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16 results on '"MESH : Risk"'

1. Description of the SAGhE Cohort: A Large European Study of Mortality and Cancer Incidence Risks after Childhood Treatment with Recombinant Growth Hormone

Author

Swerdlow , Anthony, Cooke , Rosie, Albertsson-Wikland , Kerstin, Borgström , Birgit, Butler , Gary, Cianfarani , Stefano, Clayton , Peter, Coste , Joël, Deodati , Annalisa, Ecosse , Emmanuel, Gausche , Ruth, Giacomozzi , Claudio, Kiess , Wieland, Hokken-Koelega , Anita, Kuehni , Claudia, Landier , Fabienne, Maes , Marc, Mullis , Primus-E, Pfaffle , Roland, Sävendahl , Lars, Sommer , Grit, Thomas , Muriel, Tollerfield , Sally, Zandwijken , Gladys, Carel , Jean-Claude, UCL - SSS/IREC/PEDI - Pôle de Pédiatrie, UCL - (SLuc) Unité d'endocrinologie pédiatrique, Institute of Cancer Research - ICR [London, U.K.], Sahlgrenska Academy at University of Gothenburg [Göteborg], Karolinska Institutet [Stockholm], Institute of Child Health [London], University College of London [London] (UCL), University College London Hospitals (UCLH), IRCCS Ospedale Pediatrico Bambino Gesù [Roma], Royal Manchester Children's Hospital, University of Manchester [Manchester], Unité d’Epidémiologie et de Biostatistiques [APHP Cochin-Broca-Hôtel Dieu], AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université Paris Descartes - Paris 5 (UPD5)-Université de Lorraine (UL), Universität Leipzig [Leipzig], Erasmus University Medical Center [Rotterdam] (Erasmus MC), Sophia Children's Hospital, Institute of Social and Preventive Medicine [Bern] (ISPM), Universität Bern [Bern], Centre de Référence des Maladies Endocriniennes Rares de la Croissance [APHP Robert Debré], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 (UPD7), Service d'endocrinologie diabétologie pédiatrique [CHU Debré], AP-HP Hôpital universitaire Robert-Debré [Paris], Université Paris Diderot - Paris 7 (UPD7), Centre d'Investigation Clinique - Epidemiologie Clinique/essais Cliniques Hopital Robert Debre, Institut National de la Santé et de la Recherche Médicale (INSERM), Cliniques universitaires St Luc [Bruxelles], Inselspital Bern, Belgian Study Group for Pediatric Endocrinology (BSGPE), Universitair Ziekenhuis Brussel, Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 (UPD7), University College of London [London] ( UCL ), University College London Hospitals ( UCLH ), Maladies chroniques, santé perçue, et processus d'adaptation. Approches épidémiologiques et psychologiques. ( APEMAC - EA 4360 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Université de Lorraine ( UL ), Erasmus Medical Center / Dutch Growth Research Foundation, Erasmus University Medical Center [Rotterdam], Institute of Social and Preventive Medicine [Bern] ( ISPM ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Robert Debré-Université Paris Diderot - Paris 7 ( UPD7 ), Université Paris Diderot - Paris 7 ( UPD7 ), Institut National de la Santé et de la Recherche Médicale ( INSERM ), Belgian Study Group for Pediatric Endocrinology ( BSGPE ), and Pediatrics

Subjects
Male, MESH : Risk, MESH : Child, Preschool, Cohort Studies, MESH: Cause of Death, MESH: Recombinant Proteins, MESH : Child, Cause of Death, Neoplasms, MESH: Child, MESH: Human Growth Hormone, MESH : Female, MESH: Neoplasms, MESH: Incidence, Child, MESH: Cohort Studies, Growth Disorders, Cancer, MESH: Risk, Human Growth Hormone, Incidence, MESH: Infant, Newborn, Cohort, MESH : Infant, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Follow-Up Studies, MESH: Growth Disorders, MESH: Infant, MESH : Incidence, Recombinant Proteins, Europe, MESH: Young Adult, Child, Preschool, Female, Risk, Adolescent, MESH : Recombinant Proteins, MESH : Male, MESH : Europe, MESH : Young Adult, MESH : Cohort Studies, 610 Medicine & health, MESH : Infant, Newborn, Young Adult, SDG 3 - Good Health and Well-being, 360 Social problems & social services, MESH : Adolescent, Humans, MESH : Growth Disorders, MESH : Human Growth Hormone, Mortality, Growth hormone, MESH : Cause of Death, Settore MED/38 - Pediatria Generale e Specialistica, MESH: Adolescent, Original Paper, MESH: Humans, MESH : Humans, MESH: Child, Preschool, Infant, Newborn, Infant, MESH : Follow-Up Studies, MESH : Neoplasms, MESH: Male, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Europe, MESH: Female, Follow-Up Studies
Abstract

International audience; BACKGROUND:The long-term safety of growth hormone treatment is uncertain. Raised risks of death and certain cancers have been reported inconsistently, based on limited data or short-term follow-up by pharmaceutical companies.PATIENTS AND METHODS:The SAGhE (Safety and Appropriateness of Growth Hormone Treatments in Europe) study assembled cohorts of patients treated in childhood with recombinant human growth hormone (r-hGH) in 8 European countries since the first use of this treatment in 1984 and followed them for cause-specific mortality and cancer incidence. Expected rates were obtained from national and local general population data. The cohort consisted of 24,232 patients, most commonly treated for isolated growth failure (53%), Turner syndrome (13%) and growth hormone deficiency linked to neoplasia (12%). This paper describes in detail the study design, methods and data collection and discusses the strengths, biases and weaknesses consequent on this.CONCLUSION:The SAGhE cohort is the largest and longest follow-up cohort study of growth hormone-treated patients with follow-up and analysis independent of industry. It forms a major resource for investigating cancer and mortality risks in r-hGH patients. The interpretation of SAGhE results, however, will need to take account of the methods of cohort assembly and follow-up in each country.

Published
2015
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2. Inflammatory response and IgE sensitization at early age

Author

Josef Riedler, Outi Vaarala, Roger Lauener, Erika von Mutius, Juha Pekkanen, K. Mustonen, Leea Keski-Nisula, Juliane Weber, Petra Ina Pfefferle, Anne Hyvärinen, Caroline Roduit, Bianca Schaub, Jon Genuneit, Charlotte Braun-Fahrländer, Jean-Charles Dalphin, L. Orivuori, Laboratoire Chrono-environnement ( LCE ), Université Bourgogne Franche-Comté ( UBFC ) -Centre National de la Recherche Scientifique ( CNRS ) -Université de Franche-Comté ( UFC ), Institute of Epidemiology, Universität Ulm, Asthma and Allergy Department, University Children's Hospital-Ludwig Maximilians University, Laboratoire Chrono-environnement - CNRS - UBFC (UMR 6249) (LCE), Centre National de la Recherche Scientifique (CNRS)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), and Universität Ulm - Ulm University [Ulm, Allemagne]

Subjects
MESH: Inflammation, Hypersensitivity, Immediate, Rural Population, Allergy, Urban Population, MESH : Risk, MESH : Child, Preschool, Immunoglobulin E, MESH : Hypersensitivity, Immediate, Allergic sensitization, 0302 clinical medicine, MESH: Rural Population, Surveys and Questionnaires, Immunology and Allergy, 2. Zero hunger, 0303 health sciences, MESH: Risk, MESH : Prognosis, biology, MESH: Immunoglobulin E, MESH : Questionnaires, MESH : Infant, Atopic dermatitis, MESH: Follow-Up Studies, Prognosis, MESH: Infant, 3. Good health, Europe, MESH: Urban Population, C-Reactive Protein, Child, Preschool, MESH : Urban Population, Hay fever, MESH: Hypersensitivity, Immediate, Risk, Immunology, MESH: Environmental Exposure, MESH : Europe, MESH : Immunoglobulin E, MESH: Prognosis, [ SDV.EE.SANT ] Life Sciences [q-bio]/Ecology, environment/Health, 03 medical and health sciences, Hygiene hypothesis, MESH: C-Reactive Protein, medicine, Humans, 030304 developmental biology, Asthma, [SDV.EE.SANT]Life Sciences [q-bio]/Ecology, environment/Health, Inflammation, MESH: Humans, MESH : Inflammation, business.industry, MESH: Questionnaires, C-reactive protein, MESH: Child, Preschool, MESH : Humans, Infant, MESH : Follow-Up Studies, Environmental Exposure, MESH : C-Reactive Protein, medicine.disease, MESH : Rural Population, 030228 respiratory system, Pediatrics, Perinatology and Child Health, biology.protein, MESH: Europe, business, MESH : Environmental Exposure, Follow-Up Studies
Abstract

International audience; BACKGROUND: Microbial exposure may induce low-grade inflammation at an early age and decrease the risk of allergic diseases, as suggested by the hygiene hypothesis. We examined the associations between low-grade inflammation and the development of allergic sensitization, atopic dermatitis (AD), and asthma at the age of 4.5 yr. METHODS: We studied 636 children participating in the PASTURE study in Finland, Germany, Austria, France, and Switzerland. Data of environmental factors, doctor-diagnosed AD, and asthma were collected by questionnaire. The serum high-sensitivity C-reactive protein (CRP) values were measured at the age of 1 yr, and serum-specific IgE concentrations (sIgE) at the age of one and 4.5 yr. Analyses were made by logistic regression analysis. RESULTS: The risk of allergic sensitization at the age of 4.5 yr was decreased in children who had increased CRP levels at the age of 1 yr (level in the highest vs. lowest quartile: aOR 0.48, 95% CI 0.24-0.95; p = 0.014). The risk of AD and asthma was not significantly related to CRP. CONCLUSION: The findings confirm that elevated levels of CRP at early age showed association with decreased allergic sensitization later in life. Our results suggest that poor inflammatory response could predispose for IgE sensitization.

