Hospital admissions related to influenza in France during the 2006/2007 epidemic.

BACKGROUND: The data available on hospital admissions related to influenza mostly concern in-patients admitted via the emergency department. Severe cases have been collated by intensive care practitioners since 2009. For this survey, we searched French hospital admission databases to estimate the prevalence rate of hospital admissions related to influenza and to record qualitative data. METHOD: All case studies identified between October 2006 and September 2007 were split into two groups: the first displaying symptoms of clinical influenza and the second suffering from influenza as an associated diagnosis. RESULTS: We collected 6797 hospital admissions, 2126 of which were closely related to clinical influenza. Fifty percent of cases concerned the elderly and young people. Fifty-six hospital deaths were recorded in which influenza was the underlying cause in 21% of the cases (12). When influenza was an associated diagnosis (44/56), cardiovascular or respiratory diseases were the main causes (26/44). CONCLUSION: During the same period (2006-2007), the French Sentinel Surveillance identified only 105 hospital admissions related to influenza. Our survey was therefore more exhaustive and was able to record qualitative data. Inclusion of hospital admissions with an associated diagnosis of influenza is debatable because this decreases specificity. The relationship between the principal diagnosis and all the associated diagnoses is difficult to study, although exclusion of this type of hospitalization could significantly underestimate these figures. Despite certain limitations, French hospital admissions databases should complement French Sentinel Surveillance data.

[Incidence and prognostic factors of breast cancer diagnosed within and outside of the organised screening program in the department of Loire-Atlantique (1991-2002)]. / Incidence et facteurs pronostiques des cancers du sein découverts au cours et en dehors du programme de dépistage organisé en Loire-Atlantique (1991-2002).

BACKGROUND: This study aimed to evaluate the impact of breast cancer mass screening, which began in 1996 in Loire-Atlantique (France), on the evolution of incidence and characteristics of breast cancer between 1991 and 2002. METHODS: The cancer Registry of Loire-Atlantique recorded characteristics of 9263 incident breast cancers diagnosed between 1991 and 2002. The level of participation to the organised screening program was 48%, thus the screening management structure allowed characterizing 736 cancers discovered by organised screening between 1997 and 2002. RESULTS: The 1991-2002 period was marked by a strong increase of in situ cancer proportion (from 5% at the beginning to 10% at the end of the period) and of standardised incidence rates (from 77 to 103/10(5) and from 4 to 13/10(5) for invasive and in situ cancers, respectively). Incidence was already rising before the beginning of the organised screening program in 1996. During the 1997-2002 period, in spite of steady rates for cancers detected by organised screening, incidence of cancers detected outside organised screening went on increasing. Cancers detected by organised screening were more often of smaller size (33% versus 22% smaller than 10mm) and without lymph node invasion (70% versus 62%). CONCLUSION: A strong increase of breast cancer incidence was observed in Loire-Atlantique, particularly in the organised screening age groups. The persistent increase of in situ cancers for women younger than 50 years old unconcerned by the organised screening program, and also for women of 50-74 years old detected outside the organised screening program suggested a parallel contribution of individual screening. These preliminary results confirm better prognostic factors for cancer detected by organised screening than for others.

[The progression of lung cancer incidence in France (1978-2000)]. / Evolution de l'incidence du cancer broncho-pulmonaire en France (1978-2000).

INTRODUCTION: Lung cancer is the most common cause of death from malignant disease in the world. Our objective was to describe the progression of this cancer's incidence, and the changing distribution of histological types in France between 1978 and 2000. METHODS: National incidence rates were obtained by modelling lung cancer incidence data provided by the French cancer registries, taking into account national mortality data. These registries also provided information about histological type. RESULTS: In the year 2000, with 28,000 estimated new diagnoses, lung cancer represented 10.0% of all incident cancers and was responsible for 18.1% of deaths from cancer. From 1980 to 2000, the incidence rose from 47.4 to 52.2 per hundred thousand in men and from 3.7 to 8.6 per hundred thousand in women. The risk of developing lung cancer, which remained constant in men, has increased considerably (+451%) between the generation of women born in 1953 and those born in 1913. The proportion of epidermoid cancers has dropped whilst that of adenocarcinomas has risen sharply. CONCLUSIONS: The last few years have seen a large increase in the incidence of lung cancer in women and an increasing incidence of adenocarcinoma in both men and women.

Cancer incidence and mortality in France over the period 1978-2000.

BACKGROUND: Monitoring cancer incidence and mortality time trends is essential for cancer research and health-care planning. French cancer registries do not cover the entire population and do not provide a representative sample of the national population. Our study aimed at estimating national cancer incidence and mortality trends over the longest period available. METHODS: Incidence and mortality data were collected over the period 1978-1997. Twenty-seven cancer sites were selected and age, sex and site specific incidence and mortality rates were estimated for each year from 1978 up to 2000. Observed incidence and mortality data in the population covered by cancer registries were modelled using age-cohort methods. An estimation of the incidence/mortality ratio was obtained from these models and applied to the mortality rates predicted from an age-cohort model for the entire French population. The person-years of observation were calculated cohort-wise from census data provided by the national institute of statistics RESULTS: Cancer incidence increased by 63% throughout the study period, from 170,000 new cases in 1980 to 278,000 in 2000. This evolution was due to demographic changes but also to an increase in the risk of cancer which was estimated to more than 35% during the same period. In men, this change is largely explain by the increase of prostate cancer incidence. Among women, the increase was dominated by the continuing increase in breast cancer incidence. Large increases were also seen for non-Hodgkin lymphoma, melanoma, and thyroid cancer in both genders and for lung cancer in women. Cancer mortality increased by 20% from 125,000 deaths in 1980 to 150,000 in 2000. This increase is less than that predicted from changes in demographic factors and corresponds in fact to a decrease in the risk of death estimated to about 8%, slightly greater for women than for men. This decrease is associated with a decreasing incidence for stomach cancers for both sexes, alcohol-related cancer for men and cervical cancer for women. Colo-rectal cancer decreasing mortality contributes to this improvement despite an incidence increase. CONCLUSION: Between 1980 and 2000, the study showed a large change in the cancer burden both quantitatively and qualitatively. Decrease in exposure, earlier diagnosis and therapeutic improvement explained part of this change, but overall the distribution of cancer cases shifted toward a distribution including less aggressive cancers. A striking divergence between incidence and mortality trends is observed for a great number of cancers. Prostate cancer shares with breast cancer the same pattern of a severe increasing incidence and a stable mortality. This points to important changes in medical practice and needs further analysis. The trend of lung cancer mortality among women should be emphasised since the situation will inevitably worsen in the coming years. It is already the third cause of cancer death among women.