[News in French cancer screenings]. / Nouveautés dans le dépistage des cancers en France.

NEWS IN FRENCH CANCER SCREENINGS. Find solutions to achieve the objectives of the French ten-year strategy against cancers is one of the challenges of the changes to come in the three French organized screening (OS) programs. We present an inventory of screenings and innovations that illustrates these issues and proposals to address them. The integration of innovations in breast cancer screening, organizational changes in colorectal and cervical cancer screening, personalization of screening according to individual level of risk or new OS programs targeting other cancers, such as lung cancer, are among the changes discussed to improve the efficiency and effectiveness of cancer screenings. The recent recommendations of the Council of the European Union reinforce the French orientations.

NOUVEAUTÉS DANS LE DÉPISTAGE DES CANCERS EN. France Répondre aux défis de la Stratégie décennale de lutte contre les cancers est un des enjeux de l'évolution des trois programmes de dépistage organisé (DO) français. Un état des lieux des dépistages et des innovations se propose d'illustrer ces enjeux et les perspectives pour y faire face. Pour améliorer l'efficience et l'efficacité des dépistages, plusieurs pistes sont notamment envisagées et évaluées : intégration des innovations dans le dépistage du cancer du sein, modification des organisations des dépistages du cancer colorectal et du col de l'utérus, personnalisation du dépistage en fonction du niveau de risque des individus, ou encore déploiement de futurs programmes de DO ciblant des cancers d'autres localisations, comme le cancer du poumon. Les recommandations récentes du Conseil de l'Union européenne viennent conforter les orientations françaises.

Cost-effectiveness analysis of alternative colorectal cancer screening strategies in high-risk individuals.

BACKGROUND AND AIMS: Current guidelines recommend colonoscopy every 3-5 years for colorectal cancer (CRC) screening of individuals with a familial history of CRC. The objective of this study was to compare the cost effectiveness of screening alternatives in this population. METHODS: Eight screening strategies were compared with no screening: fecal immunochemical test (FIT), Stool DNA and blood-based screening every 2 years, colonoscopy, computed tomography colonography, colon capsules, and sigmoidoscopy every 5 years, and colonoscopy at 45 years followed, if negative, by FIT every 2 years. Screening test and procedures performance were obtained from the literature. A microsimulation model reproducing the natural history of CRC was used to estimate the cost (€2018) and effectiveness [quality-adjusted life-years (QALYs)] of each strategy. A lifetime horizon was used. Costs and effectiveness were discounted at 3.5% annually. RESULTS: Compared with no screening, colonoscopy and sigmoidoscopy at a 30% uptake were the most effective strategy (46.3 and 43.9 QALY/1000). FIT at a 30 µg/g threshold with 30% uptake was only half as effective (25.7 QALY). Colonoscopy was associated with a cost of €484,000 per 1000 individuals whereas sigmoidoscopy and FIT were associated with much lower costs (€123,610 and €66,860). Incremental cost-effectiveness rate for FIT and sigmoidoscopy were €2600/QALY (versus no screening) and €3100/QALY (versus FIT), respectively, whereas it was €150,000/QALY for colonoscopy (versus sigmoidoscopy). With a lower threshold (10 µg/g) and a higher uptake of 45%, FIT was more effective and less costly than colonoscopy at a 30% uptake and was associated with an incremental cost-effectiveness ratio (ICER) of €4240/QALY versus no screening. CONCLUSION: At 30% uptake, current screening is the most effective screening strategy for high-risk individuals but is associated with a high ICER. Sigmoidoscopy and FIT at lower thresholds (10 µg/g) and a higher uptake should be given consideration as cost-effective alternatives. PLAIN LANGUAGE SUMMARY: Cost-effectiveness analysis of colorectal cancer screening strategies in high-risk individuals Fecal occult blood testing with an immunochemical test (FIT) is generally considered as the most cost-effective alternative in colorectal cancer screening programs for average risk individuals without family history.Current screening guidelines for high-risk individuals with familial history recommend colonoscopy every 3-5 years.Colonoscopy every 3-5 years for individuals with familial history is the most effective strategy but is associated with a high incremental cost-effectiveness ratio.Compared with colonoscopy, if screening based on FIT is associated with a higher participation rate, it can achieve a similar effectiveness at a lower cost.

