Participation au dépistage du cancer colorectal selon le taux de pauvreté dans les Bouches-du-Rhône.

INTRODUCTION: The rate of participation in organized colorectal cancer screening (DOCCR) remains insufficient in France, with strong disparities between departments. PURPOSE OF RESEARCH: The aim of this work was to assess the relationship between the DOCCR response rates for the communes of the Bouches-du-Rhône (BdR) department and the boroughs of Marseille and their poverty levels. The DOCCR response rate was assessed for the 2017-2018 campaign. The Pearson coefficient was calculated to assess correlations with the average poverty rate per commune/borough, the density of general practitioners (GPs) and Potential Localized Accessibility (PLA) to GPs. RESULTS: Among the DOCCR guests, 29.7% (± 4.7) responded. The rate of respondents differed significantly between the communes/boroughs of the department (P < 0.001). The rate of respondents was inversely correlated with the rate of people living below the poverty line, both for the communes/boroughs of the department, with a high correlation (r = - 0.795, P < 0.001) and for the Marseille boroughs, with an even higher correlation (r = - 0.910, P < 0.001). It was inversely correlated with the density of GPs (r = - 0.430, P < 0.001). On the other hand, there was a weak positive correlation with Potential Localized Accessibility to GPs (r = 0.193, P < 0.001), as well as with the age of guests (r = 0.476, P < 0.001). CONCLUSIONS: The poverty rate in the BdR, which is higher than the national average, may partly explain the low rate of DOCCR respondents; other factors such as the density of GPs and their accessibility may play a role.

Comparison of direct digital mammography, computed radiography, and film-screen in the French national breast cancer screening program.

OBJECTIVE: The purpose of this article was to compare the performance of digital mammography using hardcopy image reading against film-screen mammography in a French national routine population-based screening program with a decentralized organization. The French context offered the opportunity to examine separately computed radiography and direct digital mammography performances in a large cohort. MATERIALS AND METHODS: The study includes 23,423 direct digital mammography, 73,320 computed radiography, and 65,514 film-screen mammography examinations performed by 123 facilities in Bouches du Rhône, France, for women 50-74 years old between 2008 and 2010. We compared abnormal mammography findings rate, cancer detection rate, and tumor characteristics among the technologies. RESULTS: Abnormal finding rates were higher for direct digital mammography (7.78% vs 6.11% for film-screen mammography and 5.34% for computed radiography), particularly in younger women and in denser breasts. Cancer detection rates were also higher for direct digital mammography (0.71% vs 0.66% for film-screen mammography and 0.55% for computed radiography). The contrast between detection rates was stronger for ductal carcinoma in situ. Breast density was the main factor explaining the differences in detection rates. For direct digital mammography only, the detection rate was clearly higher in dense breasts whatever the age (odds ratio, 2.20). Except for grade, no differences were recorded concerning tumor characteristics in which the proportion of high-grade tumors was larger for direct digital mammography for invasive and in situ tumors. CONCLUSION: Direct digital mammography has a higher detection rate than film-screen mammography in dense breasts and for tumors of high grade. This latter association warrants further study to measure the impact of technology on efficacy of screening. The data indicate that computed radiography detects fewer tumors than film-screen mammography in most instances.

[Second reading in breast cancer screening program: State of knowledge and future]. / Seconde lecture en dépistage organisé du cancer du sein. États des lieux et perspectives d'évolution.

Second reading is an important part of breast cancer organized screening program. Image quality control and detection of non-diagnosed cancer by first reader are the two goals of this process. In France, 6 % of all screening cancer are diagnosed by second reading, actually done on screen film. With the technologic evolution (Digital breast tomosynthesis, Artificial intelligence) and societal digitalization, this process need to evolve. After some report about organization and results for second reading in France and outside, current and future shortcomings, proposition from professionals involved in breast cancer screening are made to improve this public health program.

Testing for human papillomavirus and measurement of viral load of HPV 16 and 18 in self-collected vaginal swabs of women who do not undergo cervical cytological screening in Southern France.

