Cancer incidence in the AGRICAN cohort study (2005-2011).

BACKGROUND: Numerous studies have been conducted among farmers, but very few of them have involved large prospective cohorts, and few have included a significant proportion of women and farm workers. Our aim was to compare cancer incidence in the cohort (overall, by sex, and by work on farm, occupational status and pesticide use) within the general population. METHODS: More than 180,000 participants in the AGRICAN cohort were matched to cancer registries to identify cancer cases diagnosed from enrolment (2005-2007) to 31st December 2011. We calculated standardized incidence ratios (SIRs) and 95% confidence intervals (95%CIs). RESULTS: Over the period, 11,067 incident cancer cases were identified (7304 men and 3763 women). Overall cancer incidence did not differ between the cohort and the general population. Moreover, SIRs were significantly higher for prostate cancer (SIR=1.07, 95%CI 1.03-1.11) and non-Hodgkin lymphoma (SIR=1.09, 95%CI 1.01-1.18) among men, skin melanoma among women (SIR=1.23, 95%CI 1.05-1.43) and multiple myeloma (men: SIR=1.38, 95%CI 1.18-1.62; women: SIR=1.26, 95%CI 1.02-1.54). In contrast, SIRs were lower for upper aerodigestive tract and respiratory cancers. Increase in risk was greater in male farm workers for prostate and lip cancer, in female farm workers for skin melanoma, and in male farm owners for multiple myeloma. Moreover, incidence of multiple myeloma and skin melanoma was higher among male and female pesticide users respectively. CONCLUSION: We found a decreased incidence for tobacco-related cancers and an increased incidence of prostate cancers, skin melanoma and multiple myeloma. Specific subgroups had a higher cancer incidence related to occupational status and pesticide use

Exposure to Farm Animals and Risk of Lung Cancer in the AGRICAN Cohort.

Epidemiologic studies have found lower risks of lung cancer in farmers. However, little is known about the types of agricultural activities concerned. In the Agriculture and Cancer cohort, we assessed the relationship between animal farming and lung cancer by investigating the types of animals, tasks, and timing of exposure. Analyses included 170,834 participants from the Agriculture and Cancer (AGRICAN) cohort in France. Incident lung cancers were identified through linkage with cancer registries from enrollment (2005-2007) to 2011. A Cox model, adjusting for pack-years of cigarette smoking, was used to calculate hazard ratios and 95% confidence intervals. Lung cancer risk was inversely related to duration of exposure to cattle (≥40 years: hazard ratio = 0.60, 95% confidence interval: 0.41, 0.89; P for trend < 0.01) and to horse farming (≥20 years: hazard ratio = 0.64, 95% confidence interval: 0.35, 1.17; P for trend = 0.09), especially for adenocarcinomas, but not with poultry or pig farming. More pronounced decreased risks were reported among individuals who had cared for animals, undertaken milking, and who had been exposed to cattle in infancy. Our study provides strong evidence of an inverse association between lung cancer and cattle and horse farming. Further research is warranted to identify the etiologic protective agents and biological mechanisms

Dépistage du cancer broncho-pulmonaire primitif par le scanner hélicoïdal faiblement irradiant après exposition professionnelle importante à l'amiante (données transversales sur la période 1er janvier2000-31 décemnbre 2002 en Basse-Normandie)

CAEN-BU Médecine pharmacie (141182102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Harcèlement moral au travail (analyse des conséquences socio-professionnelles à partir de cent vingt-trois cas issus de la consultation de pathologie professionnelle du Centre Hospitalier de Cherbourg)

CAEN-BU Médecine pharmacie (141182102) / SudocSudocFranceF

Evaluation de la prise en charge médicale et sociale des patients exposés à des cancérogènes professionnels

