Dépistage du cancer du sein (facteurs socio-économiques influençant la participation et rythme de suivi)

Les travaux réalisés dans le cadre de cette thèse avaient pour objectifs :- déterminer les facteurs socio-économiques individuels et collectifs influençant la participation des femmes au dépistage organisé du cancer du sein, - étudier les facteurs individuels influençant l adéquation du rythme de suivi des femmes selon leur niveau de risque, - analyser l importance du dépistage et du suivi médical sur le stade de découverte des tumeurs. Les résultats des travaux ont montré que les femmes qui habitaient dans des zones économiquement défavorisées ou dans des zones rurales, celles affiliées au Régime Social des Indépendants ainsi que celles habitant à plus de 15 minutes d un cabinet de radiologie participaient moins au dépistage organisé du cancer du sein. Les femmes qui avaient un suivi gynécologique régulier ainsi que celles qui avaient une activité professionnelle faisaient plus souvent des mammographies à titre individuel ou cumulaient les deux types de dépistage. Les résultats de nos travaux ont également montré qu un dépistage et un suivi médical régulier permettaient la découverte de cancers du sein à des stades précoces, le recours plus fréquent à des traitements par chirurgie et radiothérapie et à moins de traitement par chimiothérapie néo-adjuvante. Les femmes suivies dans le cadre du dépistage organisé du cancer du sein et celles qui avaient un suivi gynécologique régulier avaient plus de chances d avoir un rythme de dépistage conforme aux recommandations. Afin de tirer un maximum de profit du dépistage organisé du cancer du sein peut-être faudrait-il impliquer beaucoup plus les médecins dans le programme de dépistage.Mammography screening allowed breast tumors detection in early stage while treatments are less aggressive. Despite the fact that organized mammography screening has been free of charge for the target population since 2004 in France, the participation rate to the programme remains low.The aim of the studies was to investigate individual and area-level socioeconomic factors explaining low breast cancer screening attendance, individual factors influencing mammography screening round adequacy and to assess the evidence of screening round adequacy in the discovery of breast tumors.The results showed that women living in most deprived areas or rural areas, those covered by self-employed insurance scheme and those living at more than 15 minutes from an accredited screening centre were less likely to attend organized breast cancer screening. Women with a regular screening and medical follow-up were more likely to be diagnosed with an early stage tumor.Attendance to mammography screening and regular medical follow up lead to have tumors discovered at an early stage, to be treated by surgery and radiotherapy and to receive less neoadjuvant chemotherapy. This supposes to be screened in the organized mammography screening programme and to have regular gynecological follow-up.DIJON-BU Doc.électronique (212319901) / SudocSudocFranceF

Enrolling study personnel in Ebola vaccine trials: from guidelines to practice in a non-epidemic context.

BACKGROUND: Enrolling participants in clinical trials can be challenging, especially with respect to prophylactic vaccine trials. The vaccination of study personnel in Ebola vaccine trials during the 2014-2016 epidemic played a crucial role in inspiring trust and facilitating volunteer enrollment. We evaluated the ethical and methodological considerations as they applied to an ongoing phase 2 randomized prophylactic Ebola vaccine trial that enrolled healthy volunteers in Guinea, Liberia, Sierra Leone, and Mali in a non-epidemic context. METHODS: On the assumption that the personnel on site involved in executing the protocol, as well as community mobilizers (not involved in the on-site procedures), might also volunteer to enter the trial, we considered both ethical and methodological considerations to set clear rules that can be shared a priori with these persons. We reviewed the scientific and gray literature to identify relevant references and then conducted an analysis of the ethical and methodological considerations. RESULTS: There are currently no regulations preventing a clinical investigator or site staff from participating in a trial. However, the enrollment of personnel raises the risk of undue influence and challenges the basic ethical principle of voluntary participation. The confidentiality of personal medical information, such as HIV test results, may also be difficult to ensure among personnel. There is a risk of disruption of trial operations due to the potential absence of the personnel for their commitment as trial participants, and there is also a potential for introducing differential behavior of on-site staff as they obtain access to accumulating information during the trial (e.g., the incidence of adverse events). Blinding could be jeopardized, given knowledge of product-specific adverse event profiles and the proximity to unblinded site staff. These aspects were considered more relevant for on-site staff than for community mobilizers, who have limited contact with site staff. CONCLUSION: In a non-epidemic context, ethical and methodological considerations limit the collective benefit of enrolling site staff in a vaccine trial. These considerations do not apply to community mobilizers, whose potential enrollment should be considered as long as they meet the inclusion criteria and they are not exposed to any form of coercion