Published
2013
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3. Protective effect of IgM against colonization of the respiratory tract by nontypeable Haemophilus influenzae in patients with hypogammaglobulinemia

Author

Julien Beauté, Pierre Galanaud, Pauline Brosselin, Capucine Picard, Romain Micol, Samer Kayal, Jean-Claude Lecron, Isabelle Pellier, Olivier Lambotte, Raphaele Nove-Josserand, Fabrice Monpoux, Nizar Mahlaoui, Fanny Lanternier, Stéphane Blanche, Anne Durandy, Caroline Thomas, Kamila Kebaili, Felipe Suarez, Marie-Alexandra Alyanakian, Pierre Teira, Olivier Lortholary, Yasmine Dudoit, Olivier Join-Lambert, Ioannis Theodorou, Alain Fischer, Alexandra Salmon, Marie-Dominique Tabone, Olivier Hermine, Marc Lecuit, Marianne Debré, Nathalie Aladjidi, Fabienne Dulieu, Gael Mouillot, Agathe Masseau, Eric Oksenhendler, Hélène Coignard-Biehler, Vincent Barlogis, Gaelle Obenga, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service d'immuno-hématologie pédiatrique [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Centre de Référence Déficits Immunitaires Héréditaires (CEREDIH), Institut Pasteur du Cambodge, Réseau International des Instituts Pasteur (RIIP), Service d'hématologie pédiatrique, Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Service d'Hémato-oncologie Pédiatrique, CHU Bordeaux [Bordeaux]-Hôpital Pellegrin, Service d'hématologie : Immuno-Hématologie pédiatrique et transplantation de moelle osseuse, Hôpital Debrousse, Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Hématologie et oncologie pédiatrique, Centre hospitalier universitaire de Nantes (CHU Nantes), Service de Médecine Interne - Centre Hospitalier Lyon Sud, Hospices Civils de Lyon (HCL)-Centre Hospitalier Lyon Sud [CHU - HCL] (CHLS), Hospices Civils de Lyon (HCL), Centre de Recherche en Cancérologie Nantes-Angers (CRCNA), Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM)-Hôtel-Dieu de Nantes-Institut National de la Santé et de la Recherche Médicale (INSERM)-Hôpital Laennec-Centre National de la Recherche Scientifique (CNRS)-Faculté de Médecine d'Angers-Centre hospitalier universitaire de Nantes (CHU Nantes), service de médecine interne, Hôpital de Bicêtre, Service de Génétique [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de médecine interne, Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Cytokines, chimiokines et immunopathologie, Université Paris-Sud - Paris 11 (UP11)-IFR13-Institut National de la Santé et de la Recherche Médicale (INSERM), Service d'immunologie clinique, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Centre d'infectiologie Necker-Pasteur [CHU Necker], Institut Pasteur [Paris]-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Pathogénie des infections systémiques (UMR_S 570), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Immunité et Infection, Université Pierre et Marie Curie - Paris 6 (UPMC)-IFR113-Institut National de la Santé et de la Recherche Médicale (INSERM), Immunologie cellulaire et tissulaire, Modélisations pharmacocinétiques-pharmacodynamiques pour un meilleur usage des anti-infectieux, Université de Poitiers-Institut National de la Santé et de la Recherche Médicale (INSERM), Imagine - Institut des maladies génétiques (IMAGINE - U1163), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), INSERM 980, Laboratory of Human Genetics of Infectious Disease, Laboratory of Human Genetics of Infectious Disease, Laboratory of molecular mechanisms of hematologic disorders and therapeutic implications (ERL 8254 - Equipe Inserm U1163), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Microorganismes et Barrières de l'Hôte (Equipe avenir), Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Pasteur [Paris], Developpement Normal et Pathologique du Système Immunitaire, Laboratoire du D eveloppement Normal et Pathologique du Syst eme Immunitaire, Unit e d'Immunologie et H ematologie P ediatrique, French Ministry of Health to the Rare Diseases National Reference Centre for Primary Immune Deficiencies (CEREDIH), INSERM, Assistance Publique-Hôpitaux de Paris [grant no. P060308], senior ERC grant 'PIDIMMUN' [grant no. 249816], ARC (Association pour la Recherche sur le Cancer), Institut Pasteur [Paris] (IP)-CHU Necker - Enfants Malades [AP-HP], Institut Pasteur [Paris] (IP)-Institut National de la Santé et de la Recherche Médicale (INSERM), Brébion, Alice, Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Centre de Référence Déficits Immunitaires Héréditaires ( CEREDIH ), Institut Pasteur du Cambodge-Réseau International des Instituts Pasteur ( RIIP ), Université de la Méditerranée - Aix-Marseille 2-Assistance Publique - Hôpitaux de Marseille ( APHM ) - Hôpital de la Timone [CHU - APHM] ( TIMONE ), Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), Centre hospitalier universitaire de Nantes ( CHU Nantes ), Hospices Civils de Lyon ( HCL ) -Centre Hospitalier Lyon Sud [CHU - HCL] ( CHLS ), Hospices Civils de Lyon ( HCL ), Centre de Recherche en Cancérologie / Nantes - Angers ( CRCNA ), CHU Angers-Centre hospitalier universitaire de Nantes ( CHU Nantes ) -Hôtel-Dieu de Nantes-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Hôpital Laennec-Centre National de la Recherche Scientifique ( CNRS ) -Faculté de Médecine d'Angers, Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Hôtel-Dieu-Centre hospitalier universitaire de Nantes ( CHU Nantes ), Université Paris-Sud - Paris 11 ( UP11 ) -IFR13-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ) -Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Pathogénie des infections systémiques ( UMR_S 570 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Université Pierre et Marie Curie - Paris 6 ( UPMC ) -IFR113-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Pharmacologie des anti-infectieux, Université de Poitiers-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Imagine - Institut des maladies génétiques ( IMAGINE - U1163 ), Laboratoire d'hématologie ( ERL 8254 ), Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Equipe avenir Microorganismes et Barrières de l'Hôte, and Institut Pasteur [Paris]-Institut National de la Santé et de la Recherche Médicale ( INSERM )

Subjects
Male, MESH : Hyper-IgM Immunodeficiency Syndrome, MESH : Risk, Respiratory System, MESH : Prospective Studies, immunoglobulins, Antibodies, Viral, Hyper-IgM Immunodeficiency Syndrome, medicine.disease_cause, Haemophilus influenzae, Hypogammaglobulinemia, 0302 clinical medicine, MESH : Child, [ SDV.MP ] Life Sciences [q-bio]/Microbiology and Parasitology, Agammaglobulinemia, MESH: Child, Immunology and Allergy, MESH : Female, Prospective Studies, infections, MESH: Incidence, Child, Immunodeficiency, IgM deficiency, MESH: Respiratory System, 0303 health sciences, MESH: Risk, Respiratory tract infections, MESH : Haemophilus Infections, Incidence, MESH : Incidence, MESH: Immunoglobulin M, 3. Good health, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Female, medicine.symptom, Antibody, MESH: Haemophilus Infections, MESH : Antibodies, Viral, Risk, Haemophilus Infections, IgM, Adolescent, MESH : Immunoglobulin M, MESH : Male, Immunology, Biology, 03 medical and health sciences, MESH : Agammaglobulinemia, MESH : Adolescent, medicine, MESH : Haemophilus influenzae, Humans, MESH: Agammaglobulinemia, MESH : Respiratory System, [SDV.MP] Life Sciences [q-bio]/Microbiology and Parasitology, 030304 developmental biology, MESH: Adolescent, Bronchiectasis, MESH: Humans, MESH : Humans, MESH: Haemophilus influenzae, medicine.disease, MESH: Male, MESH: Prospective Studies, Immunoglobulin M, MESH: Hyper-IgM Immunodeficiency Syndrome, biology.protein, Sputum, immunodeficiency, MESH: Female, MESH: Antibodies, Viral, 030215 immunology
Abstract

International audience; BACKGROUND: Primary immunoglobulin deficiencies lead to recurrent bacterial infections of the respiratory tract and bronchiectasis, even with adequate immunoglobulin replacement therapy. It is not known whether patients able to secrete IgM (eg, those with hyper-IgM [HIgM] syndrome) are as susceptible to these infections as patients who lack IgM production (eg, those with panhypogammaglobulinemia [PHG]). OBJECTIVE: This study is aimed at identifying specific microbiological and clinical (infections) characteristics that distinguish immunoglobulin-substituted patients with PHG from patients with HIgM syndrome. METHODS: A cohort of patients with HIgM syndrome (n = 25) and a cohort of patients with PHG (n = 86) were monitored prospectively for 2 years while receiving similar polyvalent immunoglobulin replacement therapies. Regular bacterial analyses of nasal swabs and sputum were performed, and clinical events were recorded. In parallel, serum and saliva IgM antibody concentrations were measured. RESULTS: When compared with patients with PHG, patients with HIgM syndrome were found to have a significantly lower risk of nontypeable Haemophilus influenzae carriage in particular (relative risk, 0.39; 95% CI, 0.21-0.63). Moreover, patients with HIgM syndrome (including those unable to generate somatic hypermutations of immunoglobulin genes) displayed anti-nontypeable H influenzae IgM antibodies in their serum and saliva. Also, patients with HIgM syndrome had a lower incidence of acute respiratory tract infections. CONCLUSIONS: IgM antibodies appear to be microbiologically and clinically protective and might thus attenuate the infectious consequences of a lack of production of other immunoglobulin isotypes in patients with HIgM syndrome. Polyvalent IgG replacement therapy might not fully compensate for IgM deficiency. It might thus be worth adapting long-term antimicrobial prophylactic regimens according to the underlying B-cell immunodeficiency phenotype.

