Publications (15)40.73 Total impact
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Article: Screening for colorectal cancer with immunochemical faecal occult blood tests.
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ABSTRACT: Population-based studies have shown that guaiac faecal occult blood testing followed by colonoscopy in case of positivity can reduce colorectal cancer mortality. However these tests have been criticised for their fairly low sensitivity. For this reason attention has been given to alternative tests. The aim of this paper is to review the evidence for screening for colorectal cancer using qualitative immunochemical faecal occult blood tests. For the complete range of tested cut-off values, immunochemical faecal occult blood tests lead to higher diagnostic yield, improved sensitivity and greater participation. The optimal number of samples and the optimal cut-off value has to suit local resources and the acceptability of missed cancers. All economic evaluations, despite some differences between studies, add further arguments to support the opinion that the immunochemical faecal occult blood test is currently the most cost-effective screening test for average-risk populations. These economic evaluations provide strong arguments in favour of the 1-sample strategy. With decreasing the cut-off value similar performances can be achieved with one-compared to two day sampling. Too few data are currently available to accurately compare existing qualitative tests.Digestive and Liver Disease 08/2012; · 3.05 Impact Factor -
Article: Attending breast cancer screening alone does not explain the detection of tumours at an early stage.
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ABSTRACT: The goal of a screening programme is to allow tumour detection at an early stage when treatments are more effective and less invasive. We examined whether attending breast cancer (BC) screening alone can explain the discovery of tumours at an early stage. Women aged 50-74 years, with a first BC diagnosed from January 2006 to December 2008, were eligible. Patients' personal and family characteristics before their BC diagnosis were collected through a questionnaire. Their tumour characteristics were provided by the Côte d'Or BC registry and staging was performed according to the criteria of the American Joint Committee on Cancer (AJCC) to provide early-stage (AJCC 0/1) and advanced-stage (AJCC 2/3/4) BC. Multivariate logistic regression analyses were performed to identify the predictive factors for the discovery of BC at an early stage. Data from 533 patients with a BC diagnosed from January 2006 to December 2008 were used. Among them, 353 patients (66.2%) had early-stage BC whereas 175 patients (32.8%) had advanced-stage BC. Patients attending mammography screening were more likely to have had early-stage BC (P=0.0003). Multivariate analyses showed that being aged 63-74 years (P=0.008) and having had a previous regular medical follow-up (P=0.02) were independent predictors for the discovery of an early-stage BC. Mammography screening certainly allowed the discovery of BC at an early stage when performed according to the recommended 2-year interval. The regular use of health services could also contribute towards the early detection of tumours and thus towards a reduction in BC mortality.European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) 06/2012; · 2.21 Impact Factor -
Article: Population-based study of breast cancer screening in Côte d'Or (France): clinical implications and factors affecting screening round adequacy.
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ABSTRACT: Factors affecting the adequacy of breast cancer screening rounds and the clinical implications of screening have been investigated in women aged 50-74 years. Questionnaires were sent to all eligible patients and to the family doctor of those patients who had died or were lost to follow-up at the time of the study. Unlike the tumour characteristics the patients' personal and family characteristics were also collected before the diagnosis. The clinical features of screening-detected tumours and those discovered on clinical signs or on metastasis were compared. On the basis of the time between two mammographies, we created the following four groups according to the recommended screening round: adequate, long, short and patients with no earlier mammography. Univariate and multivariate generalized logit models were obtained to determine factors affecting the adequacy of breast cancer screening rounds. Five hundred and thirty-three patients were included. Two hundred and seventy-seven (52%) had inadequate breast cancer screening rounds (long, short or no earlier mammography). The American Joint Committee on Cancer stage was less advanced (0/1) in screening-detected tumours and among tumours of patients with an adequate screening round (P=0.014). Multivariate analyses showed that patients with an earlier organized screening mammography (P<0.0001) and those with gynaecological follow-up (P=0.03) were more likely to have an adequate rather than an inadequate breast cancer screening round. Screening leads to the detection of early-stage tumours when it is performed according to the recommendations. Organizing mammography rounds as recommended is essential to optimize the benefits of breast cancer screening.European journal of cancer prevention: the official journal of the European Cancer Prevention Organisation (ECP) 11/2011; 20(6):462-74. · 2.21 Impact Factor -
Article: Socio-geographical determinants of colonoscopy uptake after faecal occult blood test.
