Validation of an algorithm for identifying incident cancer cases based on long-term illness and diagnosis related group program data from the French National Health Insurance Information System (SNDS).

PURPOSE: Three generic claims-based algorithms based on the Illness Classification of Diseases (10th revision- ICD-10) codes, French Long-Term Illness (LTI) data, and the Diagnosis Related Group program (DRG) were developed to identify retirees with cancer using data from the French national health insurance information system (Système national des données de santé or SNDS) which covers the entire French population. The present study aimed to calculate the algorithms' performances and to describe false positives and negatives in detail. METHODS: Between 2011 and 2016, data from 7544 participants of the French retired self-employed craftsperson cohort (ESPrI) were first matched to the SNDS data, and then toFrench population-based cancer registries data, used as the gold standard. Performance indicators, such as sensitivity and positive predictive values, were estimated for the three algorithms in a subcohort of ESPrI. RESULTS: The third algorithm, which combined the LTI and DRG program data, presented the best sensitivities (90.9%-100%) and positive predictive values (58.1%-95.2%) according to cancer sites. The majority of false positives were in fact nearby organ sites (e.g., stomach for esophagus) and carcinoma in situ. Most false negatives were probably due to under declaration of LTI. CONCLUSION: Validated algorithms using data from the SNDS can be used for passive epidemiological follow-up for some cancer sites in the ESPrI cohort.

Lifetime occupational exposure proportion estimation methods: a sensitivity analysis in the general population.

OBJECTIVE: To present a sensitivity analysis of the most widely used means of estimating lifetime occupational exposure proportion (LOEP) and their respective impacts on LOEP and population-attributable fraction (PAF) estimates. METHODS: A French population-based sample with full job history (N = 10,010) was linked with four Matgéné job-exposure matrices: flour, cement, silica and benzene. LOEP and the 95% confidence interval were estimated using four methods: the maximum exposure probability during the career (Proba_max), two methods subdividing careers into job-periods (job-period_M1, job-period_M2) and one into job-years (job-year). To quantify differences between methods, percentages of variation were calculated for proportion values and PAF, and compared with published results for France using cross-sectional proportion multiplied by a factor. RESULTS: For each agent, LOEP estimated from the maximum probability during the career (Proba_max) was consistently lower than proportion taking account of job-periods or job-years. LOEP on Proba_max for flour, cement, silica and benzene were, respectively, 4.4% 95% CI (4.0-4.7), 4.3% (3.9-4.6), 6.1% (5.7-6.5) and 3.9% (3.6-4.2). Percentage of variation ranged from 0 to 55.8% according to the agent. The number of cancer cases varied by a twofold factor for exposure to silica and lung cancer and by a fourfold factor for exposure to benzene and acute myeloid lymphoma. CONCLUSIONS: The present study provides a description of several LOEP estimation methods based on exposure assessment over the entire career and describes their impact on PAF. For health monitoring purposes, we recommend to report a range of LOEP with low and high estimates obtained using job-periods (job-period_M1 and job-period_M2).

French colorectal cancer screening pilot programme: results of the first round.

OBJECTIVES: In France, a national pilot population-based screening programme on colorectal cancer was set up in 2002. In 2006, 23 French districts were included, targeting a population of more than five million people. This programme offers biennial screening using the fecal occult blood test (FOBT) to average risk subjects aged between 50 and 74 years. People receive a letter inviting them to consult their GPs, who in turn provide the FOBT. People with a positive test result are proposed a full colonoscopy. The results of the programme's first-round performance indicators are presented. METHODS: The monitoring centre collected data from GPs and gastroenterologists on follow-up and colonoscopy results for people who were screened positive. Data were transferred to the French Institute for Public Health Surveillance (InVS) for the analysis. RESULTS: The overall participation rate for the 19 districts having completed a first screening round reached 42%. The overall positive test rate was 2.7%. In the eight districts with comprehensive follow-up data for the first round, 86% of colonoscopies were completed after a positive test. A total of 1615 people were diagnosed with cancer, and 4612 people with adenoma. The cancer detection rate reached 2.3/1000 [corrected] it was higher in men than in women (3.4/1000 [corrected] versus 1.4/1000) [corrected] and increased with age. Forty-three percent of invasive detected cancers were stage I, 24% stage II, 23% had lymph node involvement and 10% presented with distant metastasis. CONCLUSION: These results suggest that indicators are consistent with international references. During 2007-2008, the programme coverage will be progressively extended, and all 99 French districts should be actively involved in its implementation.