Les cancers professionnels représentent un important problème de santé publique. Le médecin du travail se trouve plongé au cœur de cette problématique, que nous avons choisi d étudier sous quatre angles de réflexion différents. Le premier concerne la confrontation de l activité du médecin du travail avec l éthique et la déontologie, en matière d exposition à des cancérogènes professionnels. En effet, la mission du médecin du travail est parfois difficile quand il est question de cancérogènes professionnels, le confrontant à de multiples contradictions entre éthique, déontologie médicale, respect des droits fondamentaux et droit du travail. Notre deuxième angle de réflexion s intéresse aux stratégies de dépistage des cancers professionnels. L objectif de notre étude a été de quantifier et de comparer dans une cohorte d anciens travailleurs de l amiante, la sensibilité et la spécificité du scanner thoracique hélicoïdal faiblement irradiant et de la radiographie pulmonaire, pour le dépistage du cancer pulmonaire, en fonction de la taille des nodules dépistés. Notre troisième angle de réflexion a été l analyse des relations entre exposition professionnelle à l amiante et incidence des cancers digestifs au sein d une cohorte de sujets ayant été exposés à ce minéral durant leur activité professionnelle. Enfin, notre quatrième angle de réflexion, juridique, a trait à la problématique de la réparation médico-légale des cancers professionnels, à partir d une comparaison avec les systèmes d indemnisation en place en Europe occidentale, afin de déterminer les critères d une indemnisation optimaleOccupational cancers are a major public health issue. The occupational physician is at the very heart of this issue, which we have chosen to study from four different reflexion angles. The first concerns the confrontation between the occupational physician's activity and ethics and deontology with regard to professional exposure to a carcinogenic substance. Indeed, the occupational physician's mission can prove to be difficult when dealing with the question of professional exposure to a carcinogenic substance, since he/she is confronted with multiple contradictions between ethics, medical deontology, and respecting fundamental rights and labour law. Our second angle of reflexion deals with occupational cancer screening strategies. The aim of our study was to compare, in a cohort of asbestos-exposed workers, the sensitivity and the specificity of low radiation helical chest CT scan with chest radiograph for the screening of bronchopulmonary cancer, according to the size of detected nodules. Our third angle of reflexion involves an analysis of the relationships between occupational exposure to asbestos and the incidence of digestive cancers in a cohort of asbestos-exposed workers. Finally, our fourth angle of reflexion considers the legal position, dealing with the question of medicolegal compensation for occupational cancers based on a comparison between the various procedures in place in different European countries, in order to identify optimal compensation for such disorders.CAEN-BU Sciences et STAPS (141182103) / SudocSudocFranceF

Diagnostic tomodensitométrique de nodules pulmonaires au cours d'un programme de dépistage après exposition professionnelle à l'amiante (Quelle signification ?)

CAEN-BU Médecine pharmacie (141182102) / SudocSudocFranceF

Medical follow-up for workers exposed to bladder carcinogens: the French evidence-based and pragmatic statement

International audienceBackground The aim of this work was to establish recommendations for the medical follow-up of workers currently or previously exposed to carcinogenic substances for the bladder.Methods A critical synthesis of the literature was conducted. Sectors of activity where workers are or were exposed to carcinogenic substances for the bladder were listed and classified according to the level of bladder cancer risk. Performances of techniques available for the targeted screening of bladder cancer were analysed, including a simulation of results among high-risk populations in France.Results The risk level for the professional group and the latency period between the start of exposure and the natural history of the disease were selected to define a targeted screening protocol. The NMP22BC test, exclusive haematuria testing, and combinations of urine cytology with, respectively, the NMP22BC test and haematuria test, generated an extremely high proportion of false positive results.Conclusion Urine cytology is the test that offers the best specificity. Although poor for all bladder cancer stages and grades combined, its sensitivity is better for high grades, which require early diagnosis since late-stage cancers are of very poor prognosis. These results suggest that urine cytology is currently the only technique suitable for proposal within the context of a first line targeted screening strategy for occupational bladder cancer. An algorithm summarising the recommended medical follow-up for workers currently or previously exposed to carcinogenic substances for the bladder is proposed, based on the level of risk of bladder cancer

Impact of adjuvant trastuzumab treatment on fatigue, emotional status and quality of personal and work life of patients with localised breast cancer: results of the ‘HER-ception’ study

International audienc

Incidence and survival of peritoneal malignant mesothelioma between 1989 and 2015: A population-based study

International audienceBACKGROUND:Peritoneal malignant mesothelioma is a rare disease for which few population-based studies are available. The aim of this study was to describe the evolution of the incidence and survival of peritoneal malignant mesothelioma in France between 1989 and 2015, using data derived from the French network of cancer registries.METHODS:Age world-standardized incidence rates and overall survival were calculated using data from 16 French cancer registries. Log-linear Poisson regression analysis was used to estimate the average annual percentage change in incidence rates. Overall survival was performed using age-adjusted Cox proportional hazards model.RESULTS:In French men, the incidence has increased quietly over the reporting period from 0.07 to 0.10 with a maximum of 0.16 per 100,000 persons-years in 2001-2003. For women, the increase in incidence has been lower than for men over the period 1989-2015, ranging from 0.04 to 0.11. A better prognosis was associated with a diagnosis made after 2000 (HR = 1.76; p = 0.013), the epithelioid histological type (p = 0.003), and the fact of being a woman, which has a 5-year risk of death half that of men (HR = 0.55; p = 0.001), regardless of age, diagnosis period or histology.CONCLUSION:Our results are similar to those currently available for other countries. In France, peritoneal mesothelioma remains a rare and fatal cancer with a small increase in the incidence rate since 1989 and a median survival of 1 year; it seemed to develop equally in women and men over this period of time