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ABSTRACT: Survival from colorectal cancer is poorer in patients of lower socioeconomic level, or living far from the cancer reference centre. To evaluate the impact of material deprivation and geographical remoteness on the uptake of colonoscopy after a positive screening faecal occult blood test. Data from two large French average-risk population-based trials comparing two faecal occult blood tests were used. Compliance with colonoscopy after a positive faecal occult blood test was analysed using a logistic model and a Cox model considering time between faecal occult blood test and colonoscopy. Covariates studied were sex, age, distance to nearest gastroenterologist, distance to regional capital, and Townsend's deprivation score. Amongst 4320 eligible subjects, 4131 were included. The rate of colonoscopy was 83.8%, within a median time of 66.0 days after faecal occult blood test. Distance to regional capital (p-trend=0.02) and study centre (p<0.0001) were independently associated with colonoscopy uptake. Time from positive faecal occult blood test to colonoscopy, was associated only with distance to the regional capital (p<0.0001, multivariate model stratified on study centre). Geographical remoteness but not material deprivation was responsible for lower uptake of colonoscopy. Healthcare decision-makers should focus on geographical remoteness to promote equal access to diagnostic procedures in faecal occult blood test colorectal cancer screening programmes.Digestive and Liver Disease 04/2011; 43(9):714-20. · 3.05 Impact Factor -
Article: Cost-effectiveness of screening for colorectal cancer in France using a guaiac test versus an immunochemical test.
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ABSTRACT: The aim of this study was to compare the cost and the effectiveness of two biennial fecal occult blood screening tests for colorectal cancer: a guaiac nonrehydrated test (G-FOBT) and an immunochemical test (I-FOBT) with the absence of screening. A Markov model was developed to compare these strategies in a general population of subjects aged 50 to 74 over a 20-year period. Compared with the absence of screening, G-FOBT and I-FOBT were associated with a decrease in colorectal cancer mortality of 17.4 percent and 25.2 percent, respectively. With regard to cost-effectiveness, expressed as cost per life-year gained, I-FOBT was the most effective and most costly alternative. Compared with no screening, G-FOBT and I-FOBT presented similar discounted incremental cost-effectiveness ratios: 2,739 euros and 2,819 euros respectively per life-year gained. When compared with G-FOBT, I-FOBT presented an incremental cost-effectiveness ratio of 2,988 euros per life-year gained. Sensitivity analyses showed the strong influence of the I-FOBT lead time, of the participation rate to screening for I-FOBT, and of the purchase price of the I-FOBT on the discounted incremental cost-effectiveness ratios. Compared with the absence of screening and with G-FOBT, the biennial two-stool immunochemical test can be considered a promising method for mass screening for colorectal cancer.International Journal of Technology Assessment in Health Care 01/2010; 26(1):40-7. · 1.37 Impact Factor -
Article: Immunochemical faecal occult blood tests are superior to guaiac-based tests for the detection of colorectal neoplasms.
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ABSTRACT: The aim of this study was to compare the performance of a guaiac-based faecal occult blood test (G-FOBT) with that of an immunochemical faecal occult blood test (I-FOBT). A total of 17,215 average risk individuals aged 50 to 74 enrolled in a population-based organised screening programme and performed a 3-day G-FOBT and a 2-day I-FOBT simultaneously. Among participants, 3.1% were found positive for the G-FOBT and 6.9% for the I-FOBT (p<10(-4)). Among the 1205 participants who tested positive and underwent a colonoscopy, the number of detected cancers and advanced adenomas was respectively 2.6 times higher and 3.5 times higher with the I-FOBT than with the G-FOBT. The positive predictive value of I-FOBT was similar to that of the G-FOBT for cancers (5.9% versus 5.2%) and was higher for advanced adenomas (27.2% versus 17.5%). The I-FOBT was superior to the G-FOBT for the detection of both cancers and advanced adenomas. However, the screen positive rate that staff and financial resources can accommodate has yet to be determined.European journal of cancer (Oxford, England: 1990) 09/2008; 44(15):2254-8. · 4.12 Impact Factor -
Article: Incidence and management of primary malignant small bowel cancers: a well-defined French population study.
