Highlights • Time trend analysis of papillary thyroid cancer showed a dramatic increase. • This increase has slowed down within in recent years, especially at younger ages. • There is a strong ...geographic disparity in incidence between areas in France. • 10-years net survival is high and has improved between 1989 and 2004.
Objective To analyze trends in cancer incidence and mortality (France, 1990-2018), with a focus on men-women disparities. Methods Incidence data stemmed from cancer registries (FRANCIM) and mortality ...data from national statistics (CépiDc). Incidence and mortality rates were modelled using bidimensional penalized splines of age and year (at diagnosis and at death, respectively). Trends in age-standardized rates were summarized by the average annual percent changes (AAPC) for all-cancers combined, 19 solid tumors, and 8 subsites. Sex gaps were indicated using male-to-female rate ratios (relative difference) and male-to-female rate differences (absolute difference) in 1990 and 2018, for incidence and mortality, respectively. Results For all-cancers, the sex gap narrowed over 1990-2018 in incidence (1.6 to 1.2) and mortality (2.3 to 1.7). The largest decreases of the male-to-female incidence rate ratio were for cancers of the lung (9.5 to 2.2), lip - oral cavity - pharynx (10.9 to 3.1), esophagus (12.6 to 4.5) and larynx (17.1 to 7.1). Mixed trends emerged in lung and oesophageal cancers, probably explained by differing risk factors for the two main histological subtypes. Sex incidence gaps narrowed due to increasing trends in men and women for skin melanoma (0.7 to 1, due to initially higher rates in women), cancers of the liver (7.4 to 4.4) and pancreas (2.0 to 1.4). Sex incidence gaps narrowed for colon-rectum (1.7 to 1.4), urinary bladder (6.9 to 6.1) and stomach (2.7 to 2.4) driven by decreasing trends among men. Other cancers showed similar increasing incidence trends in both sexes leading to stable sex gaps: thyroid gland (0.3 to 0.3), kidney (2.2 to 2.4) and central nervous system (1.4 to 1.5). Conclusion In France in 2018, while men still had higher risks of developing or dying from most cancers, the sex gap was narrowing. Efforts should focus on avoiding risk factors (e.g., smoking) and developing etiological studies to understand currently unexplained increasing trends. Keywords: Cancer, Incidence, Mortality, Registries, Sex, Trends
•Short term projections showed the high prevalence of persons alive with previous cancer diagnosis in a high-income country.•Trends in prevalence were influenced by incidence, survival and demography ...among ≥65y and by incidence and survival among <65y.•Time variation of prevalence among men was influenced by the recent incidence decrease of prostate cancer.
This study analyzes time trends in cancer prevalence in France and provides short-term projections up to the year 2017. The 15-year prevalence for 24 cancers was estimated from the French cancer registries network (FRANCIM) incidence and survival data.
We estimated prevalence using the P = I × S relationship, with flexible modeling of incidence and survival. Based on observations of the incidence and survival up to 2010, different scenarios for evolution up to 2017 were studied, combining stable and dynamic incidence and survival. The determinants of variations in prevalence (incidence, survival and demography) were quantified.
At the end of 2017, an estimated 1,396,000 men and 1,359,000 women having had cancer in the previous 15 years were alive, respectively 5.4% and 4.8% of the population. Twelve percent had been diagnosed in the preceding year and 23% between 10 and 15 years. Between 2010 and 2017, changes in incidence and survival depended on the cancer site. The effect of the demographic change was null for those under age 65, whereas above age 65, the contribution of this factor was 20% in men and 17% in women at 15 years. The different projection scenarios led to very different estimates for some cancers for which incidence strongly varied in the last decades.
Prevalent cases are numerous in a country such as France, where incidence and survival are high. Due to the sensitivity of prevalence to changes in incidence and survival, we recommend that the results of projections are presented under different scenarios. We propose a robust and flexible prevalence estimate.
Survival rates of lung cancer remains poor and the impact of comorbidities on the prognosis is discussed. The objective of this study was to assess if the Charlson Comorbidity Index (CCI) was ...associated with 8-year survival rates by histological type.
A cohort study was conducted using randomly selected cases from 10 French cancer registries. Net survival rates were computed using the Pohar-Perme estimator of the net cumulative rate. Three Cox models were independently built for adenocarcinomas, squamous cell and small cell cancers to estimate prognostic factors including CCI grade.
A total of 646 adenocarcinomas, 524 squamous cell and 233 small cell cancers were included in the analysis. The net 8-year survival rate ranged from 12.6% (95% CI: 9.8-15.4%) for adenocarcinomas and 13.4% (95% CI: 10.1-16.7%) for squamous cell carcinomas, to 3.7% (95% CI: 1.1-6.3%) for small cell cancers. Observed and net survival rates decreased for CCI grades ≥3 for all histological group considered. After adjustment for sex, age group, stage and diagnostic mode, CCI grades 1 (HR = 1.6 95% CI: 1.1-2.3), 2 (HR = 1.7 95% CI: 1.1-2.7) and ≥ 3 (HR = 2.7 95% CI: 1.7-4.4) were associated with lower survival rates only for small cell cancers.
