Exposure to airborne cadmium and breast cancer stage, grade and histology at diagnosis: findings from the E3N cohort study

Molecular studies suggest that cadmium due to its estrogenic properties, might play a role in breast cancer (BC) progression. However epidemiological evidence is limited. This study explored the association between long-term exposure to airborne cadmium and risk of BC by stage, grade of differentiation, and histological types at diagnosis. A nested case-control study of 4401 cases and 4401 matched controls was conducted within the French E3N cohort. A Geographic Information System (GIS)-based metric demonstrated to reliably characterize long-term environmental exposures was employed to evaluate airborne exposure to cadmium. Multivariable adjusted odds ratios (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression models. There was no relationship between cadmium exposure and stage of BC. Also, no association between cadmium exposure and grade of differentiation of BC was observed. However, further analyses by histological type suggested a positive association between cadmium and risk of invasive tubular carcinoma (ITC) BC [ORQ5 vs Q1 = 3.4 (95% CI 1.1-10.7)]. The restricted cubic spline assessment suggested a dose-response relationship between cadmium and ITC BC subtype. Our results do not support the hypothesis that airborne cadmium exposure may play a role in advanced BC risk, but suggest that cadmium may be associated with an increased risk of ITC

Mycotoxin Exposure and Renal Cell Carcinoma Risk: An Association Study in the EPIC European Cohort

Background: Mycotoxins have been suggested to contribute to a spectrum of adverse health effects in humans, including at low concentrations. The recognition of these food contaminants being carcinogenic, as co-occurring rather than as singularly present, has emerged from recent research. The aim of this study was to assess the potential associations of single and multiple mycotoxin exposures with renal cell carcinoma risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Methods: Food questionnaire data from the EPIC cohort were matched to mycotoxin food occurrence data compiled by the European Food Safety Authority (EFSA) from European Member States to assess long-term dietary mycotoxin exposures, and to associate these with the risk of renal cell carcinoma (RCC, n = 911 cases) in 450,112 EPIC participants. Potential confounding factors were taken into account. Analyses were conducted using Cox's proportional hazards regression models to compute hazard ratios (HRs) and 95% confidence intervals (95% CIs) with mycotoxin exposures expressed as mu g/kg body weight/day. Results: Demographic characteristics differed between the RCC cases and non-cases for body mass index, age, alcohol intake at recruitment, and other dietary factors. In addition, the mycotoxin exposure distributions showed that a large proportion of the EPIC population was exposed to some of the main mycotoxins present in European foods such as deoxynivalenol (DON) and derivatives, fumonisins, Fusarium toxins, Alternaria toxins, and total mycotoxins. Nevertheless, no statistically significant associations were observed between the studied mycotoxins and mycotoxin groups, and the risk of RCC development. Conclusions: These results show an absence of statistically significant associations between long-term dietary mycotoxin exposures and RCC risk. However, these results need to be validated in other cohorts and preferably using repeated dietary exposure measurements. In addition, more occurrence data of, e.g., citrinin and fumonisins in different food commodities and countries in the EFSA database are a prerequisite to establish a greater degree of certainty

Pragmatic evidence and textual arrangements: A case study of French clinical cancer guidelines

Both critics and supporters of evidence-based medicine view clinical practice guidelines as an important component of this self-defined "new paradigm" whose goal is to rationalize medicine by grounding clinical decision-making in a careful assessment of the medical literature. We present an analysis of the debates within a guideline development group (GDG) that led to the drafting, revision and publication of a French cancer guideline. Our ethnographic approach focuses on the various aspects of the dispositif (or apparatus) that defines the nature and roles of participants, procedures, topics and resources within the GDG. Debates between GDG members are framed (but not dictated) by procedural and methodological rules as well as by the reflexive critical contributions of the GDG members themselves, who justify their (tentative) recommendations by relating to its (possible or intended) audiences. Guideline production work cannot be reduced to an exchange of arguments and to consensus-seeking between pre-defined professional interests. It is about the production of a text in the material sense of the term, i.e. as a set of sentences, paragraphs, statements and formulations that GDG members constantly readjust and rearrange until closure is achieved. As such, guidelines partake in the emergence and stabilization of a new configuration of biomedical knowledge and practices grounded in the establishment of mutually constitutive links between two processes: on the one hand, the re-formatting of clinical trials into a device for producing carefully monitored evidence statements targeting specific populations and clinical indications and, on the other hand, the increasingly pervasive role of regulatory processes.France Evidence-based medicine Clinical practice guidelines Oncology Pragmatic sociology Dispositif Regulation

