Endometrial cancer risk and trends among distinct African descent populations.

BACKGROUND: Endometrial cancer (EC) is the fourth most common cancer among Black women in the United States, a population disproportionately affected by aggressive nonendometrioid subtypes (e.g., serous, carcinosarcoma). To examine EC vulnerability among a wider spectrum of African descent populations, a comparison between Black women residing in different countries, rather than in the United States alone, is needed. METHODS: The authors analyzed 34,789 EC cases from Florida (FL) (2005-2018), Martinique (2005-2018), and Guadeloupe (2008-2018) based on cancer registry data. Age-adjusted incidence rates, incidence rate ratios (IRRs), and annual percent changes (APC) in trends were estimated for Black populations residing in the United States (non-Hispanic Blacks [NHB]) and Caribbean. The US non-Hispanic White (NHW) population was used as a reference. RESULTS: Caribbean Black women had the lowest rates for endometrioid and nonendometrioid subtypes. Nonendometrioid types were most common among US (FL) NHBs (9.2 per 100,000), 2.6 times greater than NHWs (IRR, 2.60; 95% confidence interval [CI], 2.44-2.76). For endometrioid EC, rates increased 1.8% (95% CI, 0.1-3.5) yearly from 2005 to 2018 for US (FL) NHBs and 1.2% (95% CI, 0.9-1.6) for US (FL) NHWs whereas no change was observed for Caribbean Blacks. For nonendometroid carcinomas, rates increased 5.6% (95% CI, 4.0-7.2) among US (FL) NHB, 4.4% (95% CI, 0.3-8.6) for Caribbean Black, and 3.9% for US (FL) NHW women (95% CI, 2.4-5.5). CONCLUSIONS: Lower rates of nonendometrioid EC among Caribbean Black women suggest that vulnerability for these aggressive tumor subtypes may not currently be an overarching African ancestry disparity. Most importantly, there is an alarmingly increasing trend in nonendometrioid across all populations studied, which warrants further surveillance and etiological research for this particular subtype. PLAIN LANGUAGE SUMMARY: We analyze population-based incidence rates and trends of endometrial cancer (EC) for African descent populations residing in different countries (i.e., United States, Martinique, Guadeloupe) to examine whether EC vulnerability among Black women is socio-environmental or more ancestry-specific in nature. The increased EC risk was not uniform across all Black women since the Caribbean had the lowest rates (for endometrioid and nonendometrioid histology subtypes). Regardless, from 2005 to 2018, there was an increasing trajectory of nonendometrioid EC for all groups, regardless of race.

Trends in Scientific Publications for the French West Indies and the Dominican Republic from 1990 through 2019: Infectious Diseases.

OBJECTIVE: The French West Indies (FWI) and the Dominican Republic (DR) are also, by virtue of their geographical positions, exposed to infectious diseases. The objective of this study was to describe trends in scientific publication for the FWI and the DR using bibliometric analysis, to describe existing international collaborations for each site, and to identify directions for potential collaboration between the 2 sites. METHODOLOGY: Using data (publications from 1990-2019) from the Web of Science and PubMed databases, a bibliometric analysis was performed. Three bibliometric indicators were used: quantitative, performance, and organization-specific. RESULTS: There were 3599 articles published in the indicated span of time, with at least 1 author affiliated with either the FWI (N = 2552) or the DR (N = 1047). Journals ranked in the first quartile, which represent the highest quality journals in each Journal Citation Record category, were the most strongly represented, (38% for the FWI and 50.32% for the DR). In terms of the FWI publications, authors from mainland France were the primary collaborators (1754, 35%); for publications from the DR, the US provided the largest number of collaborators (898; 43%). The infectious disease category predominated, with 2 clusters emerging: arbovirus infections (FWI) and HIV infection (DR). CONCLUSION: This study is one of the first to perform a bibliometric analysis of the 30-year scientific output of the FWI and the DR. Both sites published articles about infectious diseases, indicating that this might be a strong area for future collaborations.

Association between sexual behaviour and head and neck cancer in the French West Indies: a case-control study based on an Afro-Caribbean population.

