Occupational exposure to pesticides and bile tract carcinoma in men: results from a European multicenter case-control study.

OBJECTIVES: To estimate the associations between occupational exposure to pesticides and extrahepatic biliary tract carcinoma in men, a population-based case-control study was carried out. METHODS: Cases (n = 104), aged 35-70, diagnosed in 1995-1997, were sampled by active reporting systems from hospitals. Controls (n = 1,401) were a random sample of the general male population. Information on occupation and confounding factors was obtained by questionnaires. Exposures were quantified with respect to time, application methods, and use of personal protective equipment. Intensity was evaluated by using a published algorithm which weighted the exposure assigned according to the use of personal protective equipment and mode of application. Logistic regression analyses were conducted adjusted for gallstones, age, and country. RESULTS: Being ever exposed to pesticides resulted in an odds ratio (OR) of 1.0 [95%-confidence interval (CI) 0.6-1.6]. A modestly elevated risk was found for backpack mounted sprayers OR = 1.4 [95% CI 0.7-2.6] and vine farmers OR = 2.5 [95% CI 0.9-7.2]. Using time periods and exposure frequency as intensity measure, no elevated risks were found. The only exception was year of maximum exposure which yielded an OR of 1.6 [95% CI 0.7-3.5]. However, no clear trend was observed in this analysis. CONCLUSIONS: This study does not rule out that pesticide exposure represents an occupational risk factor for extrahepatic biliary tract carcinoma, but no indication of a strong association was observed. Some modes of exposure were weakly, albeit not significantly associated with carcinoma risk. The observed estimates of effects may be influenced by a lack of precise exposure assessment. Different chemical compositions of pesticides were utilized during a long time span of pesticide exposure, and it should be considered that the exposure is assessed with substantial uncertainty that could non-differential and bias results toward the null.

Cancer incidence and mortality in France over the period 1980-2005.

BACKGROUND: The objective of this study was to provide updated estimates of national trends in cancer incidence and mortality for France for 1980-2005. METHODS: Twenty-five cancer sites were analysed. Incidence data over the 1975-2003 period were collected from 17 registries working at the department level, covering 16% of the French population. Mortality data for 1975-2004 were provided by the Inserm. National incidence estimates were based on the use of mortality as a correlate of incidence, mortality being available at both department and national levels. Observed incidence and mortality data were modelled using an age-cohort approach, including an interaction term. Short-term predictions from that model gave estimates of new cancer cases and cancer deaths in 2005 for France. RESULTS: The number of new cancer cases in 2005 was approximately 320,000. This corresponds to an 89% increase since 1980. Demographic changes were responsible for almost half of that increase. The remainder was largely explained by increases in prostate cancer incidence in men and breast cancer incidence in women. The relative increase in the world age-standardised incidence rate was 39%. The number of deaths from cancer increased from 130,000 to 146,000. This 13% increase was much lower than anticipated on the basis of demographic changes (37%). The relative decrease in the age-standardised mortality rate was 22%. This decrease was steeper over the 2000-2005 period in both men and women. Alcohol-related cancer incidence and mortality continued to decrease in men. The increasing trend of lung cancer incidence and mortality among women continued; this cancer was the second cause of cancer death among women. Breast cancer incidence increased regularly, whereas mortality has decreased slowly since the end of the 1990s. CONCLUSION: This study confirmed the divergence of cancer incidence and mortality trends in France over the 1980-2005 period. This divergence can be explained by the combined effects of a decrease in the incidence of the most aggressive cancers and an increase in the incidence of less aggressive cancers, partly due to changes in medical practices leading to earlier diagnoses.

A time trend analysis of papillary and follicular cancers as a function of tumour size: a study of data from six cancer registries in France (1983-2000).

