The exhaustive collection of new sarcoma cases and their second histologic review offer a unique opportunity to study their incidence and time trends in France according to the major subtypes.
Data ...were collected from population-based cancer registries covering 22% of the French population. Crude and world age-standardized incidence rates (ASR) were estimated according to anatomic, histological and genetic groups, age and sex over the 2010-2013 period.
Time trends in incidence were calculated by the annual percent change over the 2000-2013 period. During the most recent period (2010-2013), 3942 patients with sarcoma were included. The ASR of soft-tissue and bone sarcomas, and gastro-intestinal stromal tumors (GIST) were 2.1, 1.0 and 0.6, respectively. For the four most frequent histological subtypes (unclassified, leiomyosarcoma, GIST and liposarcoma), the ASR ranged from 0.4 to 0.7. ASRs were 1.9 for complex genomic and 1.3 for recurrent translocation sarcomas. The time-trend analysis showed a significant increase of sarcoma incidence rate between 2000 and 2005, which stabilized thereafter. Incidence rates increased for four histological subtypes (GIST, chondrosarcoma, myxofibrosarcoma, solitary fibrous tumors) and decreased for three (leiomyosarcomas, Kaposi sarcoma and fibrosarcoma).
To our knowledge, this study is the first to investigate sarcoma incidence based on a systematic pathological review of these cancers and on the updated sarcoma classifications. Due to the paucity of literature on sarcomas, future studies using data from population-based cancer registries should consider a standardized inclusion criterion presented in our study to better describe and compare data between countries.
•Women with breast cancer participating to mass screening had higher survival.•Attender women to mass screening had a good survival regardless deprivation.•Survival was lower for non-attender women ...in deprived areas.•Effect of mass screening in survival seemed higher for women in deprived areas.
Some studies have investigated the role of socio-demographic inequalities in the association between screening and survival. However, in France, no study has been conducted to describe the socio-demographic characteristics and survival of women with breast cancer based on their participation to mass screening. The aim of this study was to assess the impact of socio-demographic inequalities on the association between participation in mass screening program and survival of women with breast cancer.
Data for 2,244 women aged 50–74 years diagnosed with breast cancer over the period 2008–2010 were obtained from the cancer registry and the screening structure of Gironde. We used the aggregated European Deprivation Index (EDI) to define the deprivation level of women. Net survival rates were estimated with the Pohar-Perme method, with and without correcting for lead-time bias.
Survival rates were lower for non-attenders than for screen-detected women (83.8% vs 97.3%, p < 0.0001), even after correcting for lead-time bias. Among the most deprived women, the survival rate was significantly different between non-attenders and screen-detected women (78.1% vs 95.6%, p = 0.0002), suggesting an important effect of mass screening in this group.
The introduction of incentive actions in deprived areas could play a key role in the adherence of women to mass screening and in improving their survival in case of a breast cancer diagnosis.
BACKGROUND
Sarcomas are rare, heterogeneous, ubiquitously localized malignancies with many histologic subtypes and genomic patterns. The survival of patients with sarcoma has rarely been described ...based on this heterogeneity; therefore, the authors' objective was to estimate survival outcomes in patients who had sarcomas using the 2020 version of the World Health Organization classification of soft tissue and bone tumors.
METHODS
Patients older than 15 years who had incident sarcoma diagnosed between 2005 and 2010 were extracted from 14 French population‐based cancer registries covering 18% of the French metropolitan population. Vital status for each patient was actively followed up to June 30, 2013. Net survival (NS) was estimated using the unbiased Pohar‐Perme method.
RESULTS
Overall, 4202 patients were included. NS declined with increasing age at diagnosis. According to topographic groups, large 5‐year NS disparities were observed, ranging from 47% among women with gynecologic sarcomas to 89% among patients with skin sarcomas. Patients with soft tissue, bone, and gastrointestinal sarcomas had 5‐year NS rates of 53%, 61%, and 70%, respectively. Similar heterogeneity was observed according to histologic subtypes, with 5‐year NS ranging from 19% for patients with angiosarcomas to 96% for patients with dermatofibrosarcomas. Patients with sarcoma who displayed missense mutations had a better 5‐year NS (74%); those with MDM2‐amplified sarcomas had the worst NS (45%).
CONCLUSIONS
NS rates in patients with sarcoma are presented here for the first time based on the 2020 World Health Organization classification applied to population‐based registry data. Large prognostic heterogeneity was observed based on age, topographic and histologic groups, and genomic alteration profiles, constituting a benchmark for future studies and clinical trials.