Air pollution exposure in active versus passive travel modes across five continents: a Bayesian random-effects meta-analysis

Epidemiological studies on health effects of air pollution usually estimate exposure at the residential address. However, ignoring daily mobility patterns may lead to biased exposure estimates, as documented in previous exposure studies. To improve the reliable integration of exposure related to mobility patterns into epidemiological studies, we conducted a systematic review of studies across all continents that measured air pollution concentrations in various modes of transport using portable sensors. To compare personal exposure across different transport modes, specifically active versus motorized modes, we estimated pairwise exposure ratios using a Bayesian random-effects meta-analysis. Overall, we included measurements of six air pollutants (black carbon (BC), carbon monoxide (CO), nitrogen dioxide (NO2), particulate matter (PM10, PM2.5) and ultrafine particles (UFP)) for seven modes of transport (i.e., walking, cycling, bus, car, motorcycle, overground, underground) from 52 published studies. Compared to active modes, users of motorized modes were consistently the most exposed to gaseous pollutants (CO and NO2). Cycling and walking were the most exposed to UFP compared to other modes. Active vs passive mode contrasts were mostly inconsistent for other particle metrics. Compared to active modes, bus users were consistently more exposed to PM10 and PM2.5, while car users, on average, were less exposed than pedestrians. Rail modes experienced both some lower exposures (compared to cyclists for PM10 and pedestrians for UFP) and higher exposures (compared to cyclist for PM2.5 and BC). Ratios calculated for motorcycles should be considered carefully due to the small number of studies, mostly conducted in Asia. Computing exposure ratios overcomes the heterogeneity in pollutant levels that may exist between continents and countries. However, formulating ratios on a global scale remains challenging owing to the disparities in available data between countries

Agricultural and domestic pesticides in house dust from different agricultural areas in France

International audienc

Design and Production of a Patient Guide to Support Return to Work after Breast Cancer: An Application of Intervention MappingConception et production d’un guide patient pour accompagner la reprise du travail après un cancer du sein : une application de l’Intervention Mapping

International audienceAims. Return to work (RTW) after breast cancer is a complex process that questions the individual trajectories of patients andstakeholders. Program planning in this context requires to rely on appropriate method like Intervention Mapping (IM) whichencompasses such complexity. Aim of the methodological study is to describe an application of IM for both the design andproduction of a patient guide supporting RTW after breast cancer.Procedure. According IM, the guide was co-constructed with a Community Advisory Board (CAB) of stakeholders (patients/associations, health professionals, companies, institutions) after considering other options (interactive website, applicationmobile). The design was done with empirical and theoretical anchoring, guided here by an Ecosystem Process of Changemodel. A communication agency was chosen to produce the document. Pre-tests were conducted with a representative panelof the target audience to assess the different prototypes elaborated, using questionnaires and a focus group.Results. The final structure of the guide is presented with comments in order to concretely illustrate the management of IM steps 3and 4. The final structure of the guide is presented, along with a description of its components that target women (accordingProchaska et Di Clemente’s stages of change) and their environment (by use of levers they may activate). The results of thepre-test led to the simplification of the guide and its structure.Conclusion. IM allows a rich integration of experiential knowledge in the planning of complex health and public health programs.The development of the guide has attempted to integrate its aspects, in particular to promote both its implementation and itseffects. Reflections are brought about the realistic evaluation of such complex interventions.Objectif. Le retour au travail (RAT) après un cancer du sein est un processus complexe qui interroge les trajectoires individuellesdes patients et celle des acteurs dans leur environnement (ou écosystème). La planification d’une intervention dans ce contextenécessite une méthodologie appropriée qui intègre cette complexité, à l’image de l’Intervention Mapping (IM). L’objectif del’article est de décrire une application de l’IM pour la conception et la production d’un guide patient de RAT après un cancerdu sein.Matériel et méthodes. Suivant le protocole d’IM, le guide a été coconstruit avec un comité stratégique (COS) de parties-prenantes(patientes/associations, professionnels de santé, entreprises, institutions) après avoir envisagé d’autres options (site web-interactif, application mobile). La conception s’est faîte dans une double démarche d’ancrage empirique et théorique, guidée ici par unmodèle Ecosystémique et Processuel du Changement. Une agence de communication a été choisie pour produire le document.Les prototypes ont été évalués à travers différents pré-tests conduits auprès d’un panel représentatif du public cible, associantdes questionnaires et un focus groupe utilisateur.Résultats. La structure finale du guide est présentée de façon commentée afin d’illustrer concrètement le déroulé des étapes 3 et 4 del’IM. Le descriptif des composantes d’intervention visant les femmes (de façon personnalisée à travers les stades de changement deProchaska et Di Clemente) et leur environnement (via des dispositifs enclenchés par leur intermédiaire). Les résultats du pré-testont conduit à simplifier le guide et sa structure.Conclusion. L’IM permet une intégration riche des savoirs expérientiels dans la planification des interventions complexes en santé/santé publique. Le développement du guide a tenté d’intégrer ces aspects, notamment pour favoriser son implantation et ses effets.Des réflexions sont amenées quant à l’évaluation réaliste de tels dispositifs

