Challenges in integrating cervical cancer screening in HIV care clinics in West Africa: a pilot study in Abidjan, Côte d’Ivoire

International audiencen.

Separate and combined analysis of successive dependent outcomes after breast-conservation surgery: recurrence, metastases, second cancer and death

<p>Abstract</p> <p>Background</p> <p>In the setting of recurrent events, research studies commonly count only the first occurrence of an outcome in a subject. However this approach does not correctly reflect the natural history of the disease. The objective is to jointly identify prognostic factors associated with locoregional recurrences (LRR), contralateral breast cancer, distant metastases (DM), other primary cancer than breast and breast cancer death and to evaluate the correlation between these events.</p> <p>Methods</p> <p>Patients (n = 919) with a primary invasive breast cancer and treated in a cancer center in South-Western France with breast-conserving surgery from 1990 to 1994 and followed up to January 2006 were included. Several types of non-independent events could be observed for the same patient: a LRR, a contralateral breast cancer, DM, other primary cancer than breast and breast cancer death. Data were analyzed separately and together using a random-effects survival model.</p> <p>Results</p> <p>LRR represent the most frequent type of first failure (14.6%). The risk of any event is higher for young women (less than 40 years old) and in the first 10 years of follow-up after the surgery. In the combined analysis histological tumor size, grade, number of positive nodes, progesterone receptor status and treatment combination are prognostic factors of any event. The results show a significant dependence between these events with a successively increasing risk of a new event after the first and second event. The risk of developing a new failure is greatly increased (RR = 4.25; 95%CI: 2.51-7.21) after developing a LRR, but also after developing DM (RR = 3.94; 95%CI: 2.23-6.96) as compared to patients who did not develop a first event.</p> <p>Conclusion</p> <p>We illustrated that the random effects survival model is a more satisfactory method to evaluate the natural history of a disease with multiple type of events.</p

Legislación sobre el consumo de tabaco en el ámbito laboral y en los espacios públicos de la Unión Europea

En este trabajo, realizado a partir de contactos con referentes en las autoridades sanitarias complementados con otros informadores clave y la consulta del Repertorio Internacional de Legislación Sanitaria, se describen las características actuales de la legislación sobre el consumo de tabaco en el lugar de trabajo de los 15 Estados miembros de la Unión Europea (UE), así como de otros países europeos como Hungría, Islandia, Noruega, Polonia, Rumania y Suiza. Se revisan también los procesos judiciales que se han producido en base a esta legislación en relación al consumo de tabaco en el ámbito laboral en estos países. La legislación es una parte crucial de toda estrategia de control del tabaquismo. Sin ella, ninguna acción contra la exposición al aire contaminado por el humo de tabaco será eficaz. Sin embargo, una ley en sí misma no es suficiente y sólo será eficaz si recibe el apoyo de la opinión pública

Legislación sobre el consumo de tabaco en el ámbito laboral y en los espacios públicos de la Unión Europea

En este trabajo, realizado a partir de contactos con referentes en las autoridades sanitarias complementados con otros informadores clave y la consulta del Repertorio Internacional de Legislación Sanitaria, se describen las características actuales de la legislación sobre el consumo de tabaco en el lugar de trabajo de los 15 Estados miembros de la Unión Europea (UE), así como de otros países europeos como Hungría, Islandia, Noruega, Polonia, Rumania y Suiza. Se revisan también los procesos judiciales que se han producido en base a esta legislación en relación al consumo de tabaco en el ámbito laboral en estos países. La legislación es una parte crucial de toda estrategia de control del tabaquismo. Sin ella, ninguna acción contra la exposición al aire contaminado por el humo de tabaco será eficaz. Sin embargo, una ley en sí misma no es suficiente y sólo será eficaz si recibe el apoyo de la opinión pública

HIV and cancer in Africa: mutual collaboration between HIV and cancer programs may provide timely research and public health data

Abstract The eruption of Kaposi sarcoma (KS) and aggressive non-Hodgkin lymphoma (NHL) in young homosexual men in 1981 in the West heralded the onset of the human immunodeficiency virus (HIV) infection epidemic, which remains one of the biggest challenges to global public health and science ever. Because KS and NHL were increased >10,000 and 50-600 times, respectively, with HIV, they were designated AIDS defining cancers (ADC). Cervical cancer (CC), increased 5-10 times was also designated as an ADC. A few other cancers are elevated with HIV, including Hodgkin lymphoma (10 times), anal cancer (15-30 times), and lung cancer (4 times) are designated as non-AIDS defining cancers (NADCs). Since 1996 when combination antiretroviral therapy (cART) became widely available in the West, dramatic decreases in HIV mortality have been observed and substantial decrease in the incidence of ADCs. Coincidentally, the burden of NADCs has increased as people with HIV age with chronic HIV infection. The impact of HIV infection on cancer in sub-Saharan Africa, where two thirds of the epidemic is concentrated, remains poorly understood. The few studies conducted indicate that risks for ADCs are also increased, but quantitatively less so than in the West. The risks for many cancers with established viral associations, including liver and nasopharynx, which are found in Africa, do not appear to be increased. These data are limited because of competing mortality, and cancer is under diagnosed, pathological confirmation is rare, and cancer registration not widely practiced. The expansion of access to life-extending cART in sub-Saharan Africa, through programs such as the Global Fund for AIDS, Malaria, and Tuberculosis and the US President's Emergency Program for AIDS Relief (PEPFAR), is leading to dramatic lengthening of life of HIV patients, which will likely influence the spectrum and burden of cancer in patients with HIV. In this paper, we review current literature and explore merits for integrating cancer research in established HIV programs to obtain timely data about the incidence and burden of cancer in HIV-infected persons in Africa.</p

L'influence de l'âge au premier accouchement sur la mortalité par cancer du sein : une méthode d'estimation

Lavertu Jacques, De Salve-Villedieu Fr.-R., Sasco Annie J. L'influence de l'âge au premier accouchement sur la mortalité par cancer du sein : une méthode d'estimation. In: Population, 50ᵉ année, n°3, 1995. pp. 844-856