In this study based on the 2020 version of the World Health Organization classification of soft tissue and bone tumors applied to the French population‐based cancer registries, large survival heterogeneity of sarcomas was observed on age, topographic and histologic groups, and genomic alteration profiles. This study emphasized the major determinants of survival in patients with sarcoma, providing a new benchmark for future studies or clinical trials.
Many studies have investigated the survival of women by comparing those who participated in organised screening with those who did not. However, among those who do not participate in organised ...screening, some women undergo opportunistic screening, but these women remain difficult to identify, particularly in France. Therefore, the aim of this study was to identify opportunistic screening, and then to study survival after breast cancer separately according to participation in organised, opportunistic or no screening, and taking into account sociodemographic inequalities.
The study population was identified from 3 French cancer registries, whose data was crossed with the screening coordination centers and the National Health Data System to identify the different type of screening. The European Deprivation Index was used to define the level of deprivation. We estimated net survival using the Pohar-Perme method.
The 5-year net survival probabilities were higher for women who attended organised screening (97.0 %) than for women with opportunistic screening (94.1 %) or non-attenders (78.1 %). According to the level of deprivation, a significant difference was observed between the groups of women screened by organised and opportunistic screening, compared to the non-attenders.
The identification of opportunistic screening is an important element in identifying women who do not screening. It enables to us to see that women who do not attend any screening have a much higher loss-of-opportunity in terms of survival than those who participate in organised or opportunistic screening, and even more so in the most deprived areas.
•Survival was lower among women who do not participated in any screening.•Participation in organised screening erases the effect of social inequalities.•Small inequalities effect among women who participate in opportunistic screening.
Background
Small bowel cancer is not a single entity. Population-based studies taking into account histological diversity are scarce. The aim of this study was to report on their trends in incidence ...by histology in France over the past 20 years.
Methods
All patients with a small bowel cancer diagnosed in 15 French administrative areas covered by a registry from the network of French cancer registries (FRANCIM) were included. Age-standardized incidence rates were estimated using the world standard population. Incidence rates were calculated by gender, age group, histology, and 5-year period.
Results
The overall age-standardized incidence rates were 1.46/100,000 inhabitants in men and 0.9/100,000 inhabitants in women. Adenocarcinoma was the most common histological type (38%), followed by neuroendocrine tumors (35%), lymphoma (15%) and sarcoma (12%). Age at diagnosis and tumor location differed between adenocarcinoma and neuroendocrine tumors. The incidence of all four tumor types increased significantly over the 20-year period, with the exception of lymphoma in men. The annual percentage change for neuroendocrine tumors was 3.89% in men and 3.61% in women; for sarcoma, it was 3.38% and 4.08%, respectively. The incidence of adenocarcinoma and lymphoma also increased in women with an annual percentage change of 3.05% and 3.32%, respectively.
Conclusion
Small bowel cancer incidence has increased over time. This increase occurred with different amplitudes and patterns in the four major histological types. The improvement in imaging techniques could partly explain this increase. It is necessary to determine whether predisposing conditions may contribute to this change.
•Dementia is associated with a lower likelihood of receiving cancer treatment.•Dementia is associated with higher mortality in cancer untreated older patients.•Dependency is associated with higher ...mortality in cancer treated older patients.
Several studies have reported disparities in the care management and survival of older cancer patients. The aim of our study was to identify determinants of treatment administration in this population of cancer patients aged over 65 years taking into account competing risks of death.
The INCAPAC study is a population-based study. Four cancer registries and three prospective cohort studies on older subjects (age ≥65 years) from Gironde, a French department, were merged to identify older cancer patients. We used a non-parametric multi-state model including three states (cancer, treatment and all-cause death). This model allowed studying determinants of treatment administration (all treatments including curative, symptomatic and palliative treatments) and mortality considering that patients can move from cancer state to death state, either directly or through the treatment phase. Studied variables were demographic and socioeconomic-, cancer-, health-, and geriatric-related.
A total of 450 patients were included in the analyses. They were mainly aged 85 and over, men and educated. Among included patients, 372 (83%) received cancer treatment. In the final multivariate model, dementia was associated with a lower likelihood of receiving cancer treatment (HR = 0.68, 95% CI = 0.47–0.99). In treated patients, age, sex, comorbidities, dependency and stage at diagnosis were associated to all-cause mortality, and in untreated patients, diagnosis of dementia and stage at diagnosis were associated to mortality.
Further studies are necessary to understand the impact of geriatric impairments on treatment administration and to develop clinical practice guidelines.
High levels of asthma prevalence and severity of respiratory symptoms have been found in the Caribbean but little is known about the impact of air pollution in these regions. This study aimed to ...describe air pollution and measure the associations with child lung function in Guadeloupe (French West Indies).