BACKGROUND: Worldwide, a significant proportion of head and neck cancers is attributed to the Human papillomavirus (HPV). It is imperative that we acquire a solid understanding of the natural history of this virus in head and neck squamous cell carcinoma (HNSCC) development. Our objective was to investigate the role of sexual behaviour in the occurrence of HNSCC in the French West Indies. Additionally, we evaluated the association of high risk of HPV (Hr-HPV) with sexual behaviour in risk of cancer. METHODS: We conducted a population-based case-control study (145 cases and 405 controls). We used logistic regression models to estimate adjusted odds-ratios (OR), and their 95% confidence intervals (CI). RESULTS: Compared to persons who never practiced oral sex, those who practiced at least occasionally had a lower HNSCC risk. First sexual intercourse after the age of 18 year was associated with a 50% reduction of HNSCC risk, compared to those who began before 15 years. HNSCC risk was significantly reduced by 60% among persons who used condoms at least occasionally. The associations for ever condom use and oral sex were accentuated following the adjustment for high-risk HPV (Hr-HPV). Oral Hr-HPV was associated with several sexual behaviour variables among HNSCC cases. However, none of these variables were significantly associated with oral HPV infections in the population controls. CONCLUSION: First intercourse after 18 years, short time interval since last intercourse and ever condom use were inversely associated with HNSCC independently of oral Hr-HPV infection. Sources of transmission other than sexual contact and the interaction between HPV and HIV could also play a role in HNSCC etiology.

Trends in prostate cancer incidence among Black men in the Caribbean and the United States.

BACKGROUND: Prostate cancer incidence is highest for Black men of the African diaspora in the United States and Caribbean. Recent changes in recommendations for prostate cancer screening have been shown to decrease overall prostate cancer incidence and increase the likelihood of late stage disease. However, it is unclear how trends in prostate cancer characteristics among high risk Black men differ by geographic region during the changes in screening recommendations. METHODS: In this study, we used population-based prostate cancer registry data to describe age-adjusted prostate cancer incidence trends from 2008 to 2015 among Black men from six geographic regions. We obtained data on incident Black prostate cancer patients from six cancer registries (in the United States: Florida, Alabama, Pennsylvania, and New York; and in the Caribbean: Guadeloupe and Martinique). After age standardization, we used descriptive analyses to compare the demographics and tumor characteristics by cancer registry site. The Joinpoint regression program was used to compare the trends in incidence by site. RESULTS: A total of 59,246 men were analyzed. We found the highest incidence rates (per 100,000) for prostate cancer in the Caribbean countries (181.99 in Martinique and 176.62 in Guadeloupe) and New York state (178.74). Incidence trends decreased significantly over time at all sites except Martinique, which also showed significantly increasing rates of late stage (III/IV) and Gleason score 7+ tumors. CONCLUSIONS: We observed significant differences in prostate cancer incidence trends among Black men after major changes prostate screening recommendations. Future studies will examine the factors that differentially influence prostate cancer trends among the African diaspora.

Lung Cancer in the French West Indies: Role of Sugarcane Work and Other Occupational Exposures.

OBJECTIVE: Our aim was to study the role of occupational exposures in lung cancer risk in the French West Indies, with special attention to some specific activities, such as sugarcane work, that can only be studied in a limited number of populations. METHODS: We used data from a population-based case-control study that included 147 incident lung cancer cases and 405 controls. Smoking histories and detailed occupational histories with descriptions of tasks and substances were collected by questionnaire during face-to-face interviews. Odds ratios (OR) adjusted for sex, age, region, smoking status, and cigarette pack-years and 95% confidence intervals (95% CI) were estimated by unconditional logistic regression. RESULTS: Significantly increased risks of lung cancer were found in sugarcane farm workers (OR = 2.7; 95% CI 1.1-6.6) and more generally in the sugarcane-growing sector (OR = 2.5; 95% CI 1.0-6.3) and to a lesser extent in rum production. Elevated risks of lung cancer were also observed among other agricultural workers, painters, warehouse porters, labourers, and maintenance and motor vehicle repair workers. Exposure to herbicides in sugarcane cultivation was associated with an increased risk of lung cancer (OR = 2.6; 95% CI 0.9-7.6). CONCLUSION: These results show that occupational exposures contributed to lung cancer risk in the French West Indies, and highlighted the role of exposures related to sugarcane work.

Vaccine effectiveness against severe COVID-19 outcomes within the French overseas territories: A cohort study of 2-doses vaccinated individuals matched to unvaccinated ones followed up until September 2021 and based on the National Health Data System.

