RESUMO
This article describes some of the key prevention services in the Leon Berard Comprehensive Cancer Center (CLB) Lyon, France, which are based on clinical prevention services, outreach activities, and collaboration with professional and territorial health communities. In addition, research is embedded at all stages of the prevention continuum, from understanding cancer causes through to the implementation of prevention interventions during and after cancer. Health promotion activities in the community and dedicated outpatient primary cancer prevention services for individuals at increased risk have been implemented. The CLB's experience illustrates how prevention can be integrated into the comprehensive mission of cancer centers, and how in turn, the cancer centers may contribute to bridging the current fragmentation between cancer care and the different components of primary, secondary, and tertiary prevention. With increasing cancer incidence, the shift toward integrated prevention-centered cancer care is not only key for improving population health, but this may also provide a response to the shortage of hospital staff and overcrowding in cancer services, as well as offer opportunities to reduce carbon emissions from cancer care.
Assuntos
Atenção à Saúde , Neoplasias , Humanos , Neoplasias/prevenção & controle , França/epidemiologia , Institutos de CâncerRESUMO
CANCER CAUSES: WHAT LEVERS FOR PRIMARY PREVENTION? Facing the continuous increase in cancer incidence, mobilizing efficient levers to act upstream of the disease is a major public health issue. Accelerating the transfer into practice of the continuous enrichment of the understanding of the multifactorial causes of cancers constitutes a first lever of prevention. This also requires a strengthening of the involvement of all actors and stakeholders, beyond the health and medico-social sectors. In order to guide practices, this article reviews the proportion of cancers attributable to the main lifestyle and environmental factors and causes, provides an update on cancers linked to heredity and the French oncogenetic organisation, addresses the specific issue of work related exposures and occupational cancers, proposes a prioritization of actions to break with the current fragmentation of prevention, in particular through improving the articulation of population-based interventions with targeted and personalized approaches, and better considering individuals in their environments.
CAUSES DES CANCERS: QUELS LEVIERS POUR LA PRÉVENTION PRIMAIRE ? Devant l'augmentation continue de l'incidence des cancers, mobiliser des leviers efficaces pour agir en amont de la maladie constitue un enjeu majeur de santé publique. L'accélération du transfert dans la pratique de l'enrichissement continu de la compréhension des causes multifactorielles des cancers constitue un premier levier de la prévention. Laquelle nécessite également un renforcement de l'implication de l'ensemble des acteurs et parties prenantes au-delà du domaine de la santé et du secteur médico-social. Dans l'objectif de guider les pratiques, il convient de faire le point sur la part attribuable des cancers aux principaux facteurs et causes liés au mode de vie et à l'environnement, de réaliser une mise au point sur la part des cancers liée à l'hérédité et le dispositif d'oncogénétique, d'aborder la problématique spécifique des expositions et cancers d'origine professionnelle, de proposer une priorisation des actions permettant de rompre avec la fragmentation actuelle de la prévention, notamment améliorer l'articulation des interventions en population avec des approches ciblées et personnalisées, et mieux considérer les individus dans leurs environnements.
Assuntos
Neoplasias , Humanos , Neoplasias/epidemiologia , Neoplasias/etiologia , Neoplasias/prevenção & controle , Prevenção PrimáriaRESUMO
The International Agency for Research on Cancer established a causal link between asbestos exposure and ovarian cancer. However, the exposure frequency and histological characteristics of asbestos-associated ovarian cancers remain to be investigated in detail. This multicenter case-case study assessed the asbestos exposure in ovarian carcinoma (OC) patients, alongside its association with histological subtype. Women were recruited in four hospitals in Lyon, France. Histological reports were reviewed by a pathologist. Patient and family members' data were collected by phone-based questionnaires. Asbestos exposure was defined as direct (occupational and environmental) and indirect (via parents, partners, and children). An industrial hygienist assessed the probability and level of exposure. The 254 enrolled patients (mean age 60 years) reported having an average of 2.3 different jobs (mean working duration 29 years). The prevalence of direct and indirect asbestos exposure was 13% (mean exposure duration 11 years) and 46%, respectively. High-grade serous carcinoma accounted for 73% of all OCs and 82% of histological subtypes in women with direct exposure. After adjustment on a familial history of OC, no significant associations between asbestos exposure (direct and/or indirect) and high-grade serous carcinoma were found. Women with OC had a high prevalence of asbestos exposure. Establishing risk profiles, as reported here, is important in facilitating compensation for asbestos-related OCs and for the surveillance of women at risk.
