Testicular cancer, both seminoma and nonseminoma tumours, account for 1 to 1.5 % of male cancers. Many studies have shown that the risk of a second cancer after radiotherapy is dependent on the size ...of the exposure fields and the strength of delivered doses of radiotherapy. According to the literature, the relative risk of second cancer among patients treated by irradiation for seminoma limited to the testis varies from 1.5 to 1.9. We conducted a retrospective epidemiological study to measure the risk of second cancer in a population treated for both seminoma and nonseminoma tumours. The study period included patients who were diagnosed from 1978 to 2002. Data were provided by the Doubs cancer registry. Among these 291 cases of testicular cancer, we found 11 cases of second cancer after 157 seminomas (stomach, lungs, testis, ORL, kidney and oesophagus), and 3 cases after 134 nonseminomas (thyroid, kidney and testis). We found a high risk for second pulmonary and testicular cancers (standardised incidence ratio almost statistically significant). While our results are not conclusive regarding the etiology of these second cancers, they do form a useful, comparative basis for further study. They constitute the first step of a study that will be carried out on the risk related to radiation after orchidectomy.
To describe circumstances of the diagnosis and access to dermatological care for patients with cutaneous melanoma (CM) and to investigate factors associated with early detection.
Retrospective ...population-based study of incident cases of invasive CM in 2004, using questionnaires to physicians and a survey of cancer registries and pathology laboratories.
Five regions in northeastern France.
Six hundred fifty-two patients who were referred to dermatologists by general practitioners (group 1) or by other specialists (group 2), who directly consulted a dermatologist for CM (group 3), or who were diagnosed as having CM during a prospective follow-up of nevi (group 4) or when consulting a dermatologist for other diseases (group 5).
Characteristics of patients, tumors, and patients' residence in each group, including the geographical concentration of dermatologists. We performed multivariate analysis of these factors to determine association with Breslow thickness.
Age, tumor location, Breslow thickness, ulceration, histological type, and geographical concentration of dermatologists significantly differed among groups. Patients consulting dermatologists directly formed the largest group (45.1%). Those referred by general practitioners (26.1%) were the oldest and had the highest frequency of thick (>3 mm), nodular, and/or ulcerated CM. Patients from groups 4 (8.4%) and 5 (14.1%) had the thinnest CMs. Ulcerated and/or thick tumors were absent in group 4. In multivariate analysis, histological types superficial spreading melanoma and lentigo maligna melanoma, younger age, high concentration of dermatologists, and detection by dermatologists were significantly associated with thinner CMs.
Easy access of patients to dermatologists, information campaigns targeting elderly people, and education of general practitioners are complementary approaches to improving early detection.
To estimate survival in patients in whom uveal melanoma was diagnosed between January 1, 1983, and December 31, 1994, in Europe.
Survival analysis of data from 32 cancer registries in 16 European ...countries adhering to the European Cancer Registry for 5788 patients with uveal melanoma diagnosed between January 1, 1983, and December 31, 1994, with follow-up to 1999.
Five-year relative survival was 68.9% overall and remained stable with the period of diagnosis. Relative excess risk of death was 2.45 (95% confidence interval CI, 2.10-2.86) in patients aged 75 years or older compared with patients aged 54 years or younger and was slightly higher in male patients (relative excess risk, 1.10; 95% CI, 1.02-1.19) than in female patients. Survival was similar in Nordic countries (relative excess risk, 1.03; 95% CI, 0.87-1.21) compared with the United Kingdom (reference country) and was lower in eastern and western European countries (1.26; 1.05-1.52, and 1.25; 0.90-1.60, respectively) compared with the reference country.
In this large series of patients with uveal melanoma, 5-year relative survival remained stable with the introduction of conservative treatment in individuals in whom uveal melanoma was diagnosed between 1983 and 1994. We found differences in survival between sexes and in European areas that should be investigated in studies that consider tumor characteristics at the individual level.
To describe current management of cutaneous melanoma (CM) and identify factors accounting for disparities.
Retrospective population-based study using survey of cancer registries and pathology ...laboratories, and questionnaires to physicians.
Five regions covering 19.2% of the French territory and including 8.2 million inhabitants.
Incident cases of patients with stage I to stage II (hereinafter, stage I-II) tumors staged according to the American Joint Committee on Cancer Staging guidelines and nodal stage III CM in 2004.