IMPORTANCE: Although several observational studies on the effectiveness of SARS-CoV-2 vaccination have been published, vaccination coverage by August, 3 2021, remained low in the French overseas territories, despite Martinique and Guadeloupe experiencing an unprecedented number of COVID-19-related hospitalizations. We aimed to determine the association between COVID-19 vaccination and severe COVID-19 in the French overseas territories. METHODS: The French National Health Data System was used to conduct a 1:1 matched-cohort study. For each individual receiving a first dose of BNT162b2, mRNA-1273, ChAdOx1 nCoV-19, or Ad26.COV2-S vaccine between December 27, 2020, and July 31, 2021, one unvaccinated individual was randomly selected and matched for year of birth, sex, and overseas territories on the date of vaccination. We estimated vaccine effectiveness against COVID-19-related hospitalization and in-hospital death after a full vaccination schedule, defined as ≥14 days after the second dose. Analyses were stratified according to the number of comorbidities. RESULTS: 276,778 vaccinated individuals had a double-dose vaccination during the follow-up period and were followed with their paired unvaccinated control. The average age was 50 years and 53% were women. During a median 77 days of follow-up from day 14 after the second injection, 96 COVID-19-related hospitalizations occurred among vaccinated individuals and 1,465 among their unvaccinated counterparts. Overall, vaccine effectiveness against hospitalization was 94% (95%CI [93-95]) and exceeded 90% in each overseas territory, except Mayotte. The results were similar looking specifically at hospitalizations between July 15 and September 30, 2021. Vaccine effectiveness against in-hospital death was similar (94% [95%CI 91-96]). The risk of COVID-19-related hospitalization increased with the number of comorbidities, especially among vaccinated individuals. CONCLUSIONS AND RELEVANCE: In conclusion, vaccination has a major effect in reducing the risk of severe Covid-19 in the French overseas territories. The risk of COVID-19-hospitalization was very low among vaccinated individuals, especially in the absence of comorbidities. These results aim to increase confidence in vaccine effectiveness in overseas territories in hope of achieving better vaccination coverage.

Geographical variations of cancer incidence in Guadeloupe, French West Indies.

BACKGROUND: Geographical disparities in cancer incidence are observed at different scales and may highlight areas of high risk that need special attention to improve health policies. In Guadeloupe, a French archipelago in the Caribbean, environmental and socioeconomic factors are potential factors associated with cancer incidence. Our objective was to describe geographical variations of cancer incidence in Guadeloupe at a small-area level, in order to identify potential clusters. METHODS: We conducted spatial analyses for the 18 most frequent cancer sites, using data collected by the population-based cancer registry of Guadeloupe over the period 2008-2017. For each cancer sites, we used the Besag, York and Mollié model to estimate smoothed standardized incidence ratios (SIRs) at a sub-municipality level. In addition, we performed ascendant hierarchical clustering of these smoothed SIRs to describe the relationship between the different cancer sites and to identify geographical clusters. RESULTS: We observed geographical disparities with a spatial pattern that varied across cancer sites. Clustering of the smoothed SIRs showed aggregations between breast cancer and multiple myeloma, thyroid and stomach cancer, cervical and head and neck cancers, lung and rectal cancers, ovarian and endometrial cancers. Cluster analysis also identified six geographical clusters. Features of these clusters suggest alcohol consumption, exposure to pesticides, pollution generated by open landfills, and ethnicity as possible explanatory factors. DISCUSSION/CONCLUSION: Our study provided for the first time an extensive description of geographical disparities in cancer incidence in Guadeloupe, in a region where socioeconomic and environmental issues are major concerns. Although the identification of underlying factors was out of the scope of the present study, we highlighted areas of special interest and put forward some hypotheses that warrant to be further investigated in more in-depth analyses.

Visualization of scientific collaboration and themes for arbovirus disease in the caribbean: A forty-year trend analysis with focus on dengue, Zika and Chikungunya.