The incidence of thyroid cancers, and in particular the papillary forms, has been increasing sharply for many years in Western countries. However, the factors explaining this increase have not been clearly established. Some studies mention the effects of radioactive fallout, particularly after the accident in Chernobyl. Another probable cause is related to progress in medical practice, and particularly in diagnosis. In this article, we describe time trends in the incidence of papillary and follicular cancers, taking into account the size of the tumour at the time of diagnosis. The analysis was carried out on cases from six French cancer registries for the period 1983-2000. Anatomopathological reports concerning 3381 cancer cases were systematically recoded and centralised, following ICDO-3 rules. Over the whole period, the annual percent change of the incidence of papillary cancers was +8.13% and +8.98%, respectively in men and in women. For micropapillary carcinomas (< or = 10 mm), this increase was respectively +12.05% and +12.85%. There is no significant effect of period apart from micropapillary carcinomas in women. However, a birth cohort effect exists for some groups. This effect corresponds to an acceleration in the risk for people born after the 1930s. For the most recent period (1998-2000), half the cases of papillary cancer were micropapillary carcinomas, and for one third of these, the tumour was < or = 5 mm. Our description of a time trend of incidence as a function of tumour size supports the hypothesis of the role of medical practice in a context of high prevalence. Obviously, these findings do not exclude the possible role of other factors.

Survival of cancer patients in France: a population-based study from The Association of the French Cancer Registries (FRANCIM).

We present the main results of the first population-based cancers survival study gathering all French registry data. Survival data on 205,562 cancer cases diagnosed between 01/01/1989 and 31/12/1997 were analysed. Relative survival was estimated using an excess rate model. The evolution of the excess mortality rate over the follow-up period was graphed. The analysis emphasised the effect of age at diagnosis and its variation with time after diagnosis. For breast and prostate cancers, the age-standardised five-year relative survivals were 84% and 77%, respectively. The corresponding results in men and women were 56% versus 58% for colorectal cancer and 12% versus 16% for lung cancer. For some cancer sites, the excess mortality rate decreased to low values by five years after diagnosis. For most cancer sites, age at diagnosis was a negative prognostic factor but this effect was often limited to the first year after diagnosis.

[Incidence and mortality of central nervous system tumors in France: trends over the period 1978-2000 and influence of registration practices on results]. / Incidence et mortalité des tumeurs du système nerveux central en France: évolution de 1978 à 2000 et influence des pratiques d'enregistrement sur les résultats.

BACKGROUND: In France, cancer incidence figures are produced by cancer registries covering only 13.5% to 16% of the whole population of the country. Thus, to produce national figures, estimates have to be computed. Registration disparities between registries concerning tumors of the Central Nervous System (CNS) could have biased these estimates. METHODS: National estimates are based on modelling of the incidence/mortality ratio. The most recent estimations for year 2000 were calculated by the French Cancer Registry Network (FRANCIM) and the department of biostatistics of Lyon University Hospital. Since benign tumors are not recorded in some cancer registries, a new estimate of the incidence of CNS tumors was produced by estimating the number of benign tumors in these registries. RESULTS: In 2000 in France, the number of estimated cases of CNS tumors was 2697 in men and 2602 in women, with incidence rates (World standard) of 7.4 and 6.4 per 100,000 respectively. The incidence increased between 1978 and 2000, on an average by 2.25% per year in men and 3.01% per year in women. However, these estimates do not provide a correct picture of CNS incidence. First of all, pathological diagnoses are not performed in 3.5%-27.5% of the patients with CNS tumors registered in French registries. Second, figures for benign tumors (mainly meningiomas) were provided by only two of nine cancer registries. If benign tumors had been registered by all cancer registries, computed incidence would have increased by 12% for men and 26% for women. CONCLUSION: Incidence of CNS tumors is increasing in France, as in many other countries. To improve comparability with other countries, French cancer registries should also collect data on benign tumors. The discrepancies observed between registries in the proportion of patients without information on histology show differences in diagnostic practices and should be the starting point for a survey on this topic.

Therapeutic management of laryngeal cancer. Results of a study of 356 patients from the Cancer Registry of the Somme, France.

CONCLUSIONS: The global survival rate was low compared to those reported in the literature, in which the analyzed populations were selected according to the tumor stage or treatment. This study should be prolonged and should also involve other cancer registries in France in order to increase the number of patients and to analyze tumors of comparable stage and therapeutic management. OBJECTIVE: To analyze the survival rate of a non-selected laryngeal cancer population from the Cancer Registry of the Somme, a French region. MATERIAL AND METHODS: A total of 356 patients were included in a retrospective study covering the period 1987-1997. Survival and prognostic factors were analyzed. Statistical analysis was performed using the Kaplan-Meier method, the Cox model and the chi2 test. RESULTS: The 5-year global survival rate was 42% for males and 55% for females. Tumor localization, T, N and M stages and surgery were found to be significant prognostic factors. Sex and age were not statistically significant factors. For stage I tumors, surgery alone gave better results than radiotherapy alone in terms of global survival. No difference occurred in terms of local recurrence. A similar comparison was not possible for stage II-IV tumors owing to the small number of cases.