Self-sampling using vaginal swabs could be a valuable alternative to screen for cervical cancer for women who do not attend regular cytological screening. The aim of this study was to determine the prevalence of high and low-risk HPV types and of HPV type 16 and 18 DNA load in self-collected vaginal swabs from 35- to 69-year-old Southern French women of low socioeconomic level or migrant populations who do not attend regular cervical screening. A good concordance (93.1%) was found between cervical brush and vaginal swabs in 29 samples. Self-collected vaginal swabs were examined from 120 women. HPV infection was found in 28 women (23.3%; median age 48 years), 17 (14.1%) of whom harbored high-risk HPV types. HPV type 16 was the high risk type found most frequently, followed by types 53, 31, 18, 58, and 66. The low-risk type detected most frequently was HPV type 6, followed by types 61, 70, and 81. The mean HPV 16 and 18 load was 6.3 log(10) copies/10(6) cells and 2.4 log(10) copies/10(6) cells, respectively. These results suggest that vaginal self-swabs can be a reliable tool for cervical cancer screening in non-attending and inadequately screened elderly women.

Genotyping and follow-up of HR-HPV types detected by self-sampling in women from low socioeconomic groups not participating in regular cervical cancer screening in France.

BACKGROUND: HPV vaginal self-sampling can be an alternative for women refusing cytological screening. OBJECTIVES: To describe HR-HPV types in 35-69 years old women from low socioeconomic groups not attending regular cytological screening in Marseille, France. STUDY DESIGN: A cervical screening campaign using HR-HPV self-sampling including 22,702 women aged 35-69 years living in low socioeconomic districts of Marseille was organized. A cytological and/or histological follow-up was undertaken for a subset of women harboring HR-HPV types. Abbott RealTime High Risk HPV test was used for screening, while INNO-LiPA HPV Genotyping Extra assay was used for genotyping. RESULTS: 4245 self-samplings were performed (participation rate, 18.7%) out of which 609 (14.3%) were HR-HPV+ by the screening test including 114HPV 16 (18.7%), 41HPV 18 (6.7%), 454HR-HPVnon-16/18 (75.4%). A sample of 260 out of the 454HR-HPVnon-16/18 were genotyped by INNO-LiPA which revealed HPV52 (35%), 66 (22.6%), 51 (19.6%), 31 (15.7%), 39 (13%), 56 (10.4%), and 53, 35, 59, 33, 58, 82, 45, 68, 73 (<10% each). At month 12, a 2nd self-collection kit was sent to 274 of 609HR-HPV+ women who did not have a Pap-test previously performed on them. Of these 274 women, 130 provided a sample for HPV testing; one was uninterpretable, 56 were HPV negative, and 73 were HR-HPV+ (10HPV16+, 3HPV18+, 60HR-HPVnon-16/18+). Of the 345 women with cytological and/or histological follow-up 19 (5.5%) had ≥CIN2 lesions, (11 were HPV16+ and 8 were HR-HPVnon-16/18). CONCLUSION: This study illustrates the potential efficacy of self-sampling as a cancer screening strategy for socioeconomically deprived women who do not participate in regular Pap screening programs.

[HPV-Hr detection by home self sampling in women not compliant with pap test for cervical cancer screening. Results of a pilot programme in Bouches-du-Rhône]. / L'auto-prélèvement vaginal à domicile pour recherche de papilloma virus à haut risque. Campagne expérimentale du département des Bouches-du-Rhône.