BACKGROUND: The (re-)emergence of arboviruses in the Caribbean, and worldwide, is a major public health issue of concern to all scientific research stakeholders. This study aimed to use bibliometric analysis to identify the contribution of Caribbean countries to scientific production regarding the three arboviruses with the greatest impact, namely zika, chikungunya and dengue. METHOD: Bibliographic data related to arbovirus diseases were collected from three international databases (Web of Science, Pubmed, and Scopus), filtered by Caribbean islands of affiliation. VosViewer was used to identify scientific connections between countries or institutions and to identify research themes. RESULTS: The dataset comprised 1332 indexed articles, with 50% of articles categorized in the top quartile of quality. Cuba was found to lead research on dengue, with a total of 300 articles, and 18 international connections. The USA-Puerto Rico duo was found to be the leader on emerging arboviruses (Zika and Chikungunya), followed by a predominantly French-language cluster (mainland France, Guadeloupe, Martinique). Key research topics were related to clinical presentations, epidemiology, and research on mosquito-borne viruses CONCLUSIONS: Co-authorship network analysis on emerging arboviruses revealed the dynamics of collaboration, and provides insights into Caribbean collaborations that deserve to be created and consolidated in case of resurgence of new arbovirus epidemics.

Burden of gastric and digestive cancers in the French Caribbean: perspectives from population-based cancer registries of Martinique, Guadeloupe and French Guiana (2007-2014).

OBJECTIVES: Data from population-based cancer registries contribute to improving our knowledge of digestive cancer trends worldwide. In this study, we present cancer incidence and mortality in Guadeloupe, French Guiana and Martinique for the periods 2008-2014, 2010-2014 and 2007-2014, respectively. DESIGN: Data were extracted from population-based cancer registries. World-standardised incidence (WSI) and mortality (WSM) rates were calculated. Main digestive cancers were analysed, including oesophagus, stomach, colorectum, liver and pancreas cancers. SETTING: This study was performed based on data from French Territories in the Caribbean. RESULTS: We observed a lower-incidence compared with mainland France, except for stomach cancer for which the incidence is high, with significant standardised incidence ratios in men and women at 1.90 vs 2.29 for Guadeloupe and French Guiana and 1.58 vs 2.31 for Martinique. We found a lower-mortality, except for stomach cancer for which the mortality remains high, with significant mortality ratios in men and women at 2.10 vs 2.74 for Guadeloupe, 1.64 vs 1.79 for French Guiana and 2.05 vs 2.53 for Martinique. Overall, these three regions have similar WSI and WSM rates which remain lower than those in mainland France. We noticed an overall high incidence and high mortality in men compared with women as in France. CONCLUSIONS: There is a high incidence of stomach cancer in French overseas territories. Publication of these data contributed to expanding knowledge on the epidemiology of world cancers with data from the Caribbean zone.

Urological Cancers in French Overseas Territories: A Population-Based Cancer Registry Pooled Analysis in Martinique, Guadeloupe and French Guiana (2007-2014).

PURPOSE: Prostate cancer is the most common cancer in the Caribbean. We present world-standardized incidence (WSI) and mortality (WSM) rates for urological cancers for French overseas territories. MATERIALS AND METHODS: Standardized incidence ratio (SIR) and standardized mortality ratio (SMR) were calculated for 2008-2014, 2007-2014 and 2010-2014 in Guadeloupe, Martinique and French Guiana. RESULTS: For prostate cancer, in Guadeloupe and Martinique, the WSI rates are among the highest in the world (173.0 and 164.5 per 100,000 person-years) and 94.4 in French Guiana. Mortality remains more than twice that observed in mainland France, at 23.0 in Guadeloupe and Martinique, and 16.9 in French Guiana. For bladder cancer, WSI rates were 5.9, 4.9 and 4.1 in men, and 1.9, 1.4 and 1.3 in women, in French Guiana, Guadeloupe and Martinique. WSM rates from bladder varied from 1.5 in French Guiana to 1.8 in Guadeloupe and 2.0 in Martinique in men. In women, it ranges from 0.2 in French Guiana to 0.5 in Guadeloupe and 1.1 in Martinique. Regarding kidney, WSI rates in men are 4.3 in Martinique, 5.2 in Guadeloupe and 6.1 in French Guiana, and 2.3, 2.5 and 3.4, respectively, in women. Mortality rates in men were 1.7 in Guadeloupe, 1.4 in Martinique, and 1.5 in French Guiana, while in women, rates were 0.8 in Guadeloupe and Martinique and 0.6 in French Guiana. All these rates are lower than in mainland France. CONCLUSIONS: Identifying the profile of patients with urological cancers is key to understanding the needs of patients in these regions.

KaruBioNet: a network and discussion group for a better collaboration and structuring of bioinformatics in Guadeloupe (French West Indies).

