[Estimated impact of the current colorectal screening program in France]. / Estimation de l'impact du programme actuel de dépistage organisé du cancer colorectal.

BACKGROUND: Colorectal cancer is the third most common cancer and the second most deadly in France. A Cochrane meta-analysis has confirmed the benefits of colorectal cancer screening. A nationwide colorectal screening program was set up in France in 2009 for medium-risk, asymptomatic people aged 50 to 74 years. It has been based, since 2015, on the Fecal Immunochemical Test. The participation rate for 2016-2017 was 34%, which is lower than the European objectives. The objective of this study was to evaluate the impact of the program at the current participation rate and at rates of 45% and 65%. METHODS: The epidemiological impact of the program was estimated from the results of an individual simulation model adapted from the Microsimulation Screening Analysis Colon model, calibrated and transposed to the French context. An initial analysis was conducted to estimate the individual impact of screening and a second for the entire eligible population, at various participation rates. RESULTS: The test is associated with a lifetime reduction in the risk of colorectal cancer of 24% for men and 21% for women, and a reduction in the risk of death from colorectal cancer of 51% and 43% respectively. At the current level of participation, the program reduces incidence by 5% and mortality by 14% compared to no organized screening. The impact would be reduced by an additional 3% and 8% for participation rates of 45% and 65% respectively. Similarly, mortality would decrease by an additional 8% and 22%. CONCLUSION: These results confirm that in a population at medium risk for colorectal cancer, the organised programme is an effective strategy for reducing its incidence. They also confirm that the achievement of European objectives remains a key issue for improving the effectiveness of organized screening. An evolution of immunological test delivery modalities could help to achieve these participation objectives.

Decision-making in fecal occult blood test compliance: A quali-quantitative study investigating motivational processes.

The qualitative-quantitative study investigates the co-existence of barriers and levers to FOBT screening in 5894 individuals reluctant to be screened, identifying operational motivational patterns that may increase screening compliance. Co-occurrence analysis was performed according to three motivational conditions (barriers, levers, or both).Cluster analysis then identified motivational predictors of effective screening. One quarter of the individuals who had refused screening nevertheless expressed at least one motivation towards FOBT. As such, co-existence of barriers and levers within the same individual demonstrates ambivalence tendencies. Intrinsic motivations appear to be the most likely to increase FOBT compliance. This study finds that certain factors well-known to improve CRC screening compliance generally, may not have much impact on reluctant individuals due to ambivalence and contextual nuances. Several practical recommendations to encourage screening participation are offered, such as focusing on levers rather barriers, providing tailored education to improve awareness and readiness, and fostering intrinsic motivation with relevant approaches.

Design and validation of a self-administered questionnaire as an aid to detection of occupational exposure to lung carcinogens.

OBJECTIVE: Ten to thirty percent of lung cancer is thought to be of occupational origin. Lung cancer is under-declared as an occupational disease in Europe, and most declarations of occupational disease concern asbestos. The purpose of this study was to design and validate a short, sensitive self-administered questionnaire, as an aid for physicians in detecting occupational exposure to asbestos and other lung carcinogens in order to remedy occupational lung cancer under-declaration. STUDY DESIGN: Cross-sectional study. METHODS: A short (30-question) self-administered questionnaire was drawn up by oncologist-pneumologists and occupational physicians, covering situations of exposure to proven and probable lung carcinogens. Understanding and acceptability were assessed on 15 lung cancer patients. Validity and reliability were assessed on 70 lung cancer patients by comparison against a semi-directive questionnaire considered as gold standard. Sensitivity and specificity were assessed by comparing responses to items on the two questionnaires. Reliability was assessed by analysing the kappa concordance coefficient for items on the two questionnaires. RESULTS: Sensitivity was 0.85 and specificity 0.875. Concordance between responses on the two questionnaires was 85.7%, with a kappa coefficient of 0.695 [0.52-0.87]. Mean self-administration time was 3.1 min (versus 8.12 min to administer the gold-standard questionnaire). In 16 patients, the self-administered questionnaire detected lung carcinogen exposure meeting the criteria for occupational disease. CONCLUSION: The present short, easy-to-use self-administered questionnaire should facilitate detection of occupational exposure to lung carcinogens. It could be used in occupational lung cancer screening and increase the presently low rate of application for recognition of lung cancer as an occupational disease.

Tailored telephone counselling to increase participation of underusers in a population-based colorectal cancer-screening programme with faecal occult blood test: A randomized controlled trial.