Data from 30 randomly chosen elementary schools (8-13 years old) were obtained using a standardized protocol adapted from the ISAAC2 study. We considered two health outcomes: peak expiratory flow (PEF) before running and the variation in peak expiratory flow (ΔPEF) after running. The associations between pollutants and outcomes were investigated using several air pollution exposure models: i) medium-term exposure to close-proximity pollution both indoor and outdoor for ozone (O₃) and nitrogen dioxide (NO₂) and ii) short- and medium-term exposure to background pollution for O₃, NO₂, sulphur dioxide (SO₂) and small particulate matter (PM10).
Of 1,463 children, 277 (16%) were found to have asthma. A 1-μg/m3 increase in medium-term exposure to outdoor close-proximity pollution by O₃ was associated with a PEF decrease (β = -0.32; 95% CI: -0.61;-0.03). No association was found with NO₂ regarding close-proximity pollution. The association between medium-term exposure to background pollution and PEF decrease was stronger in asthmatic children than in non-asthmatic children for O₃. No reduction in PEF or ΔPEF was shown with NO₂, SO₂ and PM₁₀ pollutants but a significant association was found between PM₁₀ and PEF increase.
Our results suggest that O₃ could have an acute effect on child lung function in the Caribbean even at a low concentration (below the WHO guidelines). Further research in the Caribbean is needed to confirm these findings.
Sarcomas are a heterogeneous group of tumors whose incidence is nearly 5 per 100 000 inhabitants in Europe. Their causes are poorly understood, although occupational exposures (especially farming and ...pesticides) are suspected. The AGRICAN cohort is a prospective study of 181 842 individuals enrolled in 2005 to 2007 who completed an enrolment questionnaire with data on lifelong agricultural exposure. Associations between agricultural exposure and sarcoma overall, gastrointestinal stromal tumors (GIST) and myomatous and fibrous sarcoma together, were analyzed with a Cox model. Until 2015, 188 incident cases of sarcoma were identified. Increased risks were observed (a) among cattle farmers working <10 years (HR<10years = 2.45, 95% CI 1.36‐4.43) and breeding ≥50 livestock (HR≥50animals = 3.84, 95% CI 1.60‐9.22), especially if involved in animal care and building disinfection, (b) in greenhouse production (HR = 1.82, 95% CI 1.01‐3.30) and (c) in field‐grown vegetable production (HR = 1.49, 95% CI 0.96‐2.32). Concerning histological subtypes, GIST were positively associated with pesticide use in vineyards (HR = 2.24, 95% CI 0.95‐5.30). For myomatous and fibrous sarcoma, the only increase was seen in field‐grown vegetable production (HR = 2.37, 95% CI 1.16‐4.85). In AGRICAN, the risk of sarcomas was increased in several farming activities with differences according to histological subtype.
What's new?
While sarcoma risk is potentially influenced by agricultural exposures, relationships between sarcoma and factors such as pesticide exposure, livestock farming and occupational history of farming remain poorly understood. Here, data from the prospective AGRIculture and CANcer (AGRICAN) cohort in France reveals an increased risk of soft‐tissue sarcoma among cattle farmers, pig farmers and farmers working in greenhouses or raising field‐grown vegetables. Associations were notable for cattle farmers who were raising 50 or more animals, had close animal contact or were involved in building disinfection. Specific exposures were identified for several sarcoma subtypes, including elevated myosarcoma/fibrosarcoma risk among field vegetable growers.
Mammography-based screening programs play a crucial role in reducing breast cancer mortality through early detection. Their efficacy is influenced by breast density, a dynamic factor that evolves ...over time, modifying breast cancer risk. Women with high breast density face increased breast cancer risk, coupled with reduced mammographic sensitivity. In this work, we present the DeepJoint algorithm, a pipeline for quantitative breast density assessment, investigating its association with breast cancer risk. First, we develop a lightweight deep-learning segmentation model that uses processed mammography images acquired from multiple manufacturers to assess quantitative breast density metrics such as dense area and percent density. Then, we fit a joint model to evaluate the association of these metrics with the time-to-breast cancer occurrence using an extensive database of 77,298 women participating in breast cancer screening in the United States. We demonstrate the impact of the current value and slope of the biomarker on breast cancer risk. We also derive individual and dynamic breast cancer risk predictions to describe how the individual longitudinal evolution of dense area and percent density impacts the risk of breast cancer. This innovative approach aligns with the growing interest in personalized risk monitoring during screening, offering valuable insights for improving breast cancer prevention strategies.
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