Published
2012
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4. Effect of dutasteride on the risk of prostate cancer

Author

Andriole, G.L., Bostwick, D.G., Brawley, O.W., Gomella, L.G., Marberger, M., Montorsi, F., Pettaway, C.A., Tammela, T.L.J., Teloken, C., Tindall, D.J., Somerville, M.C., Wilson, T.H., Fowler, I.L., Rittmaster, R.S., Mulders, P.F.A., Schrier, B.P., Department of urology, Università Vita-Salute San Raffaele, Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), Service de Néphrologie et Urologie, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Saint-Jacques, Andriole Gerald, L., Bostwick David, G., Brawley Otis, W., Gomella Leonard, G., Marberger, Michael, Montorsi, Francesco, Pettaway Curtis, A., Tammela Teuvo, L., Teloken, Claudio, Tindall Donald, J., Somerville Matthew, C., Wilson Timothy, H., Fowler Ivy, L., Rittmaster Roger, S., Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Service d'urologie, andrologie et transplantation rénale, and Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Hôpital Saint-Jacques

Subjects
Male, Relative risk reduction, Prostate biopsy, Biopsy, MESH : Risk, Prostatic Hyperplasia, 030232 urology & nephrology, MESH : Aged, MESH: Protein Isoforms, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, MESH: Biopsy, chemistry.chemical_compound, Prostate cancer, 5-alpha Reductase Inhibitors, 0302 clinical medicine, Erectile Dysfunction, Protein Isoforms, MESH: Double-Blind Method, Enzyme Inhibitors, MESH : Prostate-Specific Antigen, 10. No inequality, MESH: Treatment Outcome, MESH: Erectile Dysfunction, MESH: Aged, MESH: Risk, MESH: Middle Aged, medicine.diagnostic_test, Prostate, General Medicine, Middle Aged, MESH : Prostatic Hyperplasia, MESH: Prostate-Specific Antigen, 3. Good health, Prostate-specific antigen, Treatment Outcome, MESH: Enzyme Inhibitors, 030220 oncology & carcinogenesis, Finasteride, medicine.symptom, MESH : Prostatic Neoplasms, Risk, medicine.medical_specialty, MESH : Male, Urology, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH : Testosterone 5-alpha-Reductase, MESH : Treatment Outcome, MESH: Prostate, MESH: Azasteroids, MESH: Prostatic Hyperplasia, 03 medical and health sciences, Double-Blind Method, Translational research [ONCOL 3], medicine, Humans, MESH : Double-Blind Method, MESH : Middle Aged, MESH: Testosterone 5-alpha-Reductase, Aged, MESH : Azasteroids, Heart Failure, Gynecology, MESH : Enzyme Inhibitors, MESH: Humans, MESH : Erectile Dysfunction, business.industry, Urinary retention, MESH : Humans, Prostatic Neoplasms, MESH : Protein Isoforms, Dutasteride, Prostate-Specific Antigen, medicine.disease, MESH: Male, chemistry, Azasteroids, MESH: Prostatic Neoplasms, MESH : Biopsy, MESH: Heart Failure, Prostate surgery, business, MESH : Heart Failure, MESH : Prostate
Abstract

Background: We conducted a study to determine whether dutasteride reduces the risk of incident prostate cancer, as detected on biopsy, among men who are at increased risk for the disease. Methods: In this 4-year, multicenter, randomized, double-blind, placebo-controlled, parallel-group study, we compared dutasteride, at a dose of 0.5 mg daily, with placebo. Men were eligible for inclusion in the study if they were 50 to 75 years of age, had a prostate-specific antigen (PSA) level of 2.5 to 10.0 ng per milliliter, and had had one negative prostate biopsy (6 to 12 cores) within 6 months before enrollment. Subjects underwent a 10-core transrectal ultrasound-guided biopsy at 2 and 4 years. Results: Among 6729 men who underwent a biopsy or prostate surgery, cancer was detected in 659 of the 3305 men in the dutasteride group, as compared with 858 of the 3424 men in the placebo group, representing a relative risk reduction with dutasteride of 22.8% (95% confidence interval, 15.2 to 29.8) over the 4-year study period (P

Published
2010
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5. Breast cancer following radiotherapy for a hemangioma during childhood

Author

Florent de Vathaire, Françoise Doyon, Nadia Haddy, Abdeddahir Mousannif, Caroline Robert, Akhtar Shamsaldin, Marie-Françoise Avril, Rogers Demars, Carole Rubino, Marie-Gabrielle Dondon, Martine Labbé, Ibrahima Diallo, Florence Molinie, Dimitri Lefkopoulos, Catherine Paoletti, Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Cancer et génome: Bioinformatique, biostatistiques et épidémiologie d'un système complexe, MINES ParisTech - École nationale supérieure des mines de Paris, Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut Curie [Paris]-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de dermatologie, Département de médecine oncologique [Gustave Roussy], Institut Gustave Roussy (IGR)-Institut Gustave Roussy (IGR), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Descartes - Paris 5 (UPD5), Caisse Nationale d'Assurance Maladie, FRANCIM, Réseau des registres français du cancer, Département de radiothérapie [Gustave Roussy], Institut Gustave Roussy (IGR), This work was supported by the Fondation de France, the Ligue Nationale Contre le Cancer (LNCC)., Centre de recherche en épidémiologie et santé des populations ( CESP ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -Université Paris-Sud - Paris 11 ( UP11 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Cancer et génôme: Bioinformatique, biostatistiques et épidémiologie d'un système complexe, MINES ParisTech - École nationale supérieure des mines de Paris-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -INSTITUT CURIE, Institut Gustave Roussy ( IGR ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Cochin [AP-HP]-Université Paris Descartes - Paris 5 ( UPD5 ), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Mines Paris - PSL (École nationale supérieure des mines de Paris), and Dondon, Marie-Gabrielle

Subjects
Cancer Research, MESH: Neoplasms, Radiation-Induced, MESH: Radiotherapy, Neoplasms, Radiation-Induced, Skin Neoplasms, Time Factors, medicine.medical_treatment, MESH : Risk, MESH: Hemangioma, MESH : Breast Neoplasms, MESH : Child, Preschool, 030218 nuclear medicine & medical imaging, Cohort Studies, 0302 clinical medicine, Breast cancer, MESH : Child, MESH: Child, Medicine, MESH : Female, MESH: Incidence, Child, MESH: Cohort Studies, MESH : Neoplasms, Radiation-Induced, MESH: Treatment Outcome, education.field_of_study, Radiation, MESH: Risk, Incidence (epidemiology), Incidence, Absolute risk reduction, Cohort, MESH : Infant, MESH: Follow-Up Studies, MESH : Adult, MESH: Infant, MESH : Incidence, 3. Good health, MESH : Radiation Dosage, Treatment Outcome, Oncology, 030220 oncology & carcinogenesis, Child, Preschool, Female, Radiology, France, Hemangioma, Cohort study, MESH : Time Factors, Adult, Risk, medicine.medical_specialty, MESH: Radiation Dosage, Adolescent, Population, MESH : Cohort Studies, Breast Neoplasms, MESH : Treatment Outcome, Radiation Dosage, 03 medical and health sciences, MESH : Adolescent, Humans, education, MESH : France, MESH : Hemangioma, Gynecology, MESH: Adolescent, MESH: Humans, Radiotherapy, business.industry, MESH : Radiotherapy, MESH: Skin Neoplasms, MESH : Humans, MESH : Skin Neoplasms, MESH: Time Factors, MESH: Child, Preschool, Infant, MESH : Follow-Up Studies, MESH: Adult, medicine.disease, Childhood, Radiation therapy, MESH: France, business, MESH: Female, MESH: Breast Neoplasms, Follow-Up Studies
Abstract

International audience; PURPOSE: A cohort study was performed to investigate the carcinogenic effect of treatment of skin hemangioma with ionizing radiation in early childhood. This paper presents the incidence of breast cancer (BC) in this cohort and its association with radiotherapy. METHODS AND MATERIALS: In an incidence study, 3,316 women treated for a skin hemangioma between 1941 and 1977 at the Institut Gustave-Roussy were included, among whom 2,697 had received radiotherapy. The mean age at first exposure was 0.7 years, and the mean absorbed dose to the breast was 70 mGy. Treatment reconstruction and the estimation of radiation doses delivered to the breast were obtained for 92% of the women who had received radiotherapy. External and internal analyses were performed. RESULTS: During an average follow-up of 35 years, a total of 17 women developed an invasive BC, compared to 7.5 expected in the French general population (SIR = 2.3, 95% CI, 1.4-3.5), and the absolute excess risk strongly increased with attained age. Compared to individuals with no radiotherapy, the risk of BC increased with increasing radiation dose with RRs of 3.2, 6.3, and 8.0 for dose categories of >0-10, 10-100, and >100 mGy, respectively; however, dose-response relationship was not significant. CONCLUSION: This study confirms that radiation treatment performed in the past for hemangioma during childhood increases the risk of BC.