After adjustment for age, sex, stage and diagnostic mode, the presence of comorbidity based on CCI grades 1-2 and ≥ 3 was associated with lower survival rates for small cell cancers whereas no differences were observed for adenocarcinomas and squamous cell cancers.
Abstract 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 (⩽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 ⩽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.
Abstract Waiting times are key indicators of a health's system performance, but are not routinely available in France. We studied waiting times for diagnosis and treatment according to patients' ...characteristics, tumours' characteristics and medical management options in a sample of 1494 breast cancers recorded in population-based registries. The median waiting time from the first imaging detection to the treatment initiation was 34 days. Older age, co-morbidity, smaller size of tumour, detection by organised screening, biopsy, increasing number of specimens removed, multidisciplinary consulting meetings and surgery as initial treatment were related to increased waiting times in multivariate models. Many of these factors were related to good practices guidelines. However, the strong influence of organised screening programme and the disparity of waiting times according to geographical areas were of concern. Better scheduling of diagnostic tests and treatment propositions should improve waiting times in the management of breast cancer in France.
The objective of this work was to detail the incidence and mortality trends of invasive and in situ breast cancer (BC) in France, especially regarding the development of screening, over the 1990–2008 ...period. Data issued from nine population-based cancer registries were studied. The incidence of invasive BC increased annually by 0.8 % from 1990 to 1996 and more markedly by 3.2 % from 1996 to 2003, and then sharply decreased until 2006 (−2.3 % per year), especially among women aged 50–69 years (−4.9 % per year). This trend was similar whatever the introduction date of the organized screening (OS) program in the different areas. The incidence of ductal carcinoma in situ steadily increased between 1990 and 2005, particularly among women aged 50–69 years and 70 and older. At the same time, the mortality from BC decreased annually by 1.1 % over the entire study period. This decrease was more pronounced in women aged 40–49 and 50–69 and, during the 1990–1999 period, in the areas where OS began in 1989–1991. The similarity in the incidence trends for all periods of implementation of OS in the different areas was striking. This suggests that OS alone does not explain the changes observed in incidence rate. Our study highlights the importance of closely monitoring the changes in incidence and mortality indicators, and of better understanding the factors causing variation.
The objective of this study is to determine whether the likelihood of returning for routine breast cancer screening differed for false-positive cases depending on the diagnostic work-up. Using the ...original data from a French population-based breast cancer screening program, we compared the attendance rates at the subsequent round of screening for 16,946 and 1,127 participants who received negative (i.e., American College of Radiology, ACR, categories 1–2) and false-positive mammograms, respectively. False-positive mammograms were categorized ACR 0 (i.e., warranting additional imaging evaluation), 3 (i.e., warranting clinical and imaging follow-up), and 4–5 (i.e., warranting biopsy). We estimated the odds ratios of attendance at subsequent screening round using logistic regression, adjusting for age and history of previous mammography. The attendance rates at the subsequent screening round were 80.6% for women who received negative mammograms versus 69.6, 74.3, and 70.1% for women who received false-positive mammograms warranting additional imaging evaluation, clinical and imaging follow-up, or biopsy, respectively. In comparison to women who received negative mammograms, the corresponding adjusted odds ratios of returning for routine screening were 0.6 95% confidence interval (CI) 0.4–0.8, 0.8 (95% CI 0.6–0.9), and 0.6 (95% CI 0.4–0.8). No significant differences were found in odds ratios of attendance across ACR categories among women who received false-positive mammograms. Similar figures were observed for attending at least one of the two subsequent screening rounds. In conclusion, in comparison to women with normal or benign findings on index mammograms, false-positive cases warranting additional imaging evaluation, clinical and imaging follow-up, or biopsy had uniformly decreased odds of attending subsequent routine screening rounds.
The hypothesis of a link between breast cancer and hormone replacement therapy (HRT) is evoked to explain the recent decrease of incidence observed in several countries. The purpose of our study is ...to analyse the evolution of breast cancer incidence by stage.
We used data from Tarn and Isère French cancer registries for the period 1990–2007. Trends of annual world population standardised incidence rates were studied using the Joinpoint method.
From 1990 to 1999, the incidence of invasive breast cancer increased annually by 1.2%, then by 4.8% from 1999 till 2003 and then decreased by 1.7%. For the women aged 50–74 years, annual changes were, respectively, 1.5%, 6.0% and 3.4%. In this group, the incidence of T1/T2–N0–M0 stages increased annually by 4.6% until 2003 and then decreased by 2.2%. Since 1990, the incidence of in situ breast cancer increased annually by 5%. From 2003 to 2004, prescribing of HRT decreased substantially.
Since 2003, the incidence of invasive breast cancer decreased for women aged 50–74 years, mainly involving T1/T2–N0–M0 stages. The reduction in HRT prescription may partly explain this decrease. The incidence of in situ breast cancer didn’t decrease during the whole period.
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