Estimation of colorectal cancer prevalence in France.

The prevalence in France of patients with colorectal cancer was estimated using data from five population-based cancer registries. At the end of 1994, the number of cases diagnosed in France no more than 5 years before was approximately 95000, of whom 12180 had suffered metastasis and 9746 a local recurrence. This type of cancer is the most common in both men and women and these results enable the need for care or surveillance to be evaluated more accurately.

Evaluation of an algorithm to identify incident breast cancer cases using DRGs data.

Hospital databases have the potential to be inexpensive, timely and nationally representative sources of information about cancer. This study examines the utility of the French hospital database adapted from the Diagnosis Related Group (DRG) classification and named 'Programme de médicalisation des systèmes d'information (PMSI)', as an independent source to identify incident cancer cases. From the 19 679 women hospitalized and treated in 1998 in the public hospitals of the Somme area in France, we identified those diagnosed with breast cancer in the PMSI database. These women were matched with women in the cancer registry of the Somme area who had been diagnosed with breast cancer in 1998. An algorithm was used to identify cancer-related diagnoses and procedures reported to PMSI. The sensitivity, specificity and positive predictive value (PPV) of the PMSI database were calculated using the cancer registry as a gold standard. The PMSI database had 85% sensitivity, 99.9% specificity and 97% PPV for women hospitalized with breast cancer as a principal diagnosis. The sensitivity was higher by 9% for hospitalization with breast cancer as a secondary diagnosis but had a lower PPV (78%). In conclusion, the PMSI database seems to offer an interesting potential to assess breast cancer incidence, because of its high sensitivity, in particular when secondary diagnosis was considered, and its very high specificity and PPV. However, these preliminary results need to be confirmed by other studies in France before such databases are used, particularly in areas without cancer registries.

Interval cancers in a French breast cancer-screening programme (Somme Department).

The objective of this study is to analyse the detection rates and tumour diameter of interval cancers in the breast cancer mass-screening programme of Somme Department (France), launched in 1990. Interval cancers are defined as breast cancers diagnosed within 36 months after a negative screening assessment, for women attending the programme between December 1990 to December 1993. Age-adjusted incidence rates were 0.51 per 1000 woman-years of follow-up in the 3-year interval after initial and subsequent screens. Diagnosis is made at early stage (sizes < or = 10 mm) in 20% of interval cancers. This stage is higher than that in screened women (9% of in situ cases and 35% of very small tumours). Interval cancer rates are low during the first year (0.18 per 1000 woman-years of follow-up) but higher in the second and third years.

Cancer incidence and mortality in France in 1975-95.

The aims of the European Network of Cancer Registries (ENCR) are to improve the quality, comparability and availability of cancer registry data in Europe. This paper on cancer incidence and mortality in France presents the most recent available data, with short-term projections to 1995, and a commentary based, where possible, on epidemiological research carried out in France. Cancer incidence in men in France increased throughout the study period 1975 to 1995, from 92,000 new cases in 1975 to about 135,000 in 1995. This increase was partly due to the ageing of the French population, but incidence rates have also increased, particularly from 1975 to 1985. The trend appears to be levelling off in the 1990s, with an incidence rate in 1995 of about 482 per 100,000 (this and subsequent rates quoted are standardized to the European Standard Population). Among women, the all-cancer incidence rates also increased during the 1970s and 1980s. Although the rate of increase was less pronounced than in men, the trend is continuing in the 1990s. The estimated age standardized rate in 1995 was 309 per 100,000, representing 104,000 new cases. The main components of these changes in the last decade were, for men, increases in large bowel and prostate cancer, which have been partly compensated for by decreases in oral cavity, larynx and stomach cancer. For women the trend was dominated by the continuing increase in breast cancer with increases also in large bowel and lung cancers. Of the numerically important cancers in women, only stomach cancer has shown a clear decline. The situation in 1995 was that breast cancer remained the predominant cancer affecting women in France, accounting for almost one third of all new cases of cancer diagnosed and one fifth of cancer deaths. The next most frequent cancers in women were those of the large bowel. Regrettably, incidence rates of both breast and bowel cancer are increasing in women. For men in France the most frequent cancers in 1995 were those of the prostate, large bowel and lung, all of which increased in incidence since 1975. Although it is estimated that there will be more newly diagnosed cases of prostate cancer than lung cancer in 1995, the latter will cause many more deaths, particularly of young men.