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ABSTRACT: Few data are available from population-based statistics on small bowel cancers. The aim of this study was to report on their incidence and management. Data were obtained from the population-based Digestive Cancer Registry of Burgundy over a 26-yr period. Incidence rates were calculated by gender, age group, histological type, and 5-yr period. Treatment and stage at diagnosis were investigated. Prognosis was determined using crude and relative survival rates. A multivariate relative survival analysis was performed. Age-standardized incidence rates were 1.2/100,000 inhabitants for men and 0.8/100,000 inhabitants for women. The mean 5-yr variation in incidence were, respectively, +46.7% (P < 0.01) and + 53.2% (P < 0.05). There were four main histological types: adenocarcinoma (40.4%), malignant endocrine tumors (30.5%), lymphoma (20.1%), and sarcoma (9.0%). Resection for cure was performed in 56.6% of the cases. Cancer was not extending beyond the organ in 33.2% of the cases, was associated with lymph node metastasis in 32.1%, and with distant metastasis or unresectability in 34.7%. The 5-yr relative survival rate was 37.4%. It varied between 56.8% for endocrine tumors and 17.8% for sarcoma. In the multivariate analysis, age, histology, and stage at diagnosis significantly influenced the prognosis. Small bowel cancers represent a heterogeneous group of rare tumors. Prognosis at a population level is worse than in hospital series. In the short term, new therapeutic possibilities represent the best way to improve prognosis.The American Journal of Gastroenterology 12/2006; 101(12):2826-32. · 7.28 Impact Factor -
Article: Are the recommendations of the French consensus conference on the management of colon cancer followed up?
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ABSTRACT: The aim of this study was to determine how the guidelines published after this conference have spread. Pretherapeutic evaluation and treatment were assessed for all colon cancers diagnosed in a well-defined French population in 2000. Patients were classified either as managed according to the recommendations, or as undermanaged or overmanaged. Outside the emergency context, pretherapeutic work-up was classified as in conformity with the consensus in 48.0% of the cases, as undervalued in 21.9% and as overvalued in 30.1%. The resection rate at 90% was not far from the optimum. Pathological data allowed us to classify nearly all cases according to the tumour node metastasis classification; however, the number of examined nodes was below the recommendations in 30.8% of cases. Chemotherapy was performed according to the recommendations in 71.4% of cases, 23.1% were undertreated and 5.5% were overtreated. The multivariate analysis indicates that patients aged 75 years or more were less likely to receive chemotherapy than was recommended (P<0.001). This study suggested that the main reasons for not following guideline recommendations were inertia due to previous practices, difficulty to perform a recommended behaviour and lack of familiarity.European Journal of Cancer Prevention 08/2006; 15(4):295-300. · 2.13 Impact Factor -
Article: Incidence of gastrointestinal cancers in France.
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ABSTRACT: Monitoring cancer incidence and time trends is essential for cancer research and health care planning. The aim of the study was to compare the incidence of gastrointestinal cancers in twelve administrative area in France to estimate the national cancer incidence during 2000 compared with the preceding 20 years. Incidence data was provided by cancer registries and mortality data by the French national medical research institute (INSERM). The two data sets were modeled separately over the period 1988-1997 using age-cohort models. The incidence/mortality ratio obtained from these models was applied to the mortality rates of an age-cohort model of the entire population. The estimated number of new cases of gastrointestinal cancer was 61,465 in 2000. Colorectal cancer was the leading localization with 36,257 cases. The incidence of gastrointestinal cancers was slightly higher in northern than in southern area. Incidence of esophageal cancer was three times that of liver cancer. Variations in incidence were less marked for other localizations. The incidence of gastric and esophageal cancer in the male population decreased between 1980 and 2000, on average by slightly more than 2% per year. Incidence of other cancers increased. The number of new cases of colorectal cancer increased by 50%. The rise in the incidence of liver cancer was particularly striking, with an increase from 2000 incident cases in 1980 to nearly 6000 in 2000. For most localizations, incidence of gastrointestinal cancers displays few geographical differences in France, but there has been a striking change in incidence trends over the past 20 years.Gastroentérologie Clinique et Biologique 11/2004; 28(10 Pt 1):877-81. · 0.80 Impact Factor -
Article: Reduction in colorectal cancer mortality by fecal occult blood screening in a French controlled study.