Summary: Sequencing and other biological data are now more frequently available and at a lower price. Mutual tools and strategies are needed to analyze the huge amount of heterogeneous data generated by several research teams and devices. Bioinformatics represents a growing field in the scientific community globally. This multidisciplinary field provides a great amount of tools and methods that can be used to conduct scientific studies in a more strategic way. Coordinated actions and collaborations are needed to find more innovative and accurate methods for a better understanding of real-life data. A wide variety of organizations are contributing to KaruBioNet in Guadeloupe (French West Indies), a Caribbean archipelago. The purpose of this group is to foster collaboration and mutual aid among people from different disciplines using a 'one health' approach, for a better comprehension and surveillance of humans, plants or animals' health and diseases. The KaruBioNet network particularly aims to help researchers in their studies related to 'omics' data, but also more general aspects concerning biological data analysis. This transdisciplinary network is a platform for discussion, sharing, training and support between scientists interested in bioinformatics and related fields. Starting from a little archipelago in the Caribbean, we envision to facilitate exchange between other Caribbean partners in the future, knowing that the Caribbean is a region with non-negligible biodiversity which should be preserved and protected. Joining forces with other Caribbean countries or territories would strengthen scientific collaborative impact in the region. Information related to this network can be found at: http://www.pasteur-guadeloupe.fr/karubionet.html. Furthermore, a dedicated 'Galaxy KaruBioNet' platform is available at: http://calamar.univ-ag.fr/c3i/galaxy_karubionet.html. Availability and implementation Information about KaruBioNet is availabe at: http://www.pasteur-guadeloupe.fr/karubionet.html. Contact: dcouvin@pasteur-guadeloupe.fr. Supplementary information: Supplementary data are available at Bioinformatics Advances online.

Research challenges and opportunities in the Caribbean area: first bibliometric study in the French West Indies, from 1989 to 2018

[ABSTRACT]. Objective. To analyze, describe, and quantify the collaborations and scientific output of the two university teaching hospitals of Martinique and Guadeloupe, at the regional, national, and international level. Methods. A bibliometrics analysis was performed from the international databases Web of Science and PubMed, for the period from 1989 to 2018, inclusive (30 years). Three types of bibliometric indicators were used, namely quantitative indicators, performance indicators, and organization-specific indicators. Affiliations of the first and last authors were identified from PubMed. Results. Between 1989 and 2018, a total of 1 522 indexed articles were published with at least one author affiliated to either the University Hospital of Martinique (n = 827) or the University Hospital of Guadeloupe (n = 685). The majority of articles were in category Q1 (35.8% for Martinique and 35.2% for Guadeloupe). In Martinique, over the last 30 years, the three main research areas have been clinical neurology, ophthalmology, and surgery, together representing 28.7% of all research areas, with the highest number of articles published in the field of clinical neurology (n = 81). In the University Hospital of Guadeloupe, the area of hematology was largely represented, with 79 articles published. For both hospitals, the first and last authors of the articles published were mainly from mainland France. Conclusions. This quantitative analysis shows the development of medical and scientific research in Martinique and Guadeloupe over the last three decades, as well as the extent of their collaborative partnerships at the national and international levels.

[RESUMEN]. Objetivo. Analizar, describir y cuantificar las colaboraciones y la producción científica de los dos hospitales docentes universitarios de Martinica y Guadalupe, al nivel regional, nacional e internacional. Métodos. Se llevó a cabo un análisis de bibliometría de las bases de datos internacionales Web of Science y PubMed, en el período de 1989 al 2018, inclusive (30 años). Se emplearon tres tipos de indicadores bibliométricos, a saber: indicadores cuantitativos, indicadores de rendimiento e indicadores específicos de organización. Se establecieron las afiliaciones de los primeros y últimos autores de PubMed. Resultados. Entre 1989 y el 2018, se publicaron en total 1 522 artículos indizados con al menos un autor afiliado al Hospital Universitario de Martinica (n = 827) o bien al Hospital Universitario de Guadalupe (n = 685). La mayoría de los artículos estaban en el cuartil 1 (35,8 % en Martinica y 35,2 % en Guadalupe). En Martinica, en los últimos 30 años las tres principales áreas de investigación han sido la neurología clínica, la oftalmología y la cirugía, que juntas representan 28,7 % de todas las áreas de investigación, con el número más alto de artículos publicado en el campo de la neurología clínica (n = 81). En el Hospital Universitario de Guadalupe, el ámbito de la hematología estaba ampliamente representado, con 79 artículos publicados. En ambos hospitales, los primeros y los últimos autores de los artículos publicados eran principalmente de Francia continental. Conclusiones. Este análisis cuantitativo demuestra el desarrollo de la investigación médica y científica en Martinica y Guadalupe en los treinta últimos años, así como el alcance de sus asociaciones colaborativas a los niveles nacional e internacional.