Published
2010
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6. The abdominoperineal resection itself is associated with an adverse outcome: the European experience based on a pooled analysis of five European randomised clinical trials on rectal cancer

Author

Joakim Folkesson, Marcel den Dulk, Krzysztof Bujko, Claus Rödel, Cornelis J.H. van de Velde, Laurence Collette, Hein Putter, Jean-François Bosset, Lars Påhlman, Corrie A.M. Marijnen, Department of Medical Statistics, Leiden University Medical Center (LUMC), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), and Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC )

Subjects
Male, Oncology, Cancer Research, Time Factors, Colorectal cancer, MESH : Risk, MESH: Lymphatic Metastasis, MESH : Abdomen, MESH : Aged, Kaplan-Meier Estimate, Perineum, MESH : Randomized Controlled Trials as Topic, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, MESH: Proportional Hazards Models, MESH : Adenocarcinoma, 0302 clinical medicine, MESH: Rectum, Abdomen, Medicine, MESH : Female, MESH: Kaplan-Meiers Estimate, MESH : Rectal Neoplasms, Randomized Controlled Trials as Topic, MESH: Treatment Outcome, MESH: Aged, MESH: Middle Aged, MESH: Risk, MESH : Neoplasm Recurrence, Local, Abdominoperineal resection, Hazard ratio, MESH : Lymphatic Metastasis, MESH: Follow-Up Studies, Middle Aged, MESH : Survival Rate, 3. Good health, Europe, Survival Rate, Treatment Outcome, Lymphatic Metastasis, 030220 oncology & carcinogenesis, MESH : Rectum, Female, 030211 gastroenterology & hepatology, MESH: Neoplasm Recurrence, Local, MESH : Time Factors, Risk, medicine.medical_specialty, animal structures, MESH: Survival Rate, MESH : Male, MESH : Europe, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH : Treatment Outcome, Adenocarcinoma, MESH : Perineum, MESH: Abdomen, 03 medical and health sciences, Internal medicine, Humans, MESH : Middle Aged, MESH: Patient Selection, MESH: Perineum, Survival rate, Aged, Proportional Hazards Models, MESH: Humans, Rectal Neoplasms, business.industry, Proportional hazards model, Patient Selection, MESH : Humans, MESH: Adenocarcinoma, MESH: Time Factors, Rectum, Cancer, MESH: Rectal Neoplasms, MESH : Follow-Up Studies, MESH : Kaplan-Meiers Estimate, MESH : Patient Selection, MESH : Proportional Hazards Models, medicine.disease, MESH: Male, Surgery, Clinical trial, MESH: Randomized Controlled Trials as Topic, Propensity score matching, MESH: Europe, Neoplasm Recurrence, Local, business, MESH: Female, Follow-Up Studies
Abstract

International audience; PURPOSE: The aim of this study is to identify factors associated with the decision to perform an abdominoperineal resection (APR) and to assess if these factors or the surgical procedure itself is associated with circumferential resection margin (CRM) involvement, local recurrence (LR), overall survival (OS) and cancer-specific survival (CSS). PATIENTS AND METHODS: The Swedish Rectal Cancer Trial (SRCT), TME trial, CAO/ARO/AIO-94 trial, EORTC 22921 trial and Polish Rectal Cancer Trial (PRCT) were pooled. A propensity score was calculated, which indicated the predicted probability of undergoing an APR given gender, age and distance, and used in the multivariate analyses. RESULTS: An APR procedure was associated with an increased risk of CRM involvement [odd ratio (OR) 2.52, p

Published
2009
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7. Risk of a second malignant neoplasm after cancer in childhood treated with radiotherapy: correlation with the integral dose restricted to the irradiated fields

Author

Sylvie Guerin, Ibrahima Diallo, Dimitri Lefkopoulos, Michael M. Hawkins, Florent de Vathaire, Odile Oberlin, Carole Rubino, Akthar Samand, Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), Epidémiologie des cancers : Radiocarcinogénèse et effets iatrogènes des traitements, Université Paris-Sud - Paris 11 ( UP11 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Department of Public Health and Epidemiology, University of Birmingham [Birmingham], Scottish Universities Physics Alliance ( SUPA ), University of Edinburgh, Département de Pédiatrie, Institut Gustave Roussy ( IGR ), Département de radiothérapie [Gustave Roussy], Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM), Scottish Universities Physics Alliance (SUPA), and Institut Gustave Roussy (IGR)

Subjects
Oncology, Male, MESH: Neoplasms, Radiation-Induced, Neoplasms, Radiation-Induced, medicine.medical_treatment, MESH: Regression Analysis, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, Correlation, 0302 clinical medicine, MESH : Child, MESH: Child, MESH : Regression Analysis, MESH : Hodgkin Disease, Medicine, MESH: Incidence, MESH : Neoplasms, Second Primary, Child, Radiation, MESH: Risk, Incidence, MESH : Infant, MESH: Bone Neoplasms, MESH: Infant, MESH : Incidence, 3. Good health, MESH : Antineoplastic Agents, Integral dose, England, 030220 oncology & carcinogenesis, Child, Preschool, Cohort, Regression Analysis, MESH : Dose-Response Relationship, Radiation, Cohort study, medicine.medical_specialty, MESH : Cohort Studies, Antineoplastic Agents, Bone Neoplasms, 03 medical and health sciences, MESH : Adolescent, Humans, MESH : Bone Neoplasms, MESH: Adolescent, MESH: Humans, MESH: Child, Preschool, MESH : Humans, Infant, Dose-Response Relationship, Radiation, medicine.disease, MESH : Neoplasms, Radiation therapy, Relative risk, MESH: Antineoplastic Agents, MESH: Female, Cancer Research, MESH : Risk, MESH : Child, Preschool, 030218 nuclear medicine & medical imaging, Cohort Studies, MESH: England, Neoplasms, MESH: Neoplasms, MESH : Female, Survivors, MESH: Radiotherapy Dosage, MESH: Cohort Studies, MESH : Neoplasms, Radiation-Induced, MESH: Survivors, MESH : England, MESH : Radiotherapy Dosage, MESH: Infant, Newborn, Neoplasms, Second Primary, Radiotherapy Dosage, Hodgkin Disease, MESH: Hodgkin Disease, MESH: Sarcoma, Ewing's, MESH : Sarcoma, Ewing's, Female, France, Risk, MESH: Neoplasms, Second Primary, Adolescent, MESH : Survivors, MESH : Male, [SDV.CAN]Life Sciences [q-bio]/Cancer, Sarcoma, Ewing, MESH : Infant, Newborn, Internal medicine, MESH: Dose-Response Relationship, Radiation, Radiology, Nuclear Medicine and imaging, MESH : France, Chemotherapy, business.industry, Infant, Newborn, Cancer, MESH: Male, MESH: France, business, Nuclear medicine
Abstract

International audience; PURPOSE: After successful treatment of cancers in childhood, the occurrence of second malignant neoplasm (SMN) came to the fore. Few studies have considered the relationship between the radiation dose received and the risk of developing an SMN. To take into account the heterogeneity of the dose distribution so as to evaluate the overall risk of an SMN after a childhood cancer, we therefore focused on the integral dose restricted to the irradiated fields. METHODS AND MATERIALS: The study was performed in a cohort of 4,401 patients who were 3-year survivors of all types of childhood cancer treated between 1947 and 1986 in France and Great Britain. For each patient, the integral dose was estimated for the volume inside the beam edges. RESULTS: We found a significant dose-response relationship between the overall risk of an SMN and the estimated integral dose. The excess relative risk for each incremental unit of the integral dose was only 0.008 in a linear model and 0.017 when a negative exponential term was considered, when adjusted for chemotherapy. The risk of SMN occurrence was 2.6 times higher in the case of irradiation. However among patients who had received radiotherapy, only those who had received the highest integral dose actually had a higher risk. CONCLUSIONS: The integral dose in our study cannot be considered as a good predictor of later risks. However other studies with the same study design are obviously needed to evaluate the use of the integral dose as a tool for decision making concerning different radiotherapy techniques.