Modalities of diagnosis and excision, surgical margins, sentinel lymph node biopsy, adjuvant therapies and surveillance procedures, and their variations according to age, sex, residence, location of primary CM, Breslow thickness, type of physicians, modalities of decisions, and health care patterns.
Clinical stage I-II CMs (n = 710 cases) slightly predominated in females (53%), with a lower mean Breslow thickness (1.4 mm) than in males (1.9 mm). Initial excisions were most often performed by private dermatologists and wide excisions by surgeons. Narrow margins (8%) were associated with advanced age, higher Breslow thickness, and head location. Sentinel lymph node biopsy was performed in 34% of CMs thicker than 1.0 mm, depending on geographical regions, distance from reference centers, and health care patterns. Adjuvant therapies (mainly low-dose interferon) were proposed in 53% of thick CMs (>1.5 mm), depending on the patient's age and geographical region. In contrast with French recommendations, surveillance procedures frequently included systematic medical imaging. Stage III nodal CMs (n = 89 cases) predominated in males (62%). After lymphadenectomy, adjuvant therapies (including high-dose interferon in 32% of cases and chemotherapies in 24% of cases) were proposed in 68% of cases, depending on the patient's age and geographical region. A complete 1-year high-dose interferon regimen was administered in less than 10% of cases.
Large disparities still exist in the management of CM in France, depending to a greater extent on medical and geographical environment than on the characteristics of either patients or tumors.
The epidemiology of cancers is known in France through mortality data provided by Inserm and morbidity data obtained by French tumor registries. The purpose of this study was to compare the incidence ...of laryngeal cancers in 9 French departments and to give an estimate of this incidence for the whole of France, based on this data. Incidence and mortality data were collected over the period 1978-1997. The 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 estimated number of laryngeal cancers was 3,865 in males and 361 in females. There were pronounced contrasts in laryngeal cancer incidence between cancer registries. The incidence rate of laryngeal cancers were especially high in the Somme and Calvados department compared to those observed in Haut-Rhin and Tarn. The ratio incidence/mortality was 2.4 in Doubs and 1.3 in Somme. France is among the countries which have the highest rates of incidence and mortality for laryngeal cancer in Europe.
Although clinical trials have demonstrated that adjuvant chemotherapy improves survival for stage-III colon cancer, the benefits remain controversial for stage-II lesions. The objective of the ...present study was to determine the extent to which adjuvant chemotherapy is used for patients with stage-II and -III colon cancers.
The study population comprised 1074 patients with stage-II and -III colon cancers diagnosed in 2000 in 12 French administrative districts and recorded in population-based cancer registries. Data were collected using a standardized procedure.
Overall, 20.4% of patients with stage II and 61.9% with stage III received adjuvant chemotherapy. Age at diagnosis was the strongest determinant of chemotherapy. Among stage-II patients, those receiving chemotherapy decreased from 57.6% in patients aged ≤
50 years to 1.1% in those aged ≥
85. The corresponding percentages with stage III were 93.6% and 1.4%. In multivariate analyses, other factors found to be independently and significantly associated with administration of adjuvant chemotherapy for stage II were extension of the cancer (stage IIA vs. stage IIB), clinical presentation (obstruction or perforation vs. uncomplicated cancer) and discussion of the case at a multidisciplinary case-review meeting. For stage III, apart from age, discussion of the case at a multidisciplinary meeting was the only factor independently associated with administration of chemotherapy.
Adjuvant chemotherapy for stage-III colon cancer is used extensively for patients under 75 years of age. However, many elderly patients do not receive such treatment. On the other hand, a substantial percentage of stage-II colon cancer patients receive adjuvant chemotherapy despite its uncertain benefits.
Bien que les essais thérapeutiques aient démontré l’efficacité de la chimiothérapie adjuvante sur l’amélioration de la survie des cancers du côlon de stade III, son bénéfice pour les cancers de stade II reste controversé. L’objectif de cette étude était de connaître la diffusion de l’administration de la chimiothérapie pour les patients porteurs d’un cancer du côlon de stade II et de stade III.
La population d’étude incluait 1074 patients ayant eu un cancer du côlon de stade II ou III diagnostiqués en 2000 dans 12 départements français couverts par un registre de cancers. Les données ont été recueillies selon une procédure standardisée.
