[Assessment of a general practitioner training campaign for early detection of cutaneous melanoma in the Haut-Rhin department of France]. / Evaluation d'une campagne de formation des médecins généralistes et des médecins du travail au dépistage du mélanome dans le Haut-Rhin.

INTRODUCTION: Dermatologists frequently provide training for general practitioners, but such training is not systematic and evaluation is rare. MATERIALS AND METHODS: A training campaign for general practitioners and occupational physicians in melanoma screening was carried out in the Haut-Rhin Department of France in 2004. The 630 general practitioners and 120 occupational physicians in this geographic department received repeated mail together with materials (posters and booklets) for their waiting rooms, and they were invited to attend medical training sessions. The sessions consisted of 10 photographs for initial evaluation, provision of epidemiological information, training in identification of subjects at risk and diagnosis of pigmented lesions, with a further 10 photographs for evaluation at the end. The 20 evaluation photographs were randomly selected for each session from 40 photographs comprising 18 cases of melanomas, 14 of nevi, 4 of basal cell carcinomas and 4 of seborrheic keratoses. At the end of each session, the physicians returned 2 anonymous questionnaires containing their overall assessment of the campaign (Q1) and their answers concerning the 20 evaluation photographs (proposed diagnosis and management strategy) (Q2). The questionnaires were then analyzed. The 40 evaluation photographs were also tested on 47 dermatologists. RESULTS: Three hundred and fifty physicians - 278/630 general practitioners (44%) and 72/120 occupational physicians (60%) - attended 18 medical training sessions. Response levels for questionnaires Q1 and Q2 were 88% and 90% respectively. Almost all of the physicians involved considered the campaign to be warranted. At the end of the training sessions, 96% felt they were better equipped to identify subjects at risk for melanoma and 53% (58% of general practitioners and 39% of occupational physicians, p=0.03) felt they had greatly improved their ability to diagnose pigmented lesions. The median number of correct replies concerning the evaluation photographs increased from 6/10 to 7/10 between the initial evaluation photographs and the final evaluation photographs (p<0.0001), with no difference being seen between the general practitioners and occupational physicians. The median number of correct replies from the 47 dermatologists was 35/40 (8.75/10). The most striking improvement noted during the campaign concerned the ability to identify melanomas. The figure rose from an initial 59% at the start of the session (initial evaluation photographs) (versus 86% for the dermatologists) to 84% by the end of the session (final evaluation photographs) (p<0.0001). The management strategy proposed for photographs of melanoma (irrespective of the proposed diagnosis) was judged "appropriate" in 86% of cases at the start of the session versus 94% at the end of the session (p<0.001). Seborrheic keratosis was correctly identified in 43% of cases by the general practitioners/occupational physicians versus 75% by the dermatologists, and was confused with melanoma in 22% of cases by the general practitioners/occupational physicians versus 5% by the dermatologists. No improvement was seen during the training session in terms of the ability of the general practitioners/occupational physicians to correctly identify seborrheic keratosis. The majority of participants indicated their willingness to participate in the screening program and asked to receive information on melanoma on a regular basis. DISCUSSION: This initial study shows the immediate impact of medical training sessions on general practitioners/occupational physicians to be important in terms of sensitization and moderate but significant in terms of improved diagnosis of pigmented lesions. The longer term impact, as well as the impact of the campaign on physicians not taking part in the medical training sessions, remains unknown. This study militates in favor of the involvement of general practitioners and occupational physicians in mass screening for melanoma in collaboration with dermatologists. The 2004 campaign in the Haut-Rhin Department also included information for the general public. The primary evaluation criterion of the campaign will be change in incidence of thick melanomas recorded by the departmental cancer registry.

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.

[An epidemiologic survey on the cosmetic use of bleaching agents by the women of Bamako (Mali)]. / Enquête épidémiologique sur l'utilisation cosmétique de produits dépigmentants par les femmes de Bamako (Mali).

In Mali, the cosmetic use of bleaching agents by black people has become a social phenomenon. How wide is this practice is not precisely known. We report the results of a survey conducted in Bamako among women aged from 15 to 45 years in order to evaluate the prevalence of this practice and its socio-economic factors. Two-hundred and ten women were questioned during the cluster survey. Among these, 53 (25 p. 100) used bleaching agents which were topical cortico-steroids (37), hydroquinone-containing products (21), mercury derivatives (11) and products of unknown composition (16). Dermatological side-effects were observed, but they did not hinder the use of these agents. Bleaching was particularly frequent in unmarried women (39 p. 100), literate women (34 p. 100) and female students (45 p. 100).

Mutilating syringoacanthoma.

Syringoacanthoma is a rare tumor derived from the eccrine acrosyringium; very few cases have been reported. The nosology of this tumor remains controversial. We present a new case of syringocanthoma occurring in a 43-year-old woman; the lesion lasted for more than 30 years and caused partial destruction of the earlobe. Histopathologic examination showed a hyperkeratotic intraepidermal tumor, with many large cavities lined by an eosinophilic cuticle and filled with a PAS-positive substance. This case is probably a mutilating variant of syringoacanthoma, despite benign histopathologic features.

[Control of malaria using mosquito nets impregnated with pyrethroids in Burkina Faso]. / La lutte contre le paludisme par des moustiquaires imprégnées de pyréthrinoides au Burkina Faso.

An experimental trial of malaria control was carried out in the village of Karangasso in the south-west Burkina Faso. It was based on the use by the whole population of deltamethrin impregnated bed nets at 25 mg/m2. During the first year pretreatment data on entomology, parasitology and pathological incidence of malaria were collected in the whole village. During the second year a quarter of the village with a population of 1,200 was chosen for the experiment and impregnated bed nets were given to everybody while the other quarter of the same population size was kept as a control area. Malaria transmission was reduced by 82% due to the decrease of both vector populations and sporozoitic indexes. It should be pointed out that this reduction in transmission was evaluated on non-protected catchers and consequently was underestimated for the villagers sleeping under nets. Parasitic index remained about the same but the mean parasitic load decreased significantly. Pathological incidence, based on the number of clinical malaria cases confirmed by blood examination, decreased by 59%. This trial shows that mass use of deltamethrin impregnated bed nets should be considered as a valuable tool for malaria control. The purchase of bed net is expensive but could be reduced sharply. The cost of the impregnation is very low regarding the residual effect which remains one year. The acceptance by the population was good.

[The impact of impregnated mosquito nets on prevalence and morbidity related to malaria in sub-Saharan africa]. / L'impact des moustiquaires imprégnées sur la prévalence et la morbidité liée au paludisme en Afrique sub-saharienne.

Insecticide treated bed nets (permethrin, deltamethrin and lambda cyalothrin) were used for malaria control in The Gambia, Burkina Faso and Tanzania where Anopheles gambiae (and An.funestus in Burkina Faso) is the main vector. Treated mosquito nets are efficient when used on a large scale and not on an individual level. Such a large scale use, acting on longevity and infectivity of vectors, always induced a decrease of malaria transmission by more than 90%. Treated bed nets had no significant effect on the overall parasite rate, showing that malaria transmission was not stopped. But it was usually found that there was a significantly smaller number of children with parasitemia higher than a critical threshold, a sensitive parameter of malaria morbidity. Indeed, in the three situations studied, malaria morbidity (fever + high parasitemia greater than critical level in the concerned area) has generally shown a similar drop of 60%. These data demonstrate that treated bed nets are useful to reduce transmission and morbidity. Advised as a new way for reduction of nuisance, treated bed nets were always welcomed by the populations and this method may be considered as a complementary weapon in public health.