Effect of Obesity among Hospitalized Cancer Patients with or without COVID-19 on a National Level

International audienceCancer and obesity are well-known prognostic factors in COVID-19. Our objective was to study the effect of obesity (and its severity) on the risk of intensive care unit (ICU) admission, severe complications, and in-hospital mortality, in a population of cancer patients hospitalized with or without COVID-19. All patients hospitalized in France for cancer from 1 March 2020 to 28 February 2022 were included from the French national administrative database. The effect of obesity was estimated in COVID-19 and in non-COVID-19 cancer patients using logistic and survival regressions, taking into account age, sex, comorbidities, and different types of cancer. Among the 992,899 cancer patients, we identified 53,090 patients with COVID-19 (5.35%), of which 3260 were obese (6.1%). After adjustment, for patients with or without COVID-19, there is an increased risk of ICU admission or severe complications in obese patients, regardless of the type of obesity. Regarding in-hospital mortality, there is no excess risk associated with overall obesity. However, massive obesity appears to be associated with an increased risk of in-hospital mortality, with a significantly stronger effect in solid cancer patients without COVID-19 and a significantly stronger effect in hematological cancer patients with COVID-19. This study showed that in France, among hospitalized patients with cancer and with or without COVID-19, increased vigilance is needed for obese patients, both in epidemic and non-epidemic periods. This vigilance should be further strengthened in patients with massive obesity for whom the risk of in-hospital mortality is higher, particularly in epidemic periods for patients with hematological cancers

Effect of Obesity among Hospitalized Cancer Patients with or without COVID-19 on a National Level

International audienceCancer and obesity are well-known prognostic factors in COVID-19. Our objective was to study the effect of obesity (and its severity) on the risk of intensive care unit (ICU) admission, severe complications, and in-hospital mortality, in a population of cancer patients hospitalized with or without COVID-19. All patients hospitalized in France for cancer from 1 March 2020 to 28 February 2022 were included from the French national administrative database. The effect of obesity was estimated in COVID-19 and in non-COVID-19 cancer patients using logistic and survival regressions, taking into account age, sex, comorbidities, and different types of cancer. Among the 992,899 cancer patients, we identified 53,090 patients with COVID-19 (5.35%), of which 3260 were obese (6.1%). After adjustment, for patients with or without COVID-19, there is an increased risk of ICU admission or severe complications in obese patients, regardless of the type of obesity. Regarding in-hospital mortality, there is no excess risk associated with overall obesity. However, massive obesity appears to be associated with an increased risk of in-hospital mortality, with a significantly stronger effect in solid cancer patients without COVID-19 and a significantly stronger effect in hematological cancer patients with COVID-19. This study showed that in France, among hospitalized patients with cancer and with or without COVID-19, increased vigilance is needed for obese patients, both in epidemic and non-epidemic periods. This vigilance should be further strengthened in patients with massive obesity for whom the risk of in-hospital mortality is higher, particularly in epidemic periods for patients with hematological cancers

Cancer Epidemiol

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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

Impact of Covid-19 on breast cancer stage at discovery, and time to treatment in Cote d’Or, France

Due to the COVID-19 pandemic, and ensuing overcrowding in the French health system, management of patients with COVID-19 was given priority over that of patients with other pathologies, including chronic diseases. The aim of this study was to study the impact of COVID-19 on the stage of discovery of cancers diagnosed in the context of an organized breast cancer screening programme, as well as the impact on time to treatment. All women diagnosed with cancer in the Côte d'Or via organized breast cancer screening (first or second reading) from January 1, 2019 to December 31, 2020 were included in this study. Using data from pathological laboratories, clinical centers, and the breast and gynecological cancer registry of the Côte d'Or, France, we collected socio-demographic, clinical and treatment data on all patients. We compared data from the year 2019 (before-Covid) with the year 2020 (Covid). We did not observe a significant difference in the stage of breast cancer at discovery, or in time to treatment. However, the number of invasive cancers and the clinical size of in situ cancers both increased in 2020. Although these results are reassuring, continued monitoring is needed to determine the downstream effects of the pandemic

Impact of organized and opportunistic screening on excess mortality and on social inequalities in breast cancer survival