Au total, 20,4 % des patients ayant un cancer de stade II et 61,9 % de ceux ayant un cancer de stade III avaient une chimiothérapie adjuvante. L’âge au diagnostic était le facteur qui influençait le plus cette pratique. Parmi les patients de stade II, la chimiothérapie était administrée à 57,6 % des moins de 50 ans et à 1,1 % des patients âgés de 85 ans ou plus. Pour les stades III, les pourcentages correspondants étaient 93,6 et 1,4 %. L’analyse multivariée montrait que l’extension du cancer (stade IIA vs IIB), le mode de découverte (occlusion ou perforation vs hors complication) et la présentation du dossier en réunion de concertation pluridisciplinaire étaient des facteurs indépendamment et significativement associés à l’administration de la chimiothérapie. Pour les stades III, en plus de l’âge, la présentation du cas en réunion de concertation pluridisciplinaire était le seul facteur indépendamment associé à l’administration de la chimiothérapie.
La chimiothérapie adjuvante des cancers du côlon de stade III est largement utilisée chez les patients âgés de moins de 75 ans. Beaucoup de sujets plus âgés ne reçoivent toutefois pas ce traitement. Un nombre non négligeable de patients ayant un cancer du côlon de stade II reçoivent également une chimiothérapie adjuvante malgré des bénéfices non démontrés.
The 1998 consensus conference dealing with colon cancer, and the 2003 Cancer Plan underlined the need for multidisciplinary meetings and for including patients in therapeutic trials. The aim of this ...study, which pooled data from the French Cancer Registries operating within the Francim network, was to report on diagnostic and therapeutic practices in the general French population before implementation of the Cancer Plan.
The study population was composed of 2935 patients with colorectal cancer diagnosed in 2000 in twelve French administrative districts accounting for 15% of the geographical area of France. Data were collected using a standardized procedure. Three categories of place of diagnosis were defined: public university hospitals, public non-university hospitals, and private clinics.
Overall, multidisciplinary meeting was conducted for 32.2% of patients with colorectal cancer. This proportion varied from 6.4% to 76.9%, depending on the geographical area (P < 0.001). The place of diagnosis affected this practice: 52% in public university hospitals, 31% in public non-university hospitals and 29% in private clinics (P < 0.001). In multivariate analysis, age (OR
> 75 years: 0.71, P < 0.001), site (OR
rectum: 1.80, P < 0.001) and health care facilities (OR
public non-university vs public university: 0.36, P < 0.001, OR
private vs public university: 0.40, P < 0.001) affected the use of multidisciplinary meeting.
Overall, 4.3% of patients were included in a therapeutic trial. This concerned 6.2% of patients aged under 75 and 1.0% of those aged over 75 (P < 0.001). The proportion of inclusions, taking into account the trials proposed in 2000 and 2001, varied from 0.7% to 16.4% according to geographical area (P < 0.001). This proportion was 10.3% if there had been multidisciplinary meeting and 5.1% if not (P < 0.001). Neither cancer site, gender, nor healthcare facility responsible for diagnosis influenced trial inclusion.
This population-based study underlines geographical variations in the management of colorectal cancer in France. In 2000, multidisciplinary meeting was conducted for an insufficient proportion of patients, and an insufficient number of patients were included in therapeutic trials. Repeating the same survey in 2005 will provide information on the effects of the Cancer Plan and the diffusion of these recommendations.
La Conférence de Consensus consacrée au côlon en 1998 puis le Plan Cancer en 2003 ont souligné la nécessité de mettre en place des Réunions de Concertation Pluridisciplinaire (RCP) et d’inclure les malades dans les essais thérapeutiques. L’objectif de ce travail était, par la mise en commun des données des registres des cancers français, au sein du réseau FRANCIM, de faire un état des lieux de la situation dans la population française avant la mise en œuvre du plan cancer.
L’étude a porté sur 2 935 cas de cancers colorectaux diagnostiqués en 2000 dans 12 départements français couvrant 15 % du territoire national. Les données ont été recueillies selon une procédure standardisée. Le lieu de diagnostic était réparti en 3 classes : CHU-CLCC, CH et secteur privé.
Globalement, 32,2 % des cas de cancers colorectaux ont été présentés en RCP. Ces proportions variaient selon le département, entre 6,4 % et 76,9 % (P < 0,001). Le lieu de diagnostic influençait cette pratique : 52 % dans les structures publiques universitaires, 31 % dans les structures publiques non universitaires et 29 % dans le secteur privé (P < 0.001). En analyse multivariée, l’âge (OR
> 75ans : 0,71, P < 0,001), la localisation (OR
rectum : 1,83, P < 0,001) et la filière (OR
public non universitaire vs public universitaire : 0,36, P < 0.001, OR
pivé
vs public universitaire
: 0,40, P < 0,001) influençaient la discussion des cas en RCP.