Systematic Screening for Occupational Exposures in Lung Cancer Patients: A Prospective French Cohort

Occupational lung cancers are under-reported and under-compensated worldwide. We assessed systematic screening for occupational exposure to carcinogens combining a self-administered questionnaire and an occupational consultation to improve the detection of occupational lung cancers and their compensation. Social deprivation and the costs of this investigation were estimated. Patients with lung cancer received a self-administered questionnaire to collect their job history, potential exposure to carcinogens and deprivation. A physician assessed the questionnaire and recommended an occupational consultation if necessary. During the consultation, a physician assessed if the lung cancer was work-related and, if it was, delivered a medical certificate to claim for compensation. Over 18 months, 440 patients received the self-administered questionnaire: 234 returned a completed questionnaire and a consultation was required for 120 patients. Compensation was judged possible for 41 patients. Among the 35 medical certificates delivered, 19 patients received compensation. Nearly half the patients (46%) were assessed as socially deprived and these patients took significantly longer to return the questionnaire compared with those who were not deprived. The mean cost of the process was €62.65 per patient. Our results showed a systematic self-administered questionnaire can be used to identify patients potentially exposed to carcinogens and to improve compensation

Feasibility Study to Assess the Impact of a Lifestyle Intervention during Colorectal Cancer Screening in France

Current evidence suggests that 30–50% of cancers are attributable to established lifestyle risk factors. Cancer-screening has been identified as an opportunity for delivering advice on lifestyle behaviour change for cancer prevention. This study aimed to evaluate the feasibility and acceptance of promoting advice on the latest evidence-based lifestyle recommendations for cancer prevention at the time of colorectal cancer screening at two hospitals in Lyon, France. This feasibility study included 49 patients (20 men and 29 women) who were invited for colonoscopy. Patients received a leaflet with lifestyle recommendations for cancer prevention, accompanied with a logbook to plan and monitor their behavioural changes. Feedback from patients, hospital staff, and researchers was received via evaluation questionnaires (n = 26) completed after testing the educational material for at least two weeks and via two focus group discussions (n = 7 and n = 9 respectively) organized at the end of the study. All interviewed patients were interested in lowering their cancer risk, and the majority felt ready to change their lifestyle (88%), although most did not know how to decrease their risk of cancer (61%). All patients found the educational material easy to understand and sufficiently attractive and 50% of the patients reported having achieved at least one of the healthy behaviours recommended within the two weeks following the intervention. All hospital staff and almost all patients (92%) involved found that the screening program and the visits planned for colonoscopy was an appropriate moment to provide them with the educational material. This feasibility study has shown that the content, paper-based format, and time of delivery of the intervention were adequate. Health professionals seem to be willing to provide lifestyle recommendations, and patients appear interested in receiving advice for lowering their cancer risk during screening visits