Published
2008
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8. Human papillomavirus genotype distribution in high grade cervical lesions (CIN 2/3) in France: EDITH study

Author

Prétet , Jean-Luc, Jacquard , Anne-Carole, Carcopino , Xavier, Monnier-Benoit , Sylvain, Averous , Gerlinde, Soubeyrand , Benoit, Leocmach , Yann, Mougin , Christiane, Riethmuller , Didier, Renseigné , Non, Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), and Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC )

Subjects
Adult, Risk, MESH : Retrospective Studies, Genotype, MESH : Prevalence, MESH : Risk, MESH : Uterine Cervical Neoplasms, MESH : Aged, Uterine Cervical Neoplasms, MESH : Genotype, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH : Cervical Intraepithelial Neoplasia, Cancer Vaccines, MESH: Cancer Vaccines, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, MESH: Genotype, MESH : Precancerous Conditions, MESH: Papillomaviridae, Prevalence, Humans, MESH : Female, MESH : Middle Aged, MESH : France, MESH : Papillomaviridae, Papillomaviridae, MESH: Prevalence, Aged, Retrospective Studies, MESH: Aged, MESH: Risk, MESH: Humans, MESH: Middle Aged, MESH : Humans, MESH : Cancer Vaccines, virus diseases, MESH: Adult, MESH: Retrospective Studies, MESH : Adult, Middle Aged, Uterine Cervical Dysplasia, female genital diseases and pregnancy complications, MESH: Uterine Cervical Neoplasms, MESH: France, MESH: Precancerous Conditions, Female, France, MESH: Cervical Intraepithelial Neoplasia, Precancerous Conditions, MESH: Female
Abstract

International audience; High grade cervical intraepithelial neoplasia (CIN 2/3) have a high potential to progress to invasive cervical cancer (ICC). Pap testing including follow-up and treatment of CIN 2/3 is currently the best prevention of ICC, but is associated with morbidity, namely obstetrical adverse effects and psychological distress. Human papillomavirus (HPV) is universally accepted as the necessary cause of ICC. The objective of the present study was to describe the type-specific prevalence of HPV in CIN 2/3 in France and hereby to locally estimate the potential benefit of an HPV 16/18 L1 virus-like particles (VLP) vaccine. A total of 493 formalin-fixed and paraffin-embedded CIN 2/3 specimens were analyzed. Medical records were examined for patient related data. HPV were genotyped with the INNO-LiPA assay allowing the detection of 24 HPV genotypes. The overall prevalence of LiPA detectable HPV was 98%. The most prevalent genotype was HPV 16 (62%) followed by HPV 31 (15%), 33 (12%), 52 (9%), 51 (8%), 58 (7%), 35 and 18 (4%). Multiple infection with at least two different high-risk (HR) HPV genotypes was observed in 26% of all specimens including 2.6% with HPV 16 and 18 multiple infections. The present study indicates that HPV 16 is by far the most common HPV type associated with CIN 2/3 in France. With an HPV 16 and 18 prevalence of 64%, HPV 16/18 L1 VLP vaccines would be expected to significantly reduce the burden associated with the management and treatment of CIN 2/3 in France.

Published
2008
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9. Human papillomavirus (HPV) genotype distribution in invasive cervical cancers in France: EDITH study

Author

Prétet, Jean-Luc, Jacquard, Anne-Carole, Carcopino, Xavier, Charlot, Jean-François, Bouhour, Damien, Kantelip, Bernadette, Soubeyrand, Benoit, Leocmach, Yann, Mougin, Christiane, Riethmuller, Didier, Renseigné, Non, Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Service d'Anatomie pathologique [CHRU Besançon], Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), Laboratoire d'anatomie pathologique [Besancon], and Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Jean Minjoz-Université de Franche-Comté ( UFC )

Subjects
Adult, Risk, Genotype, MESH : Prevalence, MESH : Risk, MESH : Uterine Cervical Neoplasms, MESH : Aged, Uterine Cervical Neoplasms, MESH : Genotype, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH : Cervical Intraepithelial Neoplasia, Cancer Vaccines, MESH: Cancer Vaccines, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, MESH: Genotype, MESH : Precancerous Conditions, MESH: Papillomaviridae, Prevalence, Humans, MESH : Female, MESH : Middle Aged, MESH : France, MESH : Papillomaviridae, Papillomaviridae, MESH: Prevalence, Aged, MESH: Aged, MESH: Risk, MESH: Humans, MESH: Middle Aged, MESH : Humans, MESH : Cancer Vaccines, virus diseases, MESH: Adult, Middle Aged, MESH : Adult, Uterine Cervical Dysplasia, female genital diseases and pregnancy complications, MESH: Uterine Cervical Neoplasms, MESH: France, MESH: Precancerous Conditions, Female, France, MESH: Cervical Intraepithelial Neoplasia, Precancerous Conditions, MESH: Female
Abstract

International audience; Invasive cervical cancer (ICC) remains a significant cause of morbidity and mortality in France. Since human papillomavirus (HPV) is the necessary cause of ICC, the aim of this study was to assess the type-specific prevalence of HPV in ICC in France in order to locally evaluate the potential benefit of an HPV 16/18 L1 virus-like particles (VLP) vaccination. A total of 516 histological specimens collected in 15 centers were analyzed. Among them, 86% had a diagnosis of squamous cell carcinoma (SCC) whereas 14% were adenocarcinomas (ADC). HPV genotyping was performed using the INNO-LiPA assay allowing the specific detection of 24 HPV genotypes both high risk (HR) and low risk (LR). The overall HPV prevalence in ICC was 97%. The most prevalent genotypes were HPV 16 (73%) and HPV 18 (19%) followed by HPV 31 (7%), 33, 68, 45, 52 and 58 (4.1-2.3%). HPV 16 and/or 18 were associated with 82% of ICC, 10% being HPV 16 and 18 coinfections. While HPV 16 was the most prevalent type in both SCC (74%) and ADC (64%), HPV 18 was by far more prevalent in ADC (37%) compared to SCC (16%; p < 0.001). Multiple infections with at least two different HR HPV genotypes were observed in 22% of ICC. Given the high HPV 16/18 prevalence and taking into account possible production of crossneutralizing antibodies against other HPV types, HPV 16/18 L1 VLP vaccination would be expected to significantly reduce the burden of ICC in France.

Published
2008
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10. Endarterectomy versus stenting in patients with symptomatic severe carotid stenosis

Author

Philippe Piquet, Jean-François Albucher, Pascal Favrole, Jean-François Bonneville, Abstr Act, Thierry Moulin, Michel Lievre, Didier Leys, Jacques Watelet, Jean-Pierre Pruvo, Xavier Ducrocq, Maurice Giroud, Alain Viguier, Fausto Viader, Gilles Chatellier, Bernard Beyssen, Vincent Larrue, Jean-Philippe Neau, Hassan Hosseini, Jean-Christophe Pillet, Alain Branchereau, S Investigators, Jean-Louis Mas, Emmanuel Touzé, Pierre Garnier, Jean-Pierre Becquemin, Service de Pédiatrie, Centre Hospitalier Universitaire de Nice (CHU Nice)-Hôpital l'Archet, Laboratoire de Santé Publique et Informatique Médicale (SPIM), Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Chirurgie Vasculaire, Hôpital de la Timone [CHU - APHM] (TIMONE), Laboratoire d'Astrophysique de Grenoble (LAOG), Université Joseph Fourier - Grenoble 1 (UJF)-Institut national des sciences de l'Univers (INSU - CNRS)-Centre National de la Recherche Scientifique (CNRS), Thérapeutiques substitutives du coeur et des vaisseaux (TSCV), Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12)-Centre National de la Recherche Scientifique (CNRS), Neurologie Vasculaire [Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Evaluation et modélisation des effets thérapeutiques, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Science et Ingénierie des Matériaux et Procédés (SIMaP), Université Joseph Fourier - Grenoble 1 (UJF)-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-Institut National Polytechnique de Grenoble (INPG)-Institut de Chimie du CNRS (INC)-Centre National de la Recherche Scientifique (CNRS), Service de neuroradiologie [Lille], Hôpital Roger Salengro [Lille]-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud ), Swedish Institute of Space Physics [Uppsala] (IRF), Neuropsychologie cognitive et neuroanatomie fonctionnelles de la mémoire humaine, Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-École Pratique des Hautes Études (EPHE), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de neurologie, Hôpital Sainte-Anne, Migrations Internationales, Territorialités, Identités (MITI), Université de Poitiers-Université Bordeaux Montaigne (UBM)-Centre National de la Recherche Scientifique (CNRS), Service de neurologie [Mondor], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), CHU Nice-Hôpital l'Archet, Laboratoire de Santé Publique et Informatique Médicale ( SPIM ), Institut National de la Santé et de la Recherche Médicale ( INSERM ), Hôpital de la Timone [CHU - APHM] ( TIMONE ), Laboratoire d'Astrophysique de Grenoble ( LAOG ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut national des sciences de l'Univers ( INSU - CNRS ) -Centre National de la Recherche Scientifique ( CNRS ), Thérapeutiques substitutives du coeur et des vaisseaux ( TSCV ), Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ) -Centre National de la Recherche Scientifique ( CNRS ), Université Toulouse III - Paul Sabatier ( UPS ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-CHU Toulouse [Toulouse]-Hôpital de Rangueil, CHU Toulouse [Toulouse], Laboratoire de Biométrie et Biologie Evolutive ( LBBE ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique ( Inria ) -Centre National de la Recherche Scientifique ( CNRS ), Science et Ingénierie des Matériaux et Procédés ( SIMaP ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut polytechnique de Grenoble - Grenoble Institute of Technology ( Grenoble INP ) -Institut National Polytechnique de Grenoble ( INPG ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ), Hôpital Roger Salengro-Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), Hôpital Sainte-Marguerite [CHU - APHM] ( Hôpitaux Sud ), Swedish Institute of Space Physics [Uppsala] ( IRF ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -École pratique des hautes études ( EPHE ) -Université de Caen Normandie ( UNICAEN ), Normandie Université ( NU ) -Normandie Université ( NU ), Migrations Internationales, Territorialités, Identités ( MITI ), Université Bordeaux Montaigne-Université de Poitiers-Centre National de la Recherche Scientifique ( CNRS ), Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Henri Mondor-Université Paris-Est Créteil Val-de-Marne - Paris 12 ( UPEC UP12 ), Normandie Université (NU)-Normandie Université (NU)-École pratique des hautes études (EPHE), Université de Poitiers-Université Bordeaux Montaigne-Centre National de la Recherche Scientifique (CNRS), Université Toulouse III - Paul Sabatier (UT3), Université Bordeaux Montaigne-Université de Poitiers-Centre National de la Recherche Scientifique (CNRS), Institut de médecine moléculaire de Rangueil ( I2MR ), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-IFR150-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Fédérale Toulouse Midi-Pyrénées, Service de chirurgie cadiovasculaire et thoracique [Rouen], CHU Rouen-Hôpital Charles Nicolle [Rouen]-Université de Rouen Normandie ( UNIROUEN ), Centre de Recherches sur la Cognition et l'Apprentissage ( CeRCA ), and Université de Poitiers-Université de Tours-Centre National de la Recherche Scientifique ( CNRS )

