[Alcohol, tobacco and colorectal adenomas and cancer. Case-control study in a population with positive fecal occult blood tests]. / Le tabac et l'alcool augmentent le risque d'adénomes et de cancers colorectaux. Etude comparant 3292 cas avec 5456 témoins dans une population à risque moyen ayant eu un test de dépistage de sang dans les selles positif.

OBJECTIVE: To analyze the associations between lifestyle factors and colorectal adenomas or cancers in a population 50-74 years old. METHOD: The study population underwent colonoscopy after positive fecal occult blood test in Health examination centers of the French general health insurance. The two sets of cases (n= 674 cancers, n=2618 adenomas) were compared with controls (n=5456). Associations between risk of colorectal disease and health data (mainly tobacco and alcohol consumption, physical activity, obesity, and laboratory test results) were analyzed with logistic regression models to estimate odds ratios. RESULTS: The probability of colorectal cancer or adenoma was statistically associated with age (60 years or older in men and women). A significant relation between these diseases was observed with smoking (in both smokers and ex-smokers) and with alcohol consumption, with odds ratios above 1.30. The other risk factors studied were not significantly associated with these colorectal diseases. CONCLUSION: This result provides still more evidence of the need for actions against these risk behaviors.

Colorectal cancer screening in Health Examination Centers.

OBJECTIVES: The aim of this study was to describe the results of colorectal cancer screening performed in the Health Examination Centers of the French general health insurance system. METHODS: The population consisted of 1,262,833 subjects (52.6% men) aged 50 to 74 years old who attended periodic health consultations from 1998 to 2003 in 89 Health Examination Centers in France. Subjects with increased risk for colorectal cancer and subjects with a positive fecal occult blood test (Hemoccult II') were invited to undergo colonoscopy. Subsequent follow-up and diagnostic data were collected. RESULTS: Prior screening practices for colorectal cancer (recent colonoscopy or fecal occult blood test, local screening campaign) were noted in 18% of the subjects attending Health Examination Center consultations. High risk for colorectal cancer (familial or personal factor) without ongoing surveillance or prior screening was observed in 3% of the study population. A fecal occult blood test was proposed to 79% of the population and of them, 89% effectively performed the test: 3.2% of tests were positive. A follow-up protocol was initiated for 63,357 subjects. A colonic exploration was performed in 69% of high-risk subjects and enabled detection of cancer in 85 and adenomas in 1683. A colonic exploration was performed in 88% of subjects with a positive fecal occult blood test and enabled detection of 674 cancers (positive predictive value of fecal occult blood test (PPV)=4.7%) including 174 Dukes A, and 2618 adenomas (PPV=18%) including 776 adenomas measuring more than 10 mm (PPV=5.4%). CONCLUSION: This study confirms the importance of implementing organized screening practices within Health Examination Centers before undertaking a generalized screen campaign targeting the entire French population.

[Colorectal cancer: assessment of two-yearly screening of the population in health care examination centres]. / Cancer colorectal: évaluation du dépistage biennal dans la population des centres d'examens de santé

OBJECTIVE: To present the first assessment of the two-yearly faecal occult blood test used to screen patients attending health care centres for examinations. Method The Hemoccult II test was proposed by correspondence to 26 530 subjects aged 52-74 years, having exhibited a negative test during their periodical check-up 2 years before. RESULTS: The test was performed by 20 590 subjects and the corrected participation rate, taking into account unjustified sending, was of 83.1%. The positivity rate was 3.5%. In the 519 colonoscopies performed (71% of positive Hemoccult II), 23 cancers and 91 adenomas (31 larger than 1 cm) were observed (positive predictive value=22%). In 213 subjects, the information on the follow-up of the positive Hemoccult II were unavailable or unexploitable (lost to follow-up, coloscopy refused, inappropriate examinations). DISCUSSION: These results show that the two-yearly screening for colorectal cancer in an informed population after a periodical check-up results in a good participation rate. The follow-up rate of positive subjects, fundamental for the assessment of the program, is lower than during the regular check-up but remains relatively satisfactory.

[Mammography use among women aged 35 to 75 years]. / Pratiques de la mammographie chez les femmes de 35 à 75 ans: étude descriptive dans la population consultant les centres d'examens de santé.

The aim of the study was to evaluate mammography use and indications (diagnosis or screening) among 19,253 women aged 35 to 75 attending a health screening centre. The data were collected by a self-administered questionnaire completed after by an interview with a nurse. Mammography use is frequent in women attending a health screening centre, even before the age of 50: 79.1% had undergone at least one mammography during their life and for 47.3% a screen had been performed within the last three years. Nevertheless mammography was only used by 65.2% of the women aged 50-69 years, target age group of the screening programme. A logistic regression model adjusting for multiple variables was used to examine factors associated with women who underwent a screen within the last three years. Women more likely to be screened were aged 50-69 (vs age 35-49: OR=3.1), used regular gynaecological care (OR=4.5), had a family history of breast cancer (OR=1.45), had in their district a breast cancer screening campaign (OR=1.93). The study indicated that women under 50 years of age with a family history of breast cancer and women aged 70 and over were under-screened. When a campaign for breast cancer screening was organised in the district the screening rates were higher in the target population (71,4% vs 60,1%) although only 64% of the women reported having attended. Current recommendations for breast cancer screening should be reviewed in the light of these results.