Cancer incidence estimation at a district level without a national registry: a validation study for 24 cancer sites using French health insurance and registry data.

BACKGROUND: District-level cancer incidence estimation is an important issue in countries without a national cancer registry. This study aims to both evaluate the validity of district-level estimations in France for 24 cancer sites, using health insurance data (ALD demands--Affection de Longue Durée) and to provide estimations when considered valid. Incidence is estimated at a district-level by applying the ratio between the number of first ALD demands and incident cases (ALD/I ratio), observed in those districts with cancer registries, to the number of first ALD demands available in all districts. These district-level estimations are valid if the ratio does not vary greatly across the districts or if variations remain moderate compared with variations in incidence rates. METHODS: Validation was performed in the districts covered by cancer registries over the period 2000-2005. The district variability of the ALD/I ratio was studied, adjusted for age (mixed-effects Poisson model), and compared with the district variability in incidence rate. The epidemiological context is also considered in addition to statistical analyses. RESULTS: District-level estimation using the ALD/I ratio was considered valid for eight cancer sites out of the 24 studied (lip-oral cavity-pharynx, oesophagus, stomach, colon-rectum, lung, breast, ovary and testis) and incidence maps were provided for these cancer sites. CONCLUSION: Estimating cancer incidence at a sub-national level remains a difficult task without a national registry and there are few studies on this topic. Our validation approach may be applied in other countries, using health insurance or hospital discharge data as correlate of incidence

Projecting the time trend of thyroid cancers: its impact on assessment of radiation-induced cancer risks.

International audienceThe incidence of thyroid cancer, which may be induced by ionizing radiation, has been rising in most Western countries for more than 20 years. In France, public worry about this increase and its possible connection with the fallout from Chernobyl led the government to ask for an evaluation of the health impact of this accident and an assessment of the feasibility of an epidemiological study. These requests raise two methodological questions: Which risk model should be used to relate exposure to risk? What is known about the spontaneous incidence rate of thyroid cancers? This article analyzes the impact of the time trend in the spontaneous incidence of thyroid cancers over the past 20 years in France when evaluating the risk of radiation-induced cancer. Age-period-cohort models were used to model the trend of spontaneous incidence from 1978 through 1997 and then to apply two scenarios for projections up to 2007: one with a constant incidence, the other using the trend observed over the past 20 years. Then the risk was assessed for a hypothetical population of 30,000 children aged 0 to 15 y, exposed to a hypothetical 0.1 Gy thyroid dose. The analysis shows that consideration of the trend instead of a constant spontaneous incidence can yield substantial differences in the risk estimates for thyroid cancer

Projecting the time trend of thyroid cancers: its impact on assessment of radiation-induced cancer risks.

International audienceThe incidence of thyroid cancer, which may be induced by ionizing radiation, has been rising in most Western countries for more than 20 years. In France, public worry about this increase and its possible connection with the fallout from Chernobyl led the government to ask for an evaluation of the health impact of this accident and an assessment of the feasibility of an epidemiological study. These requests raise two methodological questions: Which risk model should be used to relate exposure to risk? What is known about the spontaneous incidence rate of thyroid cancers? This article analyzes the impact of the time trend in the spontaneous incidence of thyroid cancers over the past 20 years in France when evaluating the risk of radiation-induced cancer. Age-period-cohort models were used to model the trend of spontaneous incidence from 1978 through 1997 and then to apply two scenarios for projections up to 2007: one with a constant incidence, the other using the trend observed over the past 20 years. Then the risk was assessed for a hypothetical population of 30,000 children aged 0 to 15 y, exposed to a hypothetical 0.1 Gy thyroid dose. The analysis shows that consideration of the trend instead of a constant spontaneous incidence can yield substantial differences in the risk estimates for thyroid cancer

Reliability of recording uterine cancer in death certification in France and age-specific proportions of deaths from cervix and corpus uteri.

French uterine cancer recordings in death certificates include 60% of "uterine cancer, Not Otherwise Specified (NOS)"; this hampers the estimation of mortalities from cervix and corpus uteri cancers. The aims of this work were to study the reliability of uterine cancer recordings in death certificates using a case matching with cancer registries and estimate age-specific proportions of deaths from cervix and corpus uteri cancers among all uterine cancer deaths by a statistical approach that uses incidence and survival data. Deaths from uterine cancer between 1989 and 2001 were extracted from the French National database of causes of death and case-to-case matched to women diagnosed with uterine cancer between 1989 and 1997 in 8 cancer registries. Registry data were considered as "gold-standard". Among the 1825 matched deaths, cancer registries recorded 830 cervix and 995 corpus uteri cancers. In death certificates, 5% and 40% of "true" cervix cancers were respectively coded "corpus" and "uterus, NOS" and 5% and 59% of "true" corpus cancers respectively coded "cervix" and "uterus, NOS". Miscoding cervix cancers was more frequent at advanced ages at death and in deaths at home or in small urban areas. Miscoding corpus cancers was more frequent in deaths at home or in small urban areas. From the statistical method, the estimated proportion of deaths from cervix cancer among all uterine cancer deaths was higher than 95% in women aged 30-40 years old but declined to 35% in women older than 70 years. The study clarifies the reason for poor encoding of uterus cancer mortality and refines the estimation of mortalities from cervix and corpus uteri cancers allowing future studies on the efficacy of cervical cancer screening