Contraceptive failures and determinants of emergency contraception use.

OBJECTIVES: Two years after emergency contraceptive pills (ECPs) were made available without prescription in France, we investigated the determinants of ECP use in a representative sample of women at risk for unintended pregnancy. STUDY DESIGN: This study is based on data collected from a population-based cohort exploring contraceptive practices and abortion (N=2863). RESULTS: Among the 706 women at risk for unintended pregnancy during the first year of follow-up (2001), only 11.1% used ECPs. Women in stable relationships or using the same contraceptive method during the year were less likely to use ECPs than other women. The study also demonstrates that detailed knowledge of ECPs increases the probability of its subsequent use. CONCLUSIONS: Given the low frequency of ECP use in cases of unintended pregnancy risk, these results suggest that information campaigns should be targeted not only at women with irregular contraceptive practices but also at women who experience errors in the use of their regular contraceptive method.

The remaining barriers to the use of emergency contraception: perception of pregnancy risk by women undergoing induced abortions.

Although access to and knowledge of emergency contraception (EC) have improved, numerous unplanned pregnancies occur each year. We thus assessed the remaining barriers to EC use in a population of women seeking an abortion in four abortion centers in France in 2002. A self-administered questionnaire was completed by 1365 women. Most women have heard of EC (89%), but access to information remained limited in socially disadvantaged populations. Nevertheless, the unperceived risk of pregnancy appeared to be the most limiting factor to EC use. Only 38.5% of women were aware of pregnancy risk at the time of the intercourse that made them pregnant. Of these women, 48% minimized the risk later, resulting in the decision not to use EC. As the perception of risk is commonly reevaluated by women over time, which probably affects EC use, it could be important to promote advance supply of EC so that women could use it immediately after a recognized unprotected intercourse.

Contraception at the time of abortion: high-risk time or high-risk women?

BACKGROUND: Despite the widespread use of highly effective contraception in France, the incidence of abortion is high. A retrospective population-based cohort study was designed to analyse women's contraceptive history. METHOD: We compared the contraceptive use of 163 women, whose last pregnancy ended in abortion, 6 months before, at the time of, 1 month and 6 months after the event with that of 1787 women who had never had an abortion. RESULTS: A total of 46% of women who experienced an abortion used a highly effective form of contraception 6 months before the event (versus 76% among women who had never had an abortion, P < 0.001). This proportion dropped to 33% at the time of the abortion and increased to 71%, 1 month after. In addition, 50% of women who had an abortion had changed their contraceptive method in the 6 months before the event (compared with 16% in the 6 months before the interview in women who had not had an abortion, P < 0.001). Women with socially deprived backgrounds were less likely to use a highly effective contraception after an abortion. CONCLUSIONS: Abortion is a good opportunity for intervention, but especially so for socially disadvantaged women. It is essential to draw the attention of prescribers and women to the higher risk of contraceptive failure at the start of use of a method.

Contraception: from accessibility to efficiency.

BACKGROUND: Despite the widespread use of medical contraception in France, the prevalence of abortion remains stable. A cross-sectional population-based survey was designed to study the characteristics of current contraceptive use in France, the different types of contraceptive failure, and the reasons reported for not using contraception. METHODS: A representative sample of 14 704 French households was randomly selected from the telephone directory. All women who in the last 5 years had had an abortion or whose last pregnancy was unintended were selected (n = 1034), whilst a fraction (n = 1829) of the other women were randomly selected. Altogether, 2863 women answered the questionnaire. RESULTS: Only 2.7% of the women aged 18-44 years who did not wish to conceive and were sexually active did not use any contraception. However, 33% of pregnancies were estimated to be unplanned, of which 50% ended in an abortion. A total of 65% of the reported unplanned pregnancies occurred among women using contraception (21% the pill, 9% IUD, 12% condoms, 23% other method). The main reasons given for these contraceptive failures were the misuse of the methods or the failure of the partner to withdraw. Reasons for not using any contraception go beyond a simple lack of information. CONCLUSIONS: The importance of-and the reasons mentioned for-contraceptive failure show a misadaptation between women's contraceptive needs and the method they use. Improving the training of family planning providers remains a major goal to ensure that women use a contraceptive method that fits their social and sexual lifestyle.