[RESUMO]. Objetivo. Analisar, descrever e quantificar as colaborações e a produção científica dos dois hospitais universitários de Martinica e Guadalupe, no âmbito regional, nacional e internacional. Métodos. Foi realizada uma análise bibliométrica das bases de dados internacionais Web of Science e PubMed, no período de 1989 a 2018, inclusive (30 anos). Três tipos de indicadores bibliométricos foram utilizados: quantitativos, de desempenho e específicos da organização. Afiliações dos primeiros e últimos autores foram identificadas na base PubMed. Resultados. Entre 1989 e 2018, um total de 1 522 artigos indexados foram publicados com pelo menos um autor afiliado ao Hospital Universitário de Martinica (n = 827) ou ao Hospital Universitário de Guadalupe (n = 685). A maioria dos artigos estava na categoria Q1 (35,8% para Martinica e 35,2% para Guadalupe). Na Martinica, nos últimos 30 anos, as três principais áreas de pesquisa foram neurologia clínica, oftalmologia e cirurgia, representando, juntas, 28,7% de todas as áreas de pesquisa, com o maior número de artigos publicados no campo da neurologia clínica (n = 81). No Hospital Universitário de Guadalupe, a área de hematologia foi amplamente representada, com 79 artigos publicados. Para ambos os hospitais, os primeiros e os últimos autores dos artigos publicados eram principalmente da França continental. Conclusões. Esta análise quantitativa demonstra o desenvolvimento da pesquisa médica e científica na Martinica e em Guadalupe nas três últimas décadas, bem como a extensão de suas parcerias colaborativas no âmbito nacional e internacional.

Heterogeneity in head and neck cancer incidence among black populations from Africa, the Caribbean and the USA: Analysis of cancer registry data by the AC3.

BACKGROUND: Africa and the Caribbean are projected to have greater increases in Head and neck cancer (HNC) burden in comparison to North America and Europe. The knowledge needed to reinforce prevention in these populations is limited. We compared for the first time, incidence rates of HNC in black populations from African, the Caribbean and USA. METHODS: Annual age-standardized incidence rates (IR) and 95% confidence intervals (95%CI) per 100,000 were calculated for 2013-2015 using population-based cancer registry data for 14,911 HNC cases from the Caribbean (Barbados, Guadeloupe, Trinidad & Tobago, N = 443), Africa (Kenya, Nigeria, N = 772) and the United States (SEER, Florida, N = 13,696). We compared rates by sub-sites and sex among countries using data from registries with high quality and completeness. RESULTS: In 2013-2015, compared to other countries, HNC incidence was highest among SEER states (IR: 18.2, 95%CI = 17.6-18.8) among men, and highest in Kenya (IR: 7.5, 95%CI = 6.3-8.7) among women. Nasopharyngeal cancer IR was higher in Kenya for men (IR: 3.1, 95%CI = 2.5-3.7) and women (IR: 1.5, 95%CI = 1.0-1.9). Female oral cavity cancer was also notably higher in Kenya (IR = 3.9, 95%CI = 3.0-4.9). Blacks from SEER states had higher incidence of laryngeal cancer (IR: 5.5, 95%CI = 5.2-5.8) compared to other countries and even Florida blacks (IR: 4.4, 95%CI = 3.9-5.0). CONCLUSION: We found heterogeneity in IRs for HNC among these diverse black populations; notably, Kenya which had distinctively higher incidence of nasopharyngeal and female oral cavity cancer. Targeted etiological investigations are warranted considering the low consumption of tobacco and alcohol among Kenyan women. Overall, our findings suggest that behavioral and environmental factors are more important determinants of HNC than race.

Head and neck cancer risk factors in the French West Indies.