International audienceAbstract In most developed countries, both organized screening (OrgS) and opportunistic screening (OppS) coexist. The literature has extensively covered the impact of organized screening on women's survival after breast cancer. However, the impact of opportunistic screening has been less frequently described due to the challenge of identifying the target population. The aim of this study was to describe the net survival and excess mortality hazard (EMH) in each screening group (OrgS, OppS, or No screening) and to determine whether there is an identical social gradient in each groups. Three data sources (cancer registry, screening coordination centers, and National Health Data System [NHDS]) were used to identify the three screening groups. The European Deprivation Index (EDI) defined the level of deprivation. We modeled excess breast cancer mortality hazard and net survival using penalized flexible models. We observed a higher EMH for “No screening” women compared with the other two groups, regardless of level of deprivation and age at diagnosis. A social gradient appeared for each group at different follow‐up times and particularly between 2 and 3 years of follow‐up for “OrgS” and “OppS” women. Net survival was higher for “OrgS” women than “OppS” women, especially for the oldest women, and regardless of the deprivation level. This study provides new evidence of the impact of OrgS on net survival and excess mortality hazard after breast cancer, compared with opportunistic screening or no screening, and tends to show that OrgS attenuates the social gradient effect

Cross-sectional nationwide mixed-methods population-based study of living conditions, and identification of sexual and fertility profiles among young women after breast cancer in France: the Candy study protocol

International audienceIntroduction At the end of the treatment, many young breast cancer (BC) survivors face difficulties related to fertility and sexuality, mainly due to the side effects of treatment. Integrating patient needs into medical decisions is becoming increasingly essential for high quality care. To this end, there is a compelling need to elicit patients’ perspectives through qualitative studies, to understand their experiences and needs in the aftermath of cancer. We aim to: (1) identify clinical, social and economic determinants of sexuality and fertility, and describe other living conditions of young BC survivors in France; and (2) explore young women’s experience after BC in relation to clinical and information needs about fertility preservation and sexual health. Methods and analysis This is a mixed-methods, cross-sectional, population-based study. In the quantitative component, women diagnosed with non-metastatic BC between 2009 and 2016 and aged 40 years or younger at diagnosis will be identified through the French network of cancer registries (FRANCIM). Participants will complete self-report questionnaires including standardised measures of sexuality, health-related quality of life (HRQoL), anxiety, depression, social deprivation and social support. Fertility and professional reintegration issues will also be assessed. Sexuality profiles will be identified by ascending hierarchical classification and fertility profiles will be identified by latent class models. Determinants of sexuality, fertility and HRQoL will be identified using a mixed regression model. Subsequently, semistructured interviews will be performed with a sample of 30 women who participated in the quantitative study. Interviews will be recorded, transcribed synthetically and content analysis will be performed, with the aid of NVivo software. Ethics and dissemination This study will be performed in accordance with the declaration of Helsinki. The protocol was approved in October 2020 by the Committee for the Protection of Persons North-West III (20.07.16.44445) and by the French national data protection authority (CNIL-MR003 No1989764-v0). The results of this project will be communicated to the scientific community through publications in international scientific peer-reviewed journals and communications to national and international congresses. Popularised results will also be provided to patient associations. The results of Candy project will also be published on the website of the sponsor, www.cgfl.fr

Management of elderly patients suffering from cancer: Assessment of perceived burden and of quality of life of primary caregivers

International audienceObjective: To evaluate the perceived burden and the quality of life (QoL) at 3 and 6 months of the primary caregiver (PC) of patients aged 70 and over suffering from cancer and the predictors of QoL in this population.Methods: In this prospective observational study, 98 patients aged 70 and older with cancer and 96 PCs were included between 01/06/2014 and 18/03/2015. The Medical Outcomes Study 12-item Short Form Health Survey (SF-12) was used to assess the QoL of PCs and the Zarit Burden Interview (ZBI) was used to measure the perceived burden at 3 and 6 months. The major determinants of QoL were identified using mixed linear models for the dimensions of the SF-12 that showed an average difference of at least 5 points between baseline and follow-up at 6 months.Results: The QoL scores of PCs showed a decrease in the dimensions "role emotional" and "bodily pain" over 6 months. In multivariate analysis, the main determinants of QoL for "role emotional" were the PC's age (p = 0.005), a low perceived burden (p < 0.0001) and a functionally independent patient (p = 0.01), and for "bodily pain" was a low perceived burden (p < 0.0001) and the non-use of hormone therapy during the treatment (p < 0.0001).Conclusion: The main determinants of the QoL of PCs concerned factors inherent to the PC (age and perceived burden) and patient (functional independence)