Cancer registry data based estimation of regional cancer incidence: application to breast and colorectal cancer in French administrative regions.

STUDY OBJECTIVE: In many countries, cancer registries cover only a small part of the national population. Cancer incidence for the rest of the country has therefore to be estimated. This can be done from mortality data using the relation between incidence and mortality observed in the cancer registry areas. Such an approach was used to study geographical variation and trend of colorectal and breast cancer incidence in France where 10% of the national population is covered by cancer registries. DESIGN: This study applies the incidence/mortality ratios of cancer registry areas to regional mortality data to obtain an estimation of cancer incidence at a given point in time. Age and period effects are included in the statistical models. MAIN RESULTS: The incidence estimations are given for 21 administrative regions and three time points (1985, 1990, 1995). The European standardised incidence rates for breast cancer ranged from 86.8 to 128.8. For colorectal cancer, these rates ranged from 48.2 to 79.6 for men, and from 32.5 to 48.8 for women. Breast cancer incidence has increased considerably between 1985 and 1995 with a higher increase in the north than in the south of France. The incidence of colorectal cancer has also increased, albeit to a lesser extent. CONCLUSION: The incidence estimation method proposed leads to regional incidence rates that are useful for planning health care services on a regional basis and may also be used to study regional differences in incidence. This method is useful when only partial incidence data are available.

High bone-mass density as a marker for breast cancer in post-menopausal women.

Bone mass has been proposed as a marker of cumulative exposure to oestrogen in women. We have studied the association between bone mass and breast cancer in postmenopausal women. In 126 cases of breast cancers and 126 controls, the bone mineral density (BMD) of the lumbar spine (L2-L4), femoral neck, trochanter and Ward's triangle was measured by dual-energy X-ray absorptiometry. All cases of cancer were confirmed by pathological reports. A questionnaire including information on reproductive history and other variables was collected. BMD was significantly higher among breast cancer patients than controls at all sites, except at the femoral neck where BMD was increased in the cancer group, but not significantly. After adjustment for potential confounding factors, the estimated relative risk of breast cancer in the highest quartile of BMD compared to the lowest quartile ranged from 2.5 to 4.8 for various sites of measurement. These results confirm that bone-mass density is a strong predictor for breast cancer in postmenopausal women. Women in the lowest quartile of bone mass appear to be protected against breast cancer. The mechanisms underlying this relation may be explained by cumulative exposure to oestrogen.

[Descriptive epidemiology of upper aerodigestive tract cancers in the department of Somme]. / Epidémiologie descriptive des cancers des voies aérodigestives supérieures dans le département de la Somme.

The aim of this study is to show the epidemiologic features of upper aerodigestive tract cancers in the department of Somme. This study focused on the 1984-1995 period. For men, the upper aerodigestive tract cancers are the most frequent cancers in the Somme area. The incidence rate of pharynx cancers has shown slightly a decline over the past 10 years. The mortality rate of larynx cancers for males fell from 18.2 in 1984-1987 to 13.8 in 1992-1995 per 100,000. 5-year survival rates are between 20 and 39% for men, and from 23 to 42% for women. France has the highest incidence of these cancers in Europe. Within the country, the Somme area has a high risk for incidences and mortality as well. The results of this study indicate that upper aerodigestive tract cancers represent a serious problem for public health. Further areas need to be researched before such factors can be causally implicated in the aetiology of the disease in order to make up the prevention.

[Lip, oral cavity and pharynx cancers in France: incidence, mortality and trends (period 1975-1995)]. / Les cancers de la lèvre, de la cavité buccale et du pharynx en France: incidence, mortalité et tendance (période 1975-1995).