Anchoring the BAC porcine map

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Cancer mortality risk among biology research workers in France: First results of two retrospective cohorts studies

Objective: To investigate all-cause and cancer mortality of biological research laboratories workers of the French Atomic Energy Commission (CEA) and the National Institute of Health and Medical Research (INSERM). Methods: Two cohorts, bioCEA (N = 3,509) and bioINSERM (N = 4,966) were followed from 1968 to 1994 and 1980 to 1993, respectively. The mortality of each cohort was compared with that of the French population by computation of the standardized mortality ratio (SMR) with their 90% confidence interval (90% CI). Trend and heterogeneity tests were computed in order to study SMRs variation by job characteristics. In the bioCEA cohort individual dosimetry data being available, a trend test was also computed according to ionizing radiation cumulative dose. Results: The SMRs were significantly below one in both cohorts for all-cause mortality (bioCEA: SMR = 0.52 [0.46-0.59], bioINSERM: SMR = 0.56 [0.46-0.67]) and for all-cancer mortality (bioCEA: SMR = 0.66 [0.54-0.80], bioINSERM: SMR = 0.55 [0.39-0.75]). There were some specific cancer sites for which the SMR was higher than 1, but not significantly. In the bioCEA cohort a positive trend was observed between ionizing radiation cumulative doses and all-cause as well as all-cancer SMRs. Conclusion: This study on two French cohorts of biological research workers found a favorable mortality pattern. These findings are consistent with recent publications. The positive trend of cancer mortality according to ionizing radiation exposure among bioCEA cohort needs to be confirmed with more precise assessment of exposures and information on individual risk factors. © Springer-Verlag 2007

Incidence of major smoking-related cancers: trends among adults aged 20-44 in France from 1982 to 2012.

BACKGROUND: Tobacco is currently the largest risk factor for cancers of the lung, lip/oral cavity/pharynx (LOCP) and esophagus. Variations in tobacco consumption over time have led to changes in cancer incidence in the general population. Data on the incidence of cancers at these sites in adults aged 20-44 years old are scarce. Our objective was to provide estimates of incidence trends for these cancers in France among this age group over the last 30 years. METHODS: Observed incidence data over the period 1982-2010 for the 20-44 age group were provided from six cancer registries (eight for esophagus) covering approximately 6% of the French population. Age-period-cohort models were used on the observed period, and estimates of cancer incidence for France in 2012 were provided on the basis of short-term predictions. RESULTS: In men, a sharp decline was observed over time for LOCP and esophageal cancers, while lung cancer saw only a slight decline. In women, a large increase was seen in lung cancer incidence, while LOCP cancer incidence did not vary significantly. CONCLUSION: Smoking behaviors among adults aged 20-44 impact incidence trends in cancers of the lung, LOCP and esophagus, although other factors are involved, particularly in LOCP and esophageal cancers. Our results highlight the importance of preventative efforts which particularly target women aged 20-44. Efforts to curb tobacco smoking in men should also be pursued

Care pathway of women with interval breast cancer in 2016, based on medico-administrative data

International audienceBackground: Since 2004, an organised screening programme (OS) for breast cancer has been in place for 50-74 years women who are not at an increased risk. Despite this, 17% of cancers diagnosed within 24 months following an OS mammogram are interval cancers (IC), diagnosed even though the OS had not reported cancer. After identifying IC from the French administrative healthcare database (SNDS), our objective was to describe the care pathways of women with IC in 2016.Materials and methods: The IC identification algorithm is based on breast imaging tests conducted in the 24 months prior to diagnosis and on the compatibility of their timeline with ACR3 lesion follow-up (BIRADS guidelines). The care pathways of 3 groups were compared: women with IC, diagnosed through the OS, and diagnosed outside the OS programme (personalised screening or based on clinical signs, PSCS group).Results: Respectively, 12,965 (46%), 3433 (12%), and 11,761 women (42%) were classified in the OS, IC and PSCS groups, i.e. 20.9% IC cases among the women taking part in the OS programme. The women from the IC group presented with more forms with lymph node or metastatic involvement than those of the OS group. Their pathways were more complex than in the OS group: at an equivalent stage, more total mastectomies and more adjuvant or neoadjuvant chemotherapy regimens.Conclusion: The care pathways of women with IC are intermediate with respect to those of the OS or PSCS group.Cases of IC probably include several cancer prognosis profiles