OBJECTIVES: The incidence of head and neck squamous cell carcinoma (HNSCC) in the French West Indies (FWI) is relatively high, despite a low prevalence of tobacco smoking and alcohol drinking. Little is known about other risk factors in the FWI. We assessed associations between several factors and HNSCC risk, their population attributable fractions (PAF) in the FWI, and compared these PAFs by subsite, sex and age. MATERIALS AND METHODS: We conducted a population-based case-control study (145 cases and 405 controls). We used logistic regression models to estimate adjusted odds-ratios (OR), PAFs and their 95% confidence intervals (CI). RESULTS: Tobacco smoking, alcohol drinking, high-risk HPV, family history of HNC, low BMI and several occupations and industries were significantly associated to the occurrence of HNSCC. The majority of HNSCC cases were attributable to tobacco smoking (65.7%) and alcohol (44.3%). The PAF for the combined consumption of tobacco and/or alcohol was 78.2% and was considerably larger in men (85%) than in women (33%). The PAFs for the remaining risk factors were 9% for family history of HNSCC, 9% for low BMI, 15% for high-risk HPV, and 25% for occupations. The overall PAF for all risk factors combined was 89.0% (95% CI = 82.0-93.2). The combined PAFs by sex were significantly greater in men (93.4%, 95% CI = 87.5-96.5) than in women (56.4%, 95% CI = 18.7-76.6). CONCLUSION: Tobacco and alcohol appeared to have the greatest impact on HNSCC incidence among the studied risk factors, especially among men. Prevention programs for HNSCC in the FWI should target tobacco and alcohol cessation, particularly in men. Future research should emphasise on the role of occupational factors to better understand this disease.

Frequent high-risk HPV co-infections excluding types 16 or 18 in cervical neoplasia in Guadeloupe.

BACKGROUND: Cervical cancer is the fourth cancer worldwide. The Human Papilloma Virus is responsible for 99% of the cases but the distribution of its genotypes varies among populations. We aimed to identify HPV genotypes distribution in women with grade 2/3 cervical intraepithelial dysplasia or invasive cervical cancer in Guadeloupe, a French Caribbean territory with a population mainly of African descent. METHODS: We used paraffin-embedded tumors for viral DNA extraction from women diagnosed between 2014 and 2016 and identified by the population-based cancer registry. The HPV Genotyping was performed with the InnoLIPA HPV Genotyping Extra kit®. RESULTS: Overall, 213 samples out of the 321 eligible records were analyzed. The HPV status was positive for 94% of the cases. The five most common oncogenic HPV genotypes were HPV31 (47%), HPV33 (38%), HPV16 (32%), HPV44 (31%) and HPV26 (28%). HPV18 was found in only in 5% of the cases. Among the studied cases, 94% had multiple infections. More than 60% of single infections were HPV16-related, accounting for 35% of HPV16 infections. CONCLUSIONS: These results show a different distribution of oncogenic HPVs in Guadeloupe with "31 >  33 > 16" and a high frequency of multiple infections. Despite a lower coverage, the nine-valent vaccine is nevertheless adequate.

Research challenges and opportunities in the Caribbean area: first bibliometric study in the French West Indies, from 1989 to 2018.

OBJECTIVE: To analyze, describe, and quantify the collaborations and scientific output of the two university teaching hospitals of Martinique and Guadeloupe, at the regional, national, and international level. METHODS: A bibliometrics analysis was performed from the international databases Web of Science and PubMed, for the period from 1989 to 2018, inclusive (30 years). Three types of bibliometric indicators were used, namely quantitative indicators, performance indicators, and organization-specific indicators. Affiliations of the first and last authors were identified from PubMed. RESULTS: Between 1989 and 2018, a total of 1 522 indexed articles were published with at least one author affiliated to either the University Hospital of Martinique (n = 827) or the University Hospital of Guadeloupe (n = 685). The majority of articles were in category Q1 (35.8% for Martinique and 35.2% for Guadeloupe). In Martinique, over the last 30 years, the three main research areas have been clinical neurology, ophthalmology, and surgery, together representing 28.7% of all research areas, with the highest number of articles published in the field of clinical neurology (n = 81). In the University Hospital of Guadeloupe, the area of hematology was largely represented, with 79 articles published. For both hospitals, the first and last authors of the articles published were mainly from mainland France. CONCLUSIONS: This quantitative analysis shows the development of medical and scientific research in Martinique and Guadeloupe over the last three decades, as well as the extent of their collaborative partnerships at the national and international levels.

Joint effect of tobacco, alcohol, and oral HPV infection on head and neck cancer risk in the French West Indies.