Globalement, 4,3 % des malades ont été inclus dans un essai thérapeutique. Cette pratique concernait 6,2 % des cas âgés de moins de 75 ans et 1,0 % des plus de 75 ans (P < 0,001). La proportion d’inclusion en tenant compte des essais proposés en 2000 et 2001 variait de 0,7 % à 16,4 % selon le département (P < 0,001). Elle était de 10,3 % pour les cas présentés en RCP et de 5,1 % pour les non présentés (P < 0,001). Ni la localisation, ni le sexe ni la filière de diagnostique n’influençaient l’inclusion dans un essai. En analyse multivariée, le stade et le passage en RCP étaient significativement associés à l’inclusion dans un essai thérapeutique.
Ce travail, qui a l’intérêt d’avoir été réalisé sur une base de population, met en évidence des variations géographiques dans la prise en charge du cancer colorectal en France. La proportion de dossiers de malades présentés en RCP ou inclus dans un essai thérapeutique était en 2000 encore insuffisante. La répétition d’une étude comparable en 2005 permettra de connaître l’influence du plan cancer dans la diffusion de ces recommandations.
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.
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.
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.
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.
Population-based registries provide excellent data for drawing an accurate picture of disease management practices. The purpose of this study was to determine whether diagnostic and therapeutic ...management practices for rectal cancer vary in different geographic regions of France.
Data issued from nine cancer registries covering 11% of the French population. The files of 683 patients with a rectal cancer diagnosed in 1995 were selected for analysis.
Colonoscopy was performed in a mean of 91.6% of patients (range: 80.9%-98.2%) (P = 0.01). The practice of colonoscopy concomitantly with barium enema varied greatly, ranging from 1.9%-57.7% of patients (P < 0.001). Pretherapeutic work-up practices were significantly different depending on the region with respect to: abdominal CT scans (13.4%-69.2 %), thoracic CT scans (0.9%-13.2%) and tumor markers (46.8%-80.8%). There were no significant differences between geographic regions concerning rate of resection, use of colostomy, or tumor stage at diagnosis. Administration of adjuvant radiotherapy (mean, 46.8%; range: 21.6%-70%; P < 0.001) and adjuvant chemotherapy (mean, 24.1%; range: 10.3%-40.6%; P < 0.05) varied significantly between regions.
Diagnostic practices and administration of adjuvant treatments vary significantly between geographic regions in France. The recommendations of the French consensus guidelines are only partially adhered to. Practitioners and healthcare authorities should be aware of these differences in order to provide more harmonious patient care.
Les études de population portant sur des données de registres représentent le meilleur moyen de savoir comment une pathologie est prise en charge. L’objectif de cette étude était de déterminer s’il existait des différences régionales dans la prise en charge diagnostique et thérapeutique du cancer du rectum.
Au total, 683 malades avec un diagnostic de cancer du rectum porté en 1995 ont été étudiés. Les données étaient issues de 9 registres départementaux de cancers couvrant 11 % de la population française.
La coloscopie a été faite dans 91,6 % des cas en moyenne avec des extrêmes allant de 80,9 % à 98,2 % (P = 0,01). La réalisation concomitante d’une coloscopie et d’un lavement baryté était très hétérogène avec des extrêmes allant de 1,9 % à 57,7 % (P < 0,001). Pour le bilan pré-thérapeutique, il existait des différences significatives dans la réalisation des scanners abdominaux (variations entre 13,4 % et 69,2 %) et thoraciques (entre 0,9 % et 13,2 %) et des marqueurs tumoraux (entre 46,8 % et 80,8 %) entre les départements. Il n’y avait pas de différence significative inter départementale pour le taux de résection, la réalisation d’une stomie ou le stade au diagnostic. En revanche, il y avait des variations significatives pour la pratique de la radiothérapie adjuvante (en moyenne 46,8 % avec des extrêmes de 21,6 % à 70,0 %; P < 0,001) ou la chimiothérapie adjuvante (en moyenne 24,1 % avec des extrêmes de 10,3 % à 40,6 %; P < 0,05).
Il existe des différences inter départementales importantes en ce qui concerne les pratiques diagnostiques et les traitements adjuvants. Les recommandations de la Conférence de Consensus n’apparaissent que partiellement suivies. Ces résultats doivent alerter la communauté médicale et les autorités sanitaires afin de rendre les pratiques plus homogènes.
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