between Europe and the US in the late 1990s were mainly explained by lower survival in Eastern Europe, where low healthcare expenditure may have constrained the quality of treatment.

Cancer net survival on registry data: use of the new unbiased Pohar-Perme estimator and magnitude of the bias with the classical methods.

Net survival, the survival which might occur if cancer was the only cause of death, is a major epidemiological indicator required for international or temporal comparisons. Recent findings have shown that all classical methods used for routine estimation of net survival from cancer‐registry data, sometimes called “relative‐survival methods,” provide biased estimates. Meanwhile, an unbiased estimator, the Pohar‐Perme estimator (PPE), was recently proposed. Using real data, we investigated the magnitude of the errors made by four “relative‐survival” methods (Ederer I, Hakulinen, Ederer II and a univariable regression model) vs. PPE as reference and examined the influence of time of follow‐up, cancer prognosis, and age on the errors made. The data concerned seven cancer sites (2,51,316 cases) collected by FRANCIM cancer registries. Net survivals were estimated at 5, 10 and 15 years postdiagnosis. At 5 years, the errors were generally small. At 10 years, in good‐prognosis cancers, the errors made in nonstandardized estimates with all classical methods were generally great (+2.7 to +9% points in prostate cancer) and increased in age‐class estimations (vs. 5‐year ones). At 15 years, in bad‐ or average‐prognosis cancers, the errors were often substantial whatever the nature of the estimation. In good‐prognosis cancers, the errors in nonstandardized estimates of all classical methods were great and sometimes very important. With all classical methods, great errors occurred in age‐class estimates resulting in errors in age‐standardized estimates (+0.4 to +3.2% points in breast cancer). In estimating net survival, cancer registries should abandon all classical methods and adopt the new Pohar‐Perme estimator.

Descriptive epidemiology of thyroid cancer in France: Incidence, mortality and survival

OBJECTIVES Describe time trends of incidence and mortality associated with thyroid cancer and provide 1 and 5-year survivals by histological group in French areas covered by cancer registries. MATERIAL AND METHODS Data for 1975 to 2004 were provided by one thyroid-dedicated and 11 general registries. Incidence estimates were obtained by correction of incidence from areas with registries, then projections for 2008 were derived. Overall and relative survivals by sex and age (diagnosis period 1989-1997; cut-off date 1st January 2002) were obtained from the dedicated and nine other registries. Comparisons between areas or time periods used world-standardized rates. RESULTS Between 1980 and 2005, incidence increased but mortality decreased in men and women. Annual cases increased five times and projections for 2008 were 8,000 cases and 400 deaths. The main increasing subtype was papillary carcinoma. One-year overall and relative survivals were 92 and 94%, respectively. Five-year overall and relative survivals were 87 and 93%, respectively. The highest survival (>94%) concerned papillary carcinomas and the lowest (<15%) anaplastic carcinomas. Survivals were generally higher in women than in men; precisely, higher in women for papillary and follicular carcinomas but higher in men for medullary and anaplastic carcinomas. Survivals increased with age, but for medullary carcinomas. Survivals from anaplastic carcinomas were very low whatever the age. CONCLUSION The increase of thyroid cancer frequency is dramatic but survivals are improving. Though the prognosis of the most increasing histological subtype is generally good, it remains very important to identify the causes of this steady increase to implement adequate preventive measures.

The embodiment of adverse childhood experiences and cancer development: potential biological mechanisms and pathways across the life course

ObjectivesTo explore current evidence of the physiological embedding of stress to discuss whether adverse childhood experiences (ACE) causing chronic or acute stress responses may alter fundamental biological functions.MethodsA non-systematic review of the literature was carried out using keyword searches in Pubmed and the web of science from May to October 2011. In reference to the literature identified, we examine the potential biological pathways potentially linking exposure to ACE and cancer development and progression in adulthood.ResultsThese mechanisms, in interaction with social position, and mediated by subsequent environmental exposures, may ultimately lead to the development of cancer. The experience of acute or chronic stressors during sensitive periods of childhood development which can induce several known biological responses, are likely to have an impact on subsequent biological and behavioural functions depending on the timing of initial exposures, and subsequently mediated by later exposures. For this reason, childhood exposure to adversity is a likely source of both acute and chronic stressors, and can be examined as an important initial exposure on a pathway towards adult ill health.ConclusionsSuch pathways justify a life course approach to understanding cancer aetiology, which may have its origins early in life.