We investigated the role of tobacco and alcohol consumption on the occurrence of head and neck squamous cell carcinomas (HNSCC), and the joint effects of these factors with oral human papillomavirus (HPV) infection in the French West Indies, in the Caribbean. We conducted a population-based case-control study (145 cases and 405 controls). We used logistic regression models to estimate adjusted odds ratios (OR) and their 95% confidence intervals (CI). Two-way interactions were assessed on both multiplicative and additive scales. Current smoking (OR = 11.6, 95% CI = 6.7-20.1), drinking more than five glasses of alcohol per day (OR = 2.7, 95% CI = 1.2-4.7), and oral infection with High-risk HPV (OR = 2.4, 95% CI = 1.1-5.0) were significantly associated with HNSCC. The combined exposure to tobacco and alcohol produced a significant synergistic effect on the incidence of HNSCC. Oral infection with High-risk HPV increased the risk of HNSCC in never smokers and nondrinkers. The effects of tobacco, alcohol, and of the combined exposure of tobacco and alcohol were substantially lower in HPV-positive than in HPV-negative HNSCC. This is the first case-control study to investigate the role of tobacco smoking, alcohol drinking and oral HPV infection in an Afro-Caribbean population. Although each of these risk factors has a significant effect, our findings indicate that tobacco and alcohol play a less important role in Hr-HPV-positive HNSCC. Further investigations are warranted notably on the interaction of these three risk factors by cancer site.

Gynaecological cancer in Caribbean women: data from the French population-based cancer registries of Martinique, Guadeloupe and French Guiana (2007-2014).

BACKGROUND: For the first time, we present regional-level cancer incidence and world-standardized mortality rates for cancers for Martinique, Guadeloupe and French Guiana. METHODS: For Martinique, Guadeloupe and French Guiana, incidence data come from population-based cancer registries, and cover the periods 2007-2014, 2008-2014 and 2010-2014 respectively. Standardized incidence and mortality rates were calculated using the world population. RESULTS: In the 3 regions, all cancers combined represent 3567 new cases per year, of which 39.8% occur in women, and 1517 deaths per year (43.4% in women). Guadeloupe and Martinique present similar world-standardized incidence rates. Among gynaecological cancers, breast cancer, the second most common cancer type in the 3 regions, has an incidence rate 35 to 46% lower than in mainland France. On the other hand, cervical cancer has a higher incidence rate, particularly in French Guiana. For both endometrial cancer and ovarian cancer, no significant differences in incidence rates are found compared to mainland France. Regarding mortality, world-standardized mortality rates are similar between Guadeloupe and Martinique, and higher than in French Guiana. This situation compares favourably with mainland France (all cancers). Among gynaecological cancers, the mortality rate is lower for breast cancer in all regions compared to mainland France, and also lower for ovarian cancer in Martinique and Guadeloupe, but higher (albeit non-significantly) in French Guiana. CONCLUSION: The ethno-geographic and socio-demographic characteristics in this population of mainly Afro-Caribbean origin could partially explain these disparities. Major disparities exist for certain cancer sites: excess incidence and excess mortality for cervical cancer; lower, but increasing incidence of breast cancer.

[Initiation of first dialysis and three months quality of life of patients with end stage renal disease in the French territories of Guadeloupe and Guyane]. / Contexte initial de prise en charge et qualité de vie à 3 mois des patients dialysés pour insuffisance rénale chronique terminale dans deux départements français d'Amérique.

End stage renal disease is a major public health problem in the French Departments of Guadeloupe and Guiana because of the high prevalence of both type 2 diabetes and hypertension. We investigated factors associated with an emergency start of dialysis, 3 months' quality of life for patients starting a first replacement therapy in Guadeloupe and French Guiana using the data of the Réseau épidémiologie et information en néphrologie network, completed with data from the quality of life questionnaires SF-36 and KDQoL. A total of 242 patients (184 in Guadeloupe and 58 in Guiana) were included. An emergency start was found for 112 (46.5%) patients (Guiana: 74.1%; Guadeloupe: 37.7%). In the multivariate model, an emergency start was associated with the number of nephrology consultations in the year before dialysis and the creation of an arteriovenous fistula prior to the first dialysis. The quality of life scores did not differ between the groups emergency start or not but were higher than those measured in mainland French studies on dialyzed population. Lack of nephrology consultations and dialysis preparation are the main factors associated with an emergency start of the first dialysis, highlighting the need to adapt the provision of care for chronic kidney disease in these departments.