BACKGROUND: Despite the involvement of general practitioners, the mailing of several recall letters and of the faecal occult blood test (FOBT) kit, the uptake remains insufficient in the French colorectal cancer-screening programme. Some studies have demonstrated a greater efficacy of tailored telephone counselling over usual care, untailored invitation mailing and FOBT kit mailing. We evaluated the feasibility and the effectiveness of telephone counselling on participation in the population-based FOBT colorectal cancer-screening programme implemented in Alsace (France). METHODS: Underusers were randomized into a control group with untailored invitation and FOBT kit mailing (n=19,756) and two intervention groups for either a computer-assisted telephone interview (n=9367), system for tailored promotion of colorectal cancer screening, or a telephone-based motivational interview (n=9374). RESULTS: Only 5691 (19.9%) people were actually counseled, so that there was no difference in participation between the intervention groups taken together (13.9%, 95% confidence interval [CI] [13.5-14.4]) and the control group (13.9%, 95% CI [13.4-14.4]) (P=1.0) in intent-to-treat analysis. However, in per-protocol analysis, participation was significantly higher in the two intervention groups than in the control group (12.9%, 95% CI [12.6-13.2]) (P<0.01), with no difference between computer-assisted telephone interview (24.6%, 95% CI [22.7-26.4]) and motivational interview (23.6%, 95% CI [21.8-25.4]) (P=0.44). CONCLUSION: There was no difference of effectiveness between tailored telephone counselling and untailored invitation and FOBT kit mailing on participation of underusers in an organized population-based colorectal cancer screening programme. A greater efficacy of telephone counselling, around twice that of invitation and FOBT kit mailing, was observed only in people who could actually be counseled, without difference between computer-assisted telephone interview and motivational interview. However, technical failures hampered telephone counselling, so that there was no difference in intent-to-treat analysis. The rate of technical success of telephone interviews should be evaluated, and enhanced if insufficient, before implementation of telephone counselling in population-based cancer screening programmes.

Predictors of adherence to repeat fecal occult blood test in a population-based colorectal cancer screening program.

BACKGROUND: Socio-economic, environmental factors and general practitioner (GP) involvement may influence adherence to repeat faecal occult blood testing (FOBT) of organised colorectal cancer (CRC) screening. The aim of the study was to identify predictors of adherence to repeat testing. METHODS: The populationcomprised people eligible for the third round of a CRC screening programme in a French district (n=118,905). Multilevel logistic regression analysis was performed to identify individual and area-level characteristics associated with 'compliant participants' participating in the all three rounds vs 'occasional participants' participating in one or two rounds. RESULTS: Compared to 'occasional participants', 'compliant participants' were more likely to participate after receiving a FOBT kit from their GP (odds ratio (OR), 10.7; 95% CI, 10.01-11.5) vs FOBT received at home, and were less likely to live in socio-economically deprived areas (OR, 0.75; 0.70-0.80) and urban areas (OR, 0.94; 0.88-1.00). CONCLUSIONS: As for a screening round participation, strategies aimed at improving the participation to a screening programme should target GPs and people living in socially deprived areas.

Colorectal cancer screening with the addition of flexible sigmoidoscopy to guaiac-based faecal occult blood testing: a French population-based controlled study (Wintzenheim trial).

OBJECTIVE: To assess the feasibility, participation and neoplasia yield of adding a flexible sigmoidoscopy (FS) once in a lifetime to a colorectal cancer screening programme with guaiac-based faecal occult blood test (gFOBT). METHODS: A total of 4771 average risk residents aged 50-74 of a canton of the Haut-Rhin, a French administrative area, were invited every other year to participate in an organised screening programme with gFOBT. Of them, those aged 55-64 (1824 people) were, in addition, invited once by mail to visit their general practitioner (GP) for a screening with FS performed by a gastroenterologist. RESULTS: In all, 2717 people (56.9%) (95% confidence interval (CI) 55.5-58.4) were screened with one or other of the two tests or with both tests. Compliance was 56.7% (55.3-58.1) with gFOBT and 20.9% (19.1-22.8) with FS. Both tests were performed by 20.2% (18.4-22.1) of people. Compliance with FS was 1.9% in people who had not complied with gFOBT and 31.9% in people who complied. The latter was 50% in patients of 26 motivated GPs. The detection rate for advanced neoplasia was 17.7 per 1000 people screened (12.7-22.6) with the combined procedure, more than three times higher than that with gFOBT alone. CONCLUSION: A population-based screening programme with the addition of FS to gFOBT is feasible and safe through an organisation involving GPs. The performances of the two screening tools are complementary: high compliance - low yield for gFOBT and vice versa for FS. The addition of a single FS screening in people aged 55-64 to an organised programme with biennial gFOBT in people aged 50-74 is a colorectal cancer screening option that deserves further exploration.