The non-participation to cervical screening is the major determinant in the risk of mortality due to cervical cancer. In France, around 40% of women do not participate to regular screening. The cultural or economic barriers for performing screening by Pap test are numerous; one of the most frequent is the refusal of gynaecological examination. A persistent HPV(HR) infection is a necessary factor for developing cervical cancer. The HPV(HR) testing has a high sensibility to detect high grade cervical intra-epithelial neoplasia (CIN 2-3) and a satisfactory specificity after 30-35 years old. The principal objective of this study was to compare the participation rates in women 35-69 years old who did not perform a Pap test after a first individual invitation, either when an HPV(HR) auto-test was offered to be performed at home or a second invitation to Pap test was sent. We also evaluated the quality of the two tests, the positive results obtained by age groups and the following histological type of lesions diagnosed in the women with positive results. The study included 9,334 women, 35-69 years old, who did not realized a Pap-test during the 2 previous years and who did not respond at a first individual invitation. These non-responders were randomized into two groups: one group (n=4,934) received a second individual invitation and the other (n=4,400) an offer of receiving and performing an HPV auto-test at home. In women 35-69 years the participation to the second invitation to Pap test was significantly lower (7.2%) than the participation to auto-test (26.4%) with P<0.001. The quality of the two tests was satisfactory; the auto-test was not altered by the postage to laboratory (non interpretable rate=1.4% [CI at 95%=0.65%; 2.15%]. From the 311 Pap tests done, 5.5% (17) were classified "abnormal" (nine ASCUS, one high grade and seven low grades). The follow up of 13 women out of 17 confirmed the diagnosis for 1 case of CIN2 and 2 cases of CIN3, 4 women are lost of follow up after 6 months. From the 939 HPV(HR) tests done, 6.2% (58) were positive. Such positivity rate was not influenced by age. Out of the 58 positive HPV(HR) cases, 27 only were of the 16 genotype (46.5% [CI 95%=33.7%; 59.3%]). This law rate is a consequence of an inversion of the ratio HPV 16 versus other types in women 60 years old and over. In this group, the follow-up of 36 women diagnosed five cases of CIN1, one of CIN2 and four of CIN3; 22 patients are lost of follow up at 6 months. Globally, in the studied population, an individual recall for pap test allowed to diagnose and treat 3 high grade lesions (7‰) and the dispatching of an auto test allowed the diagnosis and treatment of five high grade lesions (1,4‰), this difference is significant (P=0.02; OR=0.25 [0.05; 0.97]). The HPV(HR) auto-test seems to be better accepted than the Pap test in the 35-69 years old women previously non-responders to individual invitation, and the quality of the test is satisfactory. Such a test can be proposed to the 35-69 years old non-participant to Pap test to increase the coverage for cervical screening, if the rates of diagnostic examinations performed in case of an HPV(HR) positive is sufficiently high.

[Organized cervical cancer screening for underpriviledged women]. / Le dépistage organisé des cancers du col utérin pour les femmes en situation médicosociale défavorisée.

Individual cervical screening with pap-smears is the major cause of the decrease in incidence and mortality of cervical cancer in France since more than 30 years. But, for the last ten years, the decrease in mortality is limited due to the persistence of poor prognostic cases and the insufficiency of treatment efficacy in such patients. These cases are mostly observed in women who did not participate to regular screening. They are generally from low socioeconomic levels or migrant populations, or both. Such an observation leads us to organize 3 successive pilot campaigns (2001, 2003, 2005) in the Northern part of Marseille city where the rate of such poor population is high (37 to 45%). The women without a pap-smear indexed in the National Insurance Register for the last 3-2 years were invited by individual mailing to perform, free of charge, a pap-smear. The evaluation of each campaign helps us to improve the next one. The major changes from the 1st one to the 3rd one were to increase the number of free screening services, to send a second invitation to the non responders, and to organize local meetings with social workers and nurses to explain to the women the importance of performing regular screening tests. The final results after the 3 campaigns showed : out of the eligible women the participation rates are dramatically low evolving from 1,56 % to 2,48% and 6,87% of pap-smears done along the 3 campaigns ; the selection of women "without pap-smear" from the national Insurance register was not good, a great number of missing data was identified, explaining partly the extremely low rate of participation ; the factors increasing a little the participation are the second mailing of invitation (39 % of pap-smears realised) ; the total gratuitous of the screening (both sampling and reading) ; the oral information delivered locally by social workers and the proximity of the places to perform the test ; the quality of the pap-smears collected by gynecologists was good but insufficient for other health professionals, requiring a specific training for cervical cell collection. The organization of such pilot projects need to be followed to find better solutions to increase the participation to cervical screening of such populations who are at high risk of poor prognosis cervical cancers.