Subjects
Male, MESH : Stroke, medicine.medical_treatment, MESH : Risk, MESH : Aged, Myocardial Infarction, 030204 cardiovascular system & hematology, MESH: Endarterectomy, Carotid, 0302 clinical medicine, MESH: Carotid Stenosis, MESH : Female, Carotid Stenosis, MESH: Incidence, Stroke, MESH : Stents, Endarterectomy, MESH: Treatment Outcome, MESH: Aged, Endarterectomy, Carotid, MESH: Risk, Incidence, MESH : Endarterectomy, Carotid, General Medicine, MESH: Follow-Up Studies, MESH : Incidence, 3. Good health, MESH: Myocardial Infarction, Treatment Outcome, Female, Stents, [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], Risk, medicine.medical_specialty, MESH : Male, MESH : Treatment Outcome, MESH: Stroke, 03 medical and health sciences, Angioplasty, medicine, Humans, MESH : Angioplasty, cardiovascular diseases, MESH : Carotid Stenosis, Aged, MESH: Angioplasty, MESH: Humans, Vascular disease, business.industry, MESH : Humans, Stent, [ SDV.SP.PHARMA ] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, MESH : Follow-Up Studies, medicine.disease, MESH: Male, Surgery, Stenosis, MESH: Stents, Relative risk, [ SDV.NEU ] Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC], [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, Carotid stenting, MESH : Myocardial Infarction, business, MESH: Female, 030217 neurology & neurosurgery, Follow-Up Studies
Abstract

International audience; BACKGROUND: Carotid stenting is less invasive than endarterectomy, but it is unclear whether it is as safe in patients with symptomatic carotid-artery stenosis. METHODS: We conducted a multicenter, randomized, noninferiority trial to compare stenting with endarterectomy in patients with a symptomatic carotid stenosis of at least 60%. The primary end point was the incidence of any stroke or death within 30 days after treatment. RESULTS: The trial was stopped prematurely after the inclusion of 527 patients for reasons of both safety and futility. The 30-day incidence of any stroke or death was 3.9% after endarterectomy (95% confidence interval [CI], 2.0 to 7.2) and 9.6% after stenting (95% CI, 6.4 to 14.0); the relative risk of any stroke or death after stenting as compared with endarterectomy was 2.5 (95% CI, 1.2 to 5.1). The 30-day incidence of disabling stroke or death was 1.5% after endarterectomy (95% CI, 0.5 to 4.2) and 3.4% after stenting (95% CI, 1.7 to 6.7); the relative risk was 2.2 (95% CI, 0.7 to 7.2). At 6 months, the incidence of any stroke or death was 6.1% after endarterectomy and 11.7% after stenting (P=0.02). There were more major local complications after stenting and more systemic complications (mainly pulmonary) after endarterectomy, but the differences were not significant. Cranial-nerve injury was more common after endarterectomy than after stenting. CONCLUSIONS: In this study of patients with symptomatic carotid stenosis of 60% or more, the rates of death and stroke at 1 and 6 months were lower with endarterectomy than with stenting. (ClinicalTrials.gov number, NCT00190398 [ClinicalTrials.gov].).

Published
2006
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11. Role of fibrinolysis and interventional therapy for acute venous thromboembolism

Author

Hervé Decousus, Guy Meyer, Giancarlo Agnelli, Joseph Emmerich, Risque Thrombotique et Mecanismes de l'Hemostase (U765), Institut des sciences du Médicament -Toxicologie - Chimie - Environnement (IFR71), Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Ecole Vétérinaire de Toulouse, Groupe de recherche sur la thrombose (GRT (EA 3065)), Université Jean Monnet [Saint-Étienne] (UJM), Risque Thrombotique et Mecanismes de l'Hemostase ( U765 ), Institut des sciences du Médicament -Toxicologie - Chimie - Environnement ( IFR71 ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL ( ENSCP ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche pour le Développement ( IRD ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL ( ENSCP ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche pour le Développement ( IRD ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Groupe de recherche sur la thrombose ( GRT (EA 3065) ), Université Jean Monnet [Saint-Étienne] ( UJM ), and Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL (ENSCP)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL (ENSCP)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
MESH: Pulmonary Embolism, Vena Cava Filters, Deep vein, medicine.medical_treatment, MESH : Risk, 030204 cardiovascular system & hematology, MESH: Fibrinolysis, MESH : Anticoagulants, 0302 clinical medicine, MESH : Thrombolytic Therapy, Thrombolytic Therapy, MESH: Vena Cava Filters, Venous Thrombosis, MESH: Thrombolytic Therapy, MESH: Risk, MESH : Fibrinolysis, Fibrinolysis, MESH : Acute Disease, Hematology, MESH : Venous Thrombosis, Thrombosis, 3. Good health, Pulmonary embolism, Venous thrombosis, medicine.anatomical_structure, medicine.vein, MESH: Thromboembolism, 030220 oncology & carcinogenesis, Acute Disease, MESH : Pulmonary Embolism, MESH: Acute Disease, Risk, medicine.medical_specialty, MESH : Vena Cava, Inferior, Inferior vena cava filter, Vena Cava, Inferior, MESH : Vena Cava Filters, MESH: Anticoagulants, Inferior vena cava, 03 medical and health sciences, Thromboembolism, medicine, Humans, cardiovascular diseases, MESH: Vena Cava, Inferior, Contraindication, MESH: Humans, business.industry, MESH : Humans, Anticoagulants, [ SDV.SP.PHARMA ] Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, medicine.disease, MESH : Thromboembolism, Surgery, MESH: Venous Thrombosis, [SDV.SP.PHARMA]Life Sciences [q-bio]/Pharmaceutical sciences/Pharmacology, business, Pulmonary Embolism
Abstract

SummaryThe initial goals of treatment for venous thromboembolism (VTE) are usually achieved with anticoagulation. This reviewfocuses on fibrinolysis and interventional therapy in VTE, treatments whose indications are much more controversial. The benefit-to-risk ratio of fibrinolysis in deep vein thrombosis (DVT) is dubious. Thrombolytic treatment is recommended forunstable patients with pulmonary embolism (PE), although these patients represent less than 5% of all patients hospitalized for PE. The use of thrombolytic treatment in patients with sub-massive PE remains controversial. Two indications are widely recognized for inferior vena cava filters: the first isa permanent or temporary contraindication to anticoagulation, in patients with proximal DVT or PE. The second is the occurrence of PE or propagation of the thrombus in patients treated for DVT or recurrence in patients with PE. The PREPIC study demonstrated that in acute VTE, vena cava filters reduced the risk of PE but increased that of DVT and had no effect on survival. The fact that prevention of PE is mainly observed during the short initial period following the diagnosis of an acute VTE event justifies a new randomized study with the use of retrievable filters as an adjuvant to anticoagulation in high risk patients with PE.

