[Patterns of health care delivery and breast cancer in the department of Isère in 1955]. / Filières de soins et cancer du sein dans le département de l'Isère en 1995.

BACKGROUND: Caring for cancer patients is expensive, warranting verification that health care organization works in a satisfactory way. A first step of this evaluation deals with the description of the pathway followed in the health care system by the patient. METHODS: 671 breast cancer cases were diagnosed in Isère in 1995. According to the place where each treatment (surgery, chemotherapy, radiotherapy) was performed, we described pathways for the patient, either entirely private, public or mixed. Characteristics of the patient (age, place of residence), of the disease (extent of disease, way of discovery) and of the physician (general practitioner, specialist) might have influenced the choice of this pathway. We described and tested the distribution of these characteristics within the 3 groups using univariate analysis. Relative risk of being affected to the private pathway compared to the public one was computed, after adjusting for age, type of physician, extent of disease, way of discovery and sanitary area, using a multivariate analysis (logistic regression). RESULTS: In the department of Isère, the private pathway cared for 55% of breast cancers, the public one 23% and the mixed one 19%. There was no preferential recruitment according to age, physician type, presence of metastasis or of the rural or urban residence. In sanitary area number 5, characterized by an important attraction of the patients by the nearby department of Rhône, 41% of the patients were cared for the private pathway, compared to 63% in sanitary area 4, where most patients were treated in the main town of Isère: Grenoble. After early breast cancer detection with mammography instead of breast cancer screening, probability of being cared for in the private pathway was 2-fold higher (OR = 2) than in the public one. CONCLUSION: In Isère department, early breast cancer detection with mammography is in favor of the private pathway. This is not true for physician type, neither for characteristics of the patient or extent of the disease. Finally, the distance to next department of oncology or radiotherapy plays a major role.

[Prevalence assessment of colorectal and breast cancers in the Rhône-Alpes area]. / Estimation de la prévalence des cancers colorectaux et du sein dans la région Rhône-Alpes.

Prevalence of malignant neoplasm is a basic health indicator used in order to evaluate needs in medical equipment for treatment and follow-up of cancer patients. Data on prevalence are regularly published by Northern European countries. Thames and Connecticut cancer registries. In France available information on prevalence are scanty, because follow-up of cancer patients is not easy. Therefore, we used a statistical method to evaluate prevalence from incidence and mortality in the Rhône-Alpes area (France, 5,300,000 inhabitants) in 1990, using the department of Isère population based registry. For females, figures for breast carcinoma and colorectal carcinoma are respectively 25,000 and 5,700, and, for males, 5,700 colorectal carcinoma. For 5 year partial prevalence, these figures are respectively 11,300, 3,100 and 3,500. The ratio prevalence/incidence is 8.9 for breast in females, 5.8 for colorectal carcinoma in females and 4.8 for colorectal carcinoma in males with a steep decrease for 5 year partial prevalence (4 for breast carcinoma, 3.1 for females colorectal carcinoma and 2.9 for males colorectal carcinoma). These ratios are consistent with those observed elsewhere in Europe.

[Use of population based registries in developing a regional medical program against cancer. Example of the Rhone-Alpes region]. / Utilisation des données des registres pour la réalisation d'un Schéma régional d'Organisation Sanitaire en cancérologie. Exemple de la région Rhône-Alpes.

The need for public health planning in France, recently led to the development of a Regional Program in Public Health Organisation (SROS) to describe geographical distribution of facilities and health care activities, in accordance with population needs. Isere Cancer Registry, using its own mortality and morbidity data, evaluated incidence (16,000 new cases each year) and prevalence (100,000 cases) in the Rh-one-Alpes area. Thus, knowing incidence and prevalence of cancer within each district by age and sex, it became much easier for public and private hospitals to quantify their future activities. Today, French cancer registries are conducting methodological studies to improve prevalence estimates, in order to use them in predicting future costs of health care in oncology.