With 10,882 estimated new cases in 1995 in France, lip, oral cavity and pharynx tumours rank 4th, representing 8.1% of all cancers in men. They are less frequent in women, with a sex ratio of 7. Based on the French cancer registries data which cover 13% of the metropolitan territory in 2000, both incidence and mortality increased until early 1980s to decrease thereafter. The main hypothesis proposed to explain the French leadership world-wide for these tumours deals with alcohol and tobacco consumption. Important differences observed between several areas within Europe, for some subsites, in connection with age or sex, are pointing toward the need of new studies about environment and/or genetics. Until now, comparisons between countries were made at the level of lip, oral cavity and pharynx category as a whole or by large subgroups. In this work we attempt to establish more accurate statistics, in order to comply with the situation of this cancer in France. Present results should encourage the scientific community to conduct site specific epidemiological studies.

[Female genital and breast cancers in France: geographic distribution and estimation of incidence]. / Les cancers génitaux et mammaires féminins en France: répartition géographique et estimation de l'incidence.

The aim of the study was to assess the incident number of female breast and genital tract cancers for the whole of France. The study focused on the 1983-1987 period and on 9.1% of the French population. The incident number of female breast and genital tract cancers was estimated for each site and for each of eight French administrative regions covered by a cancer registry qualified through the National Committee of Registries (Calvados, Côte-d'Or, Doubs, Hérault, Isère, Bas-Rhin, Somme, Tarn). Information on mortality rates was available at a regional level as well as at a nationwide level. The method estimated the national incidence rate modelizing the regional age-specific incidence rate as a function of corresponding mortality rate. Breast cancer was the leading site with 25,277 new cases per year while female genital tract cancers affected about 13,856 women. The cancer risk, estimated in using cumulative rate 0-74 years, was assessed at 7.1% for breast and at 1.2%, 1.4% and 1.1% for cervix uteri, corpus uteri and ovary respectively. Breast and genital tract cancers constituted 49% of the whole of cancers in women. Observed breast incidence rate was stable through French regions. There were pronounced contrasts in cervix uteri cancer risk, and some french regions displayed a high risk close to the observed European maxima. Interregional contrasts in risk of the other genital tract cancers were less striking. This study emphasized the importance of female breast and genital tract cancers for public health in France. The main aim of the French Cancer Registries Network is to provide a comprehensive description of cancer risk in France and to produce pertinent projection to 2005 horizon, combining the present data and the already accumulated 1988-1992 data.

[Digestive cancers in France. Geographic distribution and estimation of national incidence]. / Les cancers digestifs en France. Distribution géographique et estimation de l'incidence nationale.

OBJECTIVES: The purpose of this study was to compare the incidence of digestive cancers in 9 French departments and to give an estimate of this incidence for the whole of France, based on this data. METHODS: This study focused on the 1983-1987 period. The record quality for the 9 included registries (Calvados, Côted'Or, Doubs, Haute-Garonne, Hérault, Isère, Bas-Rhin, Somme, Tarn) has been assessed by the National Committee of Registries. The crude incidence rates and those standardized according to the world population have been worked out per localization and per sex. Incidence and mortality rates per department as well as mortality rates for the whole of France have enabled the assessment of the incidence and number of new digestive cancer cases per year. RESULTS: Esophagus and liver cancers are distinguished by large incidence disparities, fluctuating in a ratio of 1 to 5, and by a high sex ratio. In other localizations, incidence rates vary in a ratio of 1 to 2. The incidence rates of digestive cancers were especialy high in the Bas-Rhin department. They tended to be higher in Côte-d'Or, Doubs, Calvados and Somme, than in Haute-Garonne. Hérault and Tarn. The estimated number of digestive cancers was 30,071 in males and 19,951 in females: colorectal cancer was particularly frequent, 14,179 cases and 12,228 cases, respectively. CONCLUSION: There are some geographical variations, from one region to another, in digestive cancer incidence in France more pronounced for esophagus and liver cancers than for other localizations. Because of its frequency, colorectal cancer represents a serious problem for public health.

[Treatment of cancer of the rectum. Practical survey based on 7 French departments in 1990]. / Traitement du cancer du rectum. Enquête de pratique dans 7 départements français en 1990.