Published
2006
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12. [The progression of lung cancer incidence in France (1978-2000)]

Author

Molinié, F., Velten, M., Remontet, L., Bercelli, P., Réseau Francim, Danzon, Arlette, Département d'Ingénierie des Systèmes (ex SIS) (DIS), Institut de Recherches sur les lois Fondamentales de l'Univers (IRFU), Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Paris-Saclay, Registre des cancers du Bas-Rhin, CRLCC Paul Strauss, Hospices Civils de Lyon, Service de Biostatistique, Université de Lyon, Biostatistiques santé, Département biostatistiques et modélisation pour la santé et l'environnement [LBBE], Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Laboratoire de Biométrie et Biologie Evolutive - UMR 5558 (LBBE), Université de Lyon-Université de Lyon-Institut National de Recherche en Informatique et en Automatique (Inria)-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (UR 3181) (CEF2P / CARCINO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Département d'Ingénierie des Systèmes (ex SIS) ( DIS ), Institut de Recherches sur les lois Fondamentales de l'Univers ( IRFU ), Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ) -Université Paris-Saclay-Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ) -Université Paris-Saclay, Laboratoire Biostatistique-Santé ( LBS ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Hospices Civils de Lyon ( HCL ) -Centre National de la Recherche Scientifique ( CNRS ), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), and Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO)

Subjects
MESH: Smoking, MESH: Registries, MESH : Male, MESH : Risk, MESH : Mortality, MESH : Age Distribution, MESH : Aged, MESH : Cohort Studies, [SDV.CAN]Life Sciences [q-bio]/Cancer, MESH : Morbidity, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, MESH : Adenocarcinoma, MESH: Aged, 80 and over, MESH : Middle Aged, MESH : Female, MESH : Lung Neoplasms, MESH: Incidence, MESH : Carcinoma, Squamous Cell, MESH : France, MESH : Aged, 80 and over, MESH : Sex Distribution, MESH: Age Distribution, MESH: Cohort Studies, MESH: Aged, MESH: Humans, MESH: Middle Aged, MESH: Risk, MESH: Mortality, MESH : Humans, MESH: Adenocarcinoma, MESH: Sex Distribution, MESH: Adult, MESH: Carcinoma, Small Cell, MESH: Carcinoma, Squamous Cell, MESH : Adult, MESH : Incidence, MESH: Male, MESH : Carcinoma, Small Cell, MESH: Lung Neoplasms, MESH : Smoking, MESH: France, MESH: Morbidity, MESH : Carcinoma, Large Cell, MESH: Carcinoma, Large Cell, MESH: Female, MESH : Registries
Abstract

International audience; INTRODUCTION: Lung cancer is the most common cause of death from malignant disease in the world. Our objective was to describe the progression of this cancer's incidence, and the changing distribution of histological types in France between 1978 and 2000. METHODS: National incidence rates were obtained by modelling lung cancer incidence data provided by the French cancer registries, taking into account national mortality data. These registries also provided information about histological type. RESULTS: In the year 2000, with 28,000 estimated new diagnoses, lung cancer represented 10.0% of all incident cancers and was responsible for 18.1% of deaths from cancer. From 1980 to 2000, the incidence rose from 47.4 to 52.2 per hundred thousand in men and from 3.7 to 8.6 per hundred thousand in women. The risk of developing lung cancer, which remained constant in men, has increased considerably (+451%) between the generation of women born in 1953 and those born in 1913. The proportion of epidermoid cancers has dropped whilst that of adenocarcinomas has risen sharply. CONCLUSIONS: The last few years have seen a large increase in the incidence of lung cancer in women and an increasing incidence of adenocarcinoma in both men and women.

Published
2006

13. Survival from rare cancer in adults: a population-based study

Author

Gatta, G., Ciccolallo, L., Kunkler, I., Capocaccia, R., Berrino, F., Coleman, M. P., De Angelis, R., Faivre, J., Lutz, J. M., Martinez, C., Möller, T., Sankila, R., Oberaigner, W., Storm, H. H., Aareleid, T., Jechova, M., Rousarova, M., Hakulinen, T., Hédelin, G., Tron, I., Le Gall, E., Launoy, G., Macé Lesec'h, J., Chaplain, G., Carli, P. M., Danzon, A., Tretarre, B., Colonna, M., Lacour, B., Raverdy, N., Berger, C., Freycon, B., Grosclaude, P., Estève, J., Kaatsch, P., Ziegler, H., Hölzel, D., Schubert Fritschle, G., Tryggvadottir, L., Allemani, C., Baili, P., Crosignani, P., Micheli, A., Sant, M., Taussig, E., Sowe, S., Ferretti, S., Conti, E., Vercelli, M., Quaglia, A., Pannelli, F., Federico, Massimo, Artioli, M. E., PONZ DE LEON, Maurizio, Benatti, Piero, De Lisi, V., Servente, L., Zanetti, R., Patriarca, S., Magnani, C., Pastore, G., Gafa, L., Tumino, R., Falcini, F., Budroni, M., Paci, E., Crocetti, E., Zambon, P., Guzzinati, S., Carrani, E., Roazzi, P., Santaquilani, M., Tavilla, A., Valente, F., Verdecchia, A., Dalmas, M., Langmark, F., Andersen, A., Pinheiro, P., Rachtan, J., Bielska Lasota, M., Wronkowski, Z., Zwierko, M., Pleško, I., Obsitníkováa, A., Pompe Kirn, V., Primic Zakelj, M., Izarzugaza, I., Martinez Garcia, C., Garau, I., Navarro, C., Chirlaque, M. D., Ardanaz, E., Moreno, C., Galceran, J., Torrella, A., Peris Bonet, R., Barlow, L., Jundt, G., Bouchardy, C., Coebergh, J. W. W., van der Does van den Berg, A., Visser, O., Godward, S., Williams, E. M. I., Forman, D., Quinn, M. J., Roche, M., Edwards, S., Stiller, C., Verne, J., Møller, H., Bell, J., Botha, H., Lawrence, G., Black, R., Steward, J. A., Evaluative Epidemiology Unit, Fondazione IRCCS, Department of Preventive & Predictive Medicine, Fondazione IRCCS-Istituto Nazionale dei Tumori, Registre Bourguignon des Cancers Digestifs, Lipides - Nutrition - Cancer (U866) ( LNC ), Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon ( ENSBANA ) -Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon ( ENSBANA ) -Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Registre Genevois des Tumeurs, CHU Genève, Service of Preventive Medicine, Hospital Clínico San Carlos, Madrid, Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), Lipides - Nutrition - Cancer (U866) (LNC), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA)-Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM)-AgroSup Dijon - Institut National Supérieur des Sciences Agronomiques, de l'Alimentation et de l'Environnement-Ecole Nationale Supérieure de Biologie Appliquée à la Nutrition et à l'Alimentation de Dijon (ENSBANA)-Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Université de Franche-Comté (UFC), and Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC)-Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)

Subjects
Male, Oncology, MESH : Risk, MESH : Aged, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, 0302 clinical medicine, Neoplasms, Angiosarcoma, MESH: Neoplasms, MESH : Female, MESH: Quality of Health Care, MESH: Aged, 0303 health sciences, MESH: Risk, MESH: Middle Aged, Relative survival, MESH : Quality of Health Care, Rare cancer survival, population-based cancer study, international comparison, Middle Aged, MESH : Adult, 3. Good health, Europe, 030220 oncology & carcinogenesis, MESH: Survival Analysis, MESH : Rare Diseases, Female, Sarcoma, Adult, Risk, MESH: Rare Diseases, medicine.medical_specialty, Adolescent, MESH : Male, MESH : Europe, [SDV.CAN]Life Sciences [q-bio]/Cancer, 03 medical and health sciences, Rare Diseases, Internal medicine, MESH : Adolescent, medicine, Carcinoma, Humans, MESH : Middle Aged, Testicular cancer, Survival analysis, Aged, Quality of Health Care, 030304 developmental biology, MESH: Adolescent, MESH: Humans, Uterine sarcoma, business.industry, MESH : Humans, Cancer, MESH: Adult, medicine.disease, Survival Analysis, MESH : Neoplasms, MESH: Male, MESH: Europe, MESH : Survival Analysis, business, MESH: Female
Abstract

International audience; BACKGROUND: Rare cancers are a challenge to clinical practice, and treatment experience, even in major cancer centres to which rare cancers are usually referred, is often limited. We aimed to study the epidemiology of rare cancers in a large population of several countries. METHODS: We analysed survival by age, sex, subsite, and morphology in 57,144 adults with 14 selected rare cancers diagnosed 1983-94. Variations in survival over time and between European regions were also assessed for variations in quality of care. We also estimated the adjusted relative excess risk of death for every rare cancer. FINDINGS: Overall 5-year relative survival was good (ie, >65%) for placental choriocarcinoma (85.4% [95% CI 81.4-89.5]), thyroid medullary carcinoma (72.4% [69.2-75.5]), ovarian germ-cell cancer (73.0% [70.0-76.0]), lung carcinoid (70.1% [67.3-72.9]), and cervical adenocarcinoma (65.5% [64.3-66.6]); intermediate (ie, 35-65%) for testicular cancer at age 65 years or older (64.0% [59.3-68.7]), sarcoma of extremities (60.0% [58.9-61.2]), digestive-system endocrine cancers (55.6% [54.9-56.3]), anal squamous-cell carcinoma (53.1% [51.5-54.8]), and uterine sarcoma (43.5% [42.0-44.9]); low for carcinoma of adrenal-gland cortex (32.7% [28.3-37.2]) and bladder squamous-cell carcinoma (20.4% [18.8-22.0]); and poor for angiosarcoma of liver (6.4% [1.8-11.0]) and mesothelioma (4.7% [4.3-5.2]). Survival was usually better for women than men and poor in those aged 75 years or older. Survival significantly improved over time for ovarian germ-cell cancer, sarcomas of extremities, digestive-system endocrine tumours, anal squamous-cell carcinoma, and angiosarcoma of liver. Survival in northern Europe was higher than in the other geographic groupings for most cancers. INTERPRETATION: Because effective treatments are available for several of the rare cancers we assessed, further research is needed to ascertain why survival is lower in some European countries than in others, particularly in older patients. Audit of best practice for rare cancers with treatment protocols would be useful.