Cost-effectiveness analysis of alternative colon cancer screening strategies in the context of the French national screening program.

BACKGROUND: A nationwide colorectal cancer (CRC) screening program was set up in France from 2009 for average-risk, asymptomatic people aged 50-74 years based on an immunochemical fecal occult blood test [faecal immunochemical test (FIT)] every 2 years, followed by colonoscopy if positive. The European standard recommends a participation rate of 45% for the program to be cost-effective, yet the latest published rate in France was 34%. The objective of this study was to compare the cost effectiveness of screening alternatives taking real-world participation rates into account. METHODS: Eight screening strategies were compared, based either on a screening test (Guaiac or FIT testing, blood-based, stool DNA, computed tomography colonography, colon capsules, and sigmoidoscopy) followed by full colonoscopy if positive or direct colonoscopy. A microsimulation model was used to estimate the cost effectiveness associated with each strategy. RESULTS: Compared with no screening, FIT was associated with a 14.0 quality-adjusted life year (QALY) increase of €50,520 per 1000 individuals, giving an incremental cost-effectiveness ratio (ICER) of €3600/QALY. Only stool DNA and blood-based testing were associated with a QALY increase compared with FIT, with stool DNA weakly dominated by blood-based testing, and the latter associated with an ICER of €154,600/QALY compared with FIT. All other strategies were dominated by FIT. CONCLUSION: FIT every 2 years appears to be the most cost-effective CRC screening strategy when taking into account a real-world participation rate of 34%.

Laurus nobilis, Zingiber officinale and Anethum graveolens Essential Oils: Composition, Antioxidant and Antibacterial Activities against Bacteria Isolated from Fish and Shellfish.

Several bacterial strains were isolated from wild and reared fish and shellfish. The identification of these strains showed the dominance of the Aeromonas hydrophila species in all seafood samples, followed by Staphylococcus spp., Vibrio alginolyticus, Enterobacter cloacae, Klebsiella ornithinolytica, Klebsiella oxytoca and Serratia odorifera. The isolates were studied for their ability to produce exoenzymes and biofilms. The chemical composition of the essential oils from Laurus nobilis leaves, Zingiber officinale rhizomes and Anethum graveolens aerial parts was studied by GC and GC/MS. The essential oils' antioxidant and antibacterial activities against the isolated microorganisms were studied. Low concentrations of the three essential oils were needed to inhibit the growth of the selected bacteria and the lowest MBCs values were obtained for the laurel essential oil. The selected essential oils can be used as a good natural preservative in fish food due to their antioxidant and antibacterial activities.

"Cancer Survivors" as Voluntary Helpers in Cancer Associations in France. Limits of the Balance between Service Offer and Social Demand.

Historically, in France, cancer associations have been managed by doctors. Despite this, the French healthcare system has increasingly encouraged them to attract voluntary helpers who are not health workers. This development has given rise to the question of the competence and legitimacy of voluntary workers in cancer associations. The aim of the present study was to identify the skills possessed by voluntary helpers who have survived the disease and the extent to which their skills meet the needs of cancer associations in responding to the demands that have emerged in this new context. This is a qualitative study based on data collected during semi-directed interviews, focus group sessions and on-site observations in a variety of French cancer associations. Categorical and thematic analyses were then carried out separately for each ethnographic method used. The study showed that because the commitment of survivor voluntary helpers derives from their own experience of the disease, it is inconsistent with the fulfilment of the association's collective aims, such as the search for funding or project development. These helpers nevertheless play an important role that involves a special link between the individual and the group, between the community and society. To conclude, "involved" volunteers have to reconcile their individual expectations with the association's collective aims.