Pharmacodynamic effects of acamprosate on markers of cerebral function in alcohol-dependent subjects administered as pretreatment and during alcohol abstinence.

Animal studies suggested that acamprosate modulates neuronal hyperexcitability of acute alcohol withdrawal, acting through the glutamatergic neurotransmission. In the present study, we further investigated whether treatment with acamprosate could attenuate the post-alcohol withdrawal hyperexcitability or hyperarousal in humans using brain magnetoencephalography mapping of spontaneous fields. A double-blind, randomised, placebo-controlled study with a parallel group design comparing 2,000 mg/day of acamprosate versus placebo was conducted in alcohol-dependent subjects meeting DSM-IV criteria for alcohol dependence. Treatments were initiated 8 days before alcohol withdrawal and prolonged during the 15 following (abstinence) days. The study demonstrated that during alcohol withdrawal, acamprosate decreased the arousal level as reflected by alpha slow-wave index (ASI) measurement. This effect was mostly evidenced in left parietotemporal regions and, to a lesser extent, in the contiguous anterior, posterior and right-sided regions. In the placebo group, on the contrary, ASI measures increased between day 2 (acute withdrawal) and day 14 (prolonged withdrawal). The present results suggest a sustained effect of acamprosate on the hyperexcitability state due to alcohol withdrawal in alcohol-dependent patients and that acamprosate may have a protective effect when administered 8 days before alcohol withdrawal.

[Current epidemiology of vulvar cancer]. / Epidémiologie actuelle des cancers de la vulve.

Cancer of the vulva is a rare disease accounting for only 3 to 5% of all gynaecologic cancers. The incidence rates of this cancer vary depending upon the country considered, the lowest rates being reported for Asian and African populations. An increased incidence of in situ carcinomas of the vulva has been noted recently among young women. In this population, the risk factors are: a young age at first sexual intercourse, multiple sexual partners, a low socio-cultural level, previous infection by human papilloma virus (HPV) and smoking. An association has also been found with other types of cancers, either in relation with HPV-infection or with tobacco use. In contrast, older women are usually diagnosed with advanced-stage, squamous or keratinous invasive forms of the disease with no clear link with either smoking experience or previous HPV-infection.

[Endometrial cancer and tamoxifen. Discussion apropos of a series of cases]. / Cancer de l'endomètre et tamoxifène. Discussion à partir d'une série de cas.

Tamoxifen is widely used nowadays in the management of breast cancer, having established its efficacy in this indication, especially for postmenopausal patients with ER-positive breast tumours. However, tamoxifen has recently been recognized as carcinogenic for the human endometrium, probably with an effect of duration of treatment. Moreover, this drug may be associated with the occurrence of endometrial cancers of unusual histological types and/or of a more aggressive nature. We describe a case series of 11 patients who developed such cancers after having previously received tamoxifen for breast cancer. Several assumptions on the mechanisms underlying the attributed carcinogenic properties of tamoxifen, for the endometrium and potentially for other organs, are discussed on the basis of current knowledge.

The role of physical exercise in the occurrence of Parkinson's disease.

A case-control study of Parkinson's disease and physical exercise was conducted in a cohort of 50,002 men who attended Harvard College (Cambridge, Mass) or the University of Pennsylvania (Philadelphia) between 1916 and 1950 and were followed up in adulthood for morbidity and mortality data. Cases of Parkinson's disease were identified from responses to mailed questionnaires and death certificates through 1978. Four controls from the same population were selected for each case. The association between physical activity at the time of college and subsequent risk of Parkinson's disease was evaluated for 137 cases and 548 controls, whereas the data on physical activity in adulthood before the disease occurrence was available only for 94 of these cases. Having belonged to a varsity team or having done regular physical exercise in college was associated with a lower nonsignificant risk of Parkinson's disease. In adulthood, practice of moderate or heavy sports was linked to a reduced risk, although more precise analysis revealed that there was only a modest nonsignificant reduction in risk for subjects who do a moderate amount of physical exercise, but this negative association disappears at higher levels of physical expenditure. These results, which require further confirmation, are compatible with a slight protective effect of physical exercise on the risk of Parkinson's disease, although the lack of association cannot be refuted.