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ABSTRACT: Several randomized population-based studies have shown that screening for colorectal cancer (CRC) by fecal occult blood tests (FOBTs) can reduce CRC mortality. The aim of this French population-based study was to assess whether a similar benefit could be obtained in countries characterized by high performances in the diagnosis and management of CRC. Small-sized geographic areas, including 91,199 individuals aged 45-74 years, were allocated to either FOBT screening or no screening. Six screening rounds were performed. The FOBT was performed without diet restriction and was sent to a central analysis center and processed without rehydration. Screening group participants who had a positive test result were offered a full colonoscopy. The entire population was followed up for 11 years after study entry. Acceptability of the test was 52.8% at the first screening round and varied between 53.8% and 58.3% in the successive rounds. Positivity rates were 2.1% initially and 1.4% on average in the successive rounds. CRC mortality was significantly lower in the screening population compared with the control population (mortality ratio, 0.84; 95% confidence interval, 0.71-0.99). The reduction in CRC mortality was more pronounced in those who participated at least once (mortality ratio, 0.67; 95% confidence interval, 0.56-0.81). Our findings, together with the results of other trials, suggest that biennial screening by FOBTs can reduce CRC mortality regardless of the quality of the health system and support attempts to introduce large-scale screening programs into the general population.Gastroenterology 06/2004; 126(7):1674-80. · 11.68 Impact Factor -
Article: [Epidemiology and screening of colorectal cancer].
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ABSTRACT: Colorectal is a major health problem in industrialized countries. Cancer registries have reported relatively large variations in incidence throughout the world. The incidence has been increasing over time. Colorectal cancer fulfills the conditions required by mass screening. Data from randomized studies indicate that it is possible to reduce colorectal cancer mortality in people who accept screening with faecal occult blood test. Time has come to implement well-organised population-based faecal occult blood screening in subjects aged between 50 and 74 despite current limitations of available tests.La Revue du praticien 02/2004; 54(2):135-42. -
Article: Cost-effectiveness analysis of fecal occult blood screening for colorectal cancer.
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ABSTRACT: Clinical trials have demonstrated that fecal occult blood screening for colorectal cancer can significantly reduce mortality. However, to be deemed a priority from a public health policy perspective, any new program must prove itself to be cost-effective. The objective of this study was to assess the cost-effectiveness of screening for colorectal cancer using a fecal occult blood screening test, the Hemoccult-II, in a cohort of 100,000 asymptomatic individuals 50-74 years of age. A decision analysis model using a Markov approach simulates the trajectory of the cohort allocated either to screening or no screening over a 20-year period through several health states. Clinical and economic data used in the model came from the Burgundy trial, French population-based studies, and Registry data. Modeling biennial screening versus the absence of screening over a 20-year period resulted in a 17.7 percent mortality reduction and a discounted incremental cost-effectiveness ratio of 3357 Euro per life-year gained among individuals 50-74 years of age. Sensitivity analyses performed on epidemiological and economic data showed the strong impact on the results of colonoscopy cost, of compliance to screening, and of specificity of the screening test. Cost-effectiveness estimates and sensitivity analyses suggest that biennial screening for colorectal cancer with fecal occult blood test could be recommended from the age of 50 until 74. Our findings support the attempts to introduce large-scale population screening programs.International Journal of Technology Assessment in Health Care 02/2004; 20(4):434-9. · 1.37 Impact Factor -
Article: [The role of cancer registries in the surveillance, epidemiologic research and disease prevention].