OBJECTIVES AND METHODS: Therapeutic modalities in rectal cancer were analyzed in a French population based study. This work reviewed all the new cases of rectal adenocarcinoma diagnosed in a one-year period from January 1st to December 31st 1990 among the population of 7 provinces. Thus, 427 new cases of rectal cancer were included in a data base (EUROCARE). The main goal of this study was to provide an up-to-date, unbiased evaluation of the different treatments of rectal cancer according to its stage when diagnosed. The aim was also to point out differences in therapeutic management between these different geographic areas. A three-stage clinico-pathological staging was used to minimize stage migration bias. RESULTS: 77.8% of the patients underwent a rectal excision; among them, 53.9% had a sphincter saving procedure. Adjuvant radiotherapy was associated to rectal resection in 46.2% of the patients and was pre-operative in 45.9%. Only 13.7% of patients had chemotherapy. CONCLUSIONS: We demonstrated a significative difference of therapeutic modalities between these different french geographic areas concerning adjuvant radiotherapy and chemotherapy. This work supports the need and the value of population-based study for clinical management, prognostic evaluation and evaluation of public health issues.

[Gynecological and breast cancer in the department of Somme]. / Cancers gynécologiques et mammaires dans le département de la Somme.

BACKGROUND: Breast and gynecological tumors are the most common cancers in women. The aim of this study was to show the epidemiologic features of gynecological and breast cancers in the French administrative district of La Somme. METHODS: This study focused on the 1982-1999 period. Incidence, mortality and survival rates were calculated. RESULTS: In 1997-1999, the world standardized breast incidence and mortality rates were 81.6 and 20.2 per 100,000 females per year. Breast and genital tract cancers accounted for 47% of all cancers in women. The incidence and mortality of uterine cervix cancers showed a clear decline over the past 10 years, whereas the trend of breast cancers was dominated by continuing increase. However, mortality was stable for breast cancers. Five year relative survival rates were respectively 80% for breast cancers, and 68%, 76%, 38%, for uterine cervix, uterine body and ovary cancers respectively. Incidence and mortality rates in Somme were in the middle risk range of other cancer French registries. CONCLUSION: The results of this study indicate that genital tract and breast cancers constitute a serious public health problem pointing out the importance of screening activities in the Somme area.

[Incidence and prevalence estimations for breast and colorectal cancer in the Picardy region]. / Estimation de l'incidence et de la prévalence du cancer du sein et du cancer colorectal dans la région de Picardie.

OBJECTIVES: To provide incidence and prevalence data on breast and colorectal cancer in the Picardie area of France. METHODS: An age-period-cohort method was used to estimate regional incidence and prevalence of cancer from regional cancer mortality data and patient survival data recorded in the Somme Cancer Registry. RESULTS: European standardized breast incidence for 1998 was 110 per 100000 inhabitants. The incidence for colorectal cancer was 67 per 100000 for men and 47 per 100000 for women. Prevalence was 9656 for breast cancer and 6283 (2941 for men and 3342 for women) for colorectal cancer. Incidence of breast cancer increased considerably (80.9%) between 1979 and 1998. CONCLUSION: These results provide data on breast cancer and colorectal cancer which are useful for planning demand for healthcare or medical surveillance in the Picardie area.

[Estimate of regional prevalence of colorectal cancer in France]. / Estimation de la prévalence régionale des tumeurs colorectales en France.

BACKGROUND: Colorectal cancer prevalence is an important determinant of the health demand that completes information provided by cancer incidence. Current estimations established from data for the years 1985 and 1995 can be used to establish a precise description of changing healthcare needs for colorectal cancer. METHOD: Prevalence estimates method were based on incidence data computed on the regional scale by the FRANCIM network and mortality data provided by INSERM. We used the relationship that exists between the net risk of cancer, the net risk of dying of the given cancer and the age-specific prevalence of cancer. RESULTS: In 1995, the prevalence of patients who had a diagnosis of colorectal cancer amounted to 200 000 persons. The estimated number of prevalent cases was never lower than 3500 in any region and in 7 regions this number was higher than 10 000. From 1985 to 1995, there has been an increase of 35% in the prevalence rates. CONCLUSION: The evaluation of the number of persons who have had a diagnosis of colorectal cancer provides knowledge for health care planning. Such information on the regional scale is very useful for the health organisation (SROS). This geographical level induces difficulties not encountered at the national level.