Breast cancer time to treatment in Martinique: predictive factors and effect on survival.

BACKGROUND: Martinique is the second French Region with the lowest physician-to-population ratio, which may affect waiting times for access to care. OBJECTIVES: To assess (i) factors influencing waiting times from diagnosis to cancer-related treatments in breast cancer women in Martinique, and (ii) the impact of waiting times on patients' survival. STUDY DESIGN: Retrospective observational study. METHODS: Data on women diagnosed with invasive breast cancer between 1st January 2013 and 31st December 2017 and initially treated by surgery were extracted from the Martinique population-based registry. A cox model was performed to find predictive factors for waiting times. A log-rank test was used to compare time-to-treatment between groups. RESULTS: In total, 713 patients were included (mean age: 58 ± 13). Median time from diagnosis to surgery was 40 [25-60] days. Age at diagnosis was found to predict variations in waiting times. Patients > 75 had longer waiting time to surgery than those < 40 or [40-50] (P = 0.016 and P < 0.001, respectively). Women with a time-to-treatment ≥ 4 months had a significant lower survival (P < 0.01). CONCLUSIONS: Specific interventions are needed to improve waiting time from diagnosis to initial treatment, as they are longer than recommended and affect survival time.

Epidemiology and survival of cervical cancer in the French West-Indies: data from the Martinique Cancer Registry (2002-2011).

BACKGROUND: The Caribbean ranks seventh among world regions most affected by cervical cancer. Social health inequalities, such as differences in access to screening services, engender disparities in incidence and mortality between low- and middle-income countries and industrialized countries. The French National Cancer Plan 2014-2019 focuses on reducing inequalities in cervical cancer. OBJECTIVE: The aim of this study was to describe the geographical distribution and overall survival of cervical cancer, based on data from a population-based cancer registry in Martinique (French West-Indies). METHODS: We included all cases of cervical cancer diagnosed between 2002 and 2011. The geographical distribution was described by zone of residence and by aggregated units for statistical information (IRIS). Based on the results of the model, standardized incidence rates (SIRs) were calculated using a Gamma Poisson model. Survival rates were calculated using the Kaplan-Meier method. Cox proportional hazards models were used to investigate the risk factors for cervical cancer mortality. RESULTS: A total of 1253 cases were analyzed (947 in situ tumors and 306 invasive cancers). 1230 cases with geolocalization were used to map the distribution of the incidence of in situ and invasive cervical cancers. Five IRIS were significantly over-incident. The 5-year overall survival rate was 55%, with a median survival of 6.5 years [95% CI: 4.9-10.1]. Multivariate analysis confirmed age at diagnosis (HR = 2.15 [1.50-3.09]; p < 0.0001), FIGO stage (HR = 3.53 [2.50-4.99]; p < 0.0001) and zone of residence (HR = 1.51 [1.06-2.13]; p = 0.02) as risk factors. CONCLUSIONS: Prognostic factors suggest that cervical cancer needs to be diagnosed at an early stage. Our results could allow cervical cancer screening programs to clearly identify geographical areas that would benefit from targeted interventions with a view to reducing incidence and mortality of cervical cancer in the Caribbean.

Trends in colorectal cancer in the Caribbean: A population-based study in Martinique, 1982-2011.

BACKGROUND: We aimed to describe incidence and mortality from colorectal cancer, and temporal trends between 1982 and 2011 in Martinique (French West-Indies). METHODS: This was a descriptive, longitudinal, observational study based on data from the Martinique cancer registry. The study included all incident cases of colorectal cancer between 1982 and 2011. We recorded sociodemographic data and clinical variables (histology, site according to the WHO classification). Cancer cases were recorded in strict conformity with the international standards. Annual rate of change was calculated, direct standardisation was used for incidence and mortality age standardised rates (ASR). The comparative incidence figure and comparative mortality figure (95% confidence intervals) were calculated. RESULTS: In total, 2530 patients were included in our study; 1243 died. In the period 2007-2011, a considerable increase in incidence was observed, making colorectal cancer the second leading cause of cancer deaths in both sexes (8.9% and 10.5%). In men, ASR for incidence increased from 9.6/100,000 person-years in the period 1982-1986 to 27.2/100,000 person-years in the period 2007-2011, with a notable acceleration of the increase. In women, ASR increased from 8.4 to 19.8/100,000 person-years over the same periods. For the latest period 2007-2011, mortality rates were 9.9 and 7.6/100,000 person-years for men and for women respectively. Regardless of the sex, there was a strong increase in the incidence of right colon cancer, which became the most common colorectal site in women in Martinique. CONCLUSION: Our findings confirm the increase in the incidence of colorectal cancer that started in the 2000s. Trends observed reflect a salient epidemiological transition of the Caribbean.

[Colorectal cancers in Martinique: incidence and mortality rates over a period of 20 years]. / Cancers colorectaux en Martinique: incidence et mortalité durant une période de 20 ans.

BACKGROUND: Colorectal cancer is the second leading cause of cancer death in Western countries, with an incidence progressively increasing in developing countries. Worldwide, colorectal cancer is the second and third leading cause of death by cancer in females and males respectively. According to the Martinique Cancer Register data, colorectal cancer is the second leading cause of death by cancer in women, and the fourth in men. Colorectal cancer exhibits a variable distribution worldwide. This study was conducted to observe variations in colorectal incidence and mortality rates observed over a twenty-year period. Such data will be useful for monitoring changing trends related to onset of an organized screening program. METHOD: Patients with colorectal cancer diagnosed from 1981 to 2000 in Martinique were included in this study. Data are obtained from the Martinique Cancer Register. RESULTS: The incidence of colorectal cancer in Martinique (16/100,000 and 17/100,000 in the female and male population respectively in the year 2000) is intermediary compared with other countries worlwide. There is a current trend towards increased incidence and mortality. The incidence has increased for cancers localized in the proximal colon, the sigmoid colon and the rectum. CONCLUSION: The increasing incidence of colorectal cancer in all localisations raises concern in Martinique. A significant predominance of colorectal cancer incidence among the male population in Martinique was not observed. Gender and age do not appear to imply any preferential localisation of colorectal cancer.