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ABSTRACT: The aim of a registry is to obtain information from all new cases in a well defined geographic area. They represent a source of data of great scientific quality. They have the double interest of describing and monitoring the cancer risk and to conduct research from collected data or punctual investigations. In the field of descriptive epidemiology, they allow to estimate national incidence, to predict times trends in incidence, to estimate the prevalence or to analyse the geographic distribution of cancers. It is important to dispose of representative health care practices information, really in use, those of specialised centres series being affected by selection bias. Population-based survival, as computed by cancer registries is an indicator of the effectiveness of health systems in cancer control. In the field of analytic epidemiology, information is measured at an individual level in the aim of identifying risk factors. For such studies a cancer registry is not indispensable but the constituted net correspondent make them easier in a rapid identification of new cases and in avoiding many bias. Population-based registries are also an essential tool for the evaluation of organized mass-screening programmes.Bulletin du cancer 11/2003; 90(10):865-71. · 0.67 Impact Factor -
Article: [Colorectal cancer screening: facts and questions].
Gastroentérologie Clinique et Biologique 06/2002; 26(5 Suppl):B86-93. · 0.80 Impact Factor -
Article: Incidence of gastrointestinal cancers in France
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ABSTRACT: AimMonitoring cancer incidence and time trends is essential for cancer research and health care planning. The aim of the study was to compare the incidence of gastrointestinal cancers in twelve administrative area in France to estimate the national cancer incidence during 2000 compared with the preceding 20 years.MethodsIncidence data was provided by cancer registries and mortality data by the French national medical research institute (INSERM). The two data sets were modeled separately over the period 1988-1997 using age-cohort models. The incidence/mortality ratio obtained from these models was applied to the mortality rates of an age-cohort model of the entire population.ResultsThe estimated number of new cases of gastrointestinal cancer was 61,465 in 2000. Colorectal cancer was the leading localization with 36,257 cases. The incidence of gastrointestinal cancers was slightly higher in northern than in southern area. Incidence of esophageal cancer was three times that of liver cancer. Variations in incidence were less marked for other localizations. The incidence of gastric and esophageal cancer in the male population decreased between 1980 and 2000, on average by slightly more than 2% per year. Incidence of other cancers increased. The number of new cases of colorectal cancer increased by 50%. The rise in the incidence of liver cancer was particularly striking, with an increase from 2000 incident cases in 1980 to nearly 6000 in 2000.ConclusionFor most localizations, incidence of gastrointestinal cancers displays few geographical differences in France, but there has been a striking change in incidence trends over the past 20 years.RésuméObjectifLa connaissance de l’incidence des cancers est essentielle à la recherche en cancérologie et à la planification en santé publique. L’objectif du travail actuel était de décrire l’incidence des cancers digestifs dans 12 départements, d’estimer leur incidence nationale en 2000 et leur évolution au cours des 20 dernières années.MéthodeLes données d’incidence provenaient des registres de cancers et les données de mortalité ont été fournies par le Centre d’épidémiologie sur les causes médicales de décès de l’Inserm. L’estimation des taux nationaux pour l’année 2000 s’appuie sur une modélisation distincte, avec un modèle âge-cohorte, de l’incidence et de la mortalité observées au cours de la période 1988-1997. Le rapport incidence/mortalité obtenu à partir de cette modélisation est appliqué aux taux de mortalité d’un modèle âge-cohorte issu des données de l’ensemble de la France.RésultatsLe nombre estimé de cancers digestifs était de 61 465 en 2000. Les cancers colorectaux représentaient à eux seuls 36 257 cas. L’incidence des cancers était un peu plus élevée au Nord qu’au Sud de la Loire. Les variations d’incidence se situaient dans un rapport de 1 à 3 pour le cancer de l’œsophage et le cancer du foie. Elles étaient moins marquées pour les autres localisations. L’incidence des cancers de l’estomac et des cancers de l’œsophage chez l’homme a diminué entre 1980 et 2000, en moyenne d’un peu plus de 2 % par an. L’incidence des autres localisations est en augmentation. Le nombre de nouveaux cas de cancers du côlon a augmenté de 50 %. L’augmentation d’incidence du cancer du foie est très importante, le nombre de cas est passé de près de 2 000 à près de 6 000.ConclusionEn dehors des cancers de l’œsophage et du foie, les variations géographiques de l’incidence des cancers digestifs en France sont peu marquées. Par contre, leur incidence s’est profondément modifiée en 20 ans.Gastroentérologie Clinique et Biologique.
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2006–2010
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Université de Bourgogne
Dijon, Bourgogne, France
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