Published
2006
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14. Indicators of lifetime endogenous estrogen exposure and risk of venous thromboembolism

Author

Simon, T., Beau Yon De Jonage-Canonico, M., Oger, Emmanuel, Wahl, Denis, Conard, Jacqueline, Meyer, Guy, Emmerich, Joseph, Barrellier, Marie-Thérèse, Guiraud, A., Scarabin, Pierre-Yves, Renseigné, Non, Epidémiologie cardiovasculaire et métabolique, Université Paris-Sud - Paris 11 (UP11)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Santé et de la Recherche Médicale (INSERM), CHU Saint-Antoine [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Groupe d'Etude de la Thrombose de Bretagne Occidentale (GETBO), Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO)-Université de Brest (UBO)-Université de Brest (UBO), Service de Médecine Interne et Vasculaire [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Unité d'hémostase-thrombose (JC - UHT), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Européen Georges Pompidou [APHP] (HEGP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO), Risque Thrombotique et Mecanismes de l'Hemostase (U765), Institut des sciences du Médicament -Toxicologie - Chimie - Environnement (IFR71), Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris - Chimie ParisTech-PSL (ENSCP), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service des Explorations Fonctionnelles [CHU Caen], CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN), Département de Pharmacologie Clinique (APHP - DPC), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Université de Brest (UBO)-Institut Brestois Santé Agro Matière (IBSAM), Université de Brest (UBO), Hôpitaux Universitaires Paris Ouest - Hôpitaux Universitaires Île de France Ouest (HUPO)-Assistance publique - Hôpitaux de Paris (AP-HP) (APHP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL (ENSCP)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL (ENSCP)-Centre National de la Recherche Scientifique (CNRS)-Institut de Recherche pour le Développement (IRD)-Université Paris Descartes - Paris 5 (UPD5)-Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université Paris-Sud - Paris 11 ( UP11 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Département de Pharmacologie Clinique ( APHP - DPC ), Assistance publique - Hôpitaux de Paris (AP-HP), Groupe d'Etude de la Thrombose de Bretagne Occidentale ( GETBO ), Université de Brest ( UBO ), Centre Hospitalier Régional Universitaire de Nancy ( CHRU Nancy ), Unité d'hémostase-thrombose ( JC - UHT ), Hôpital Européen Georges Pompidou [APHP] ( HEGP ), Risque Thrombotique et Mecanismes de l'Hemostase ( U765 ), Institut des sciences du Médicament -Toxicologie - Chimie - Environnement ( IFR71 ), Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL ( ENSCP ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche pour le Développement ( IRD ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Ecole Nationale Supérieure de Chimie de Paris- Chimie ParisTech-PSL ( ENSCP ) -Centre National de la Recherche Scientifique ( CNRS ) -Institut de Recherche pour le Développement ( IRD ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Université Paris Descartes - Paris 5 ( UPD5 ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Service d'Explorations Fonctionnelles, and Hôpital côte de nacre

Subjects
MESH: Pulmonary Embolism, MESH: Menopause, MESH : Risk, Osteoporosis, MESH : Aged, 030204 cardiovascular system & hematology, MESH: Estrogens, 0302 clinical medicine, MESH: Pregnancy, Pregnancy, Odds Ratio, Medicine, MESH : Female, 030212 general & internal medicine, Venous Thrombosis, First episode, MESH: Aged, MESH: Risk, MESH: Middle Aged, Obstetrics, Confounding, Age Factors, MESH : Menopause, Hematology, Middle Aged, MESH : Venous Thrombosis, MESH: Case-Control Studies, 3. Good health, Menopause, Parity, MESH: Thromboembolism, MESH : Pulmonary Embolism, Female, Risk, MESH : Case-Control Studies, medicine.medical_specialty, 03 medical and health sciences, Breast cancer, Thromboembolism, [ SDV.MHEP ] Life Sciences [q-bio]/Human health and pathology, Humans, MESH : Middle Aged, MESH : Parity, Aged, Gynecology, MESH: Age Factors, MESH: Humans, business.industry, MESH : Humans, MESH: Parity, Case-control study, Estrogens, Odds ratio, medicine.disease, MESH : Thromboembolism, Confidence interval, MESH: Odds Ratio, MESH : Pregnancy, Case-Control Studies, MESH: Venous Thrombosis, MESH : Estrogens, MESH : Odds Ratio, MESH : Age Factors, Pulmonary Embolism, business, MESH: Female, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Abstract

International audience; BACKGROUND: Lifetime estrogen exposure has been related to breast cancer risk, osteoporosis, and cardiovascular disease but data on venous thromboembolism (VTE) risk are limited. METHODS: Data from a hospital-based case-control study among 608 postmenopausal women (191 with a first episode of idiopathic VTE and 417 age-matched controls) were used to determine whether estrogen exposure, as assessed by age at menopause [classified as early (< or = 45 years), normal (46-54 years) and late menopause (> or = 55 years)] and parity, was associated with the risk of VTE. RESULTS: After adjustment for potential confounding variables, the risk of VTE was increased with each year's delay in the menopause [odds ratio (OR) = 1.06, 95% confidence interval (CI) = 1.02-1.10, P < 0.0075]. When compared with women with normal menopause used as a reference, the adjusted OR for VTE was 0.59 (95% CI = 0.36-0.97) and 2.53 (95% CI = 1.28-4.99) for women with early menopause and late menopause, respectively (P = 0.001). Adjusted OR for VTE was also higher for women with more than two children when compared with those with less than or equal to two children (1.56, 95% CI = 1.03-2.34, P = 0.03). The lowest risk of VTE was observed in women with early menopause and lower parity (adjusted OR = 0.60, 95% CI = 0.30-1.24), the highest risk was among women with late menopause who have had more than two children (adjusted OR = 3.41, 95% CI = 1.46-9.25). CONCLUSION: These results show that the longer exposure to endogenous estrogen is associated with an increased VTE risk.

Published
2006
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15. [Informing the transfused patient of the possible transmission of variant Creutzfeldt-Jakob disease by blood transfusion]

Author

Boixière, Aurélia, Hergon, Eric, Duchange, Nathalie, Bellier, Lucile, Moutel, Grégoire, Rouger, Philippe, Hervé, Christian, Institut National de la Transfusion Sanguine [Paris] ( INTS ), Laboratoire d'Ethique Médicale, de Droit de la Santé et de Santé Publique, Université Paris Descartes - Paris 5 ( UPD5 ), Institut National de la Transfusion Sanguine [Paris] (INTS), Université Paris Descartes - Paris 5 (UPD5), and Duchange, Nathalie

Subjects
Risk, MESH: Ethics, Medical, [SDV.MHEP.HEM] Life Sciences [q-bio]/Human health and pathology/Hematology, MESH : Risk, MESH: Blood Transfusion, Creutzfeldt-Jakob Syndrome, MESH : Ethics, Medical, MESH: Informed Consent, MESH : Blood Transfusion, Humans, MESH : Creutzfeldt-Jakob Syndrome, [ SDV.MHEP.HEM ] Life Sciences [q-bio]/Human health and pathology/Hematology, Blood Transfusion, Ethics, Medical, Physician's Role, MESH : France, MESH : Physician's Role, Informed Consent, MESH: Humans, MESH: Risk, MESH : Humans, Transfusion Reaction, MESH: Physician's Role, [SDV.MHEP.HEM]Life Sciences [q-bio]/Human health and pathology/Hematology, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Creutzfeldt-Jakob Syndrome, [SDV.ETH] Life Sciences [q-bio]/Ethics, [SDV.ETH]Life Sciences [q-bio]/Ethics, MESH: France, MESH : Informed Consent, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, [ SDV.ETH ] Life Sciences [q-bio]/Ethics, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France
Abstract

TRUE RISKS AND THEORETICAL RISKS: The texts ruling the obligation of the physician to inform the patient appears not to include theoretical risks in their application. In France however, the field of blood transfusions extends this obligation to the theoretical risk of potential transmission through the blood of the infectious agent responsible for Creutzfeldt-Jakob's disease. UNANSWERED QUESTIONS: From an ethical point of view, is information on the theoretical risk of transmission founded? From a formal point of view, the means used for such an extension (i.e.,a bulletin) is debatable; was this an adequate measure? THE RETURN OF COMMON SENSE: If we look at the earlier texts, the principle of an obligation to inform the patient of the theoretical risks does not appear widespread or even confirmed. Do these text simply the return of "common sense"? And if so, to what extent does it encourage the illusion of a zero risk...?

Published
2004

16. [Hormone replacement therapy in menopause and risk of breast cancer]

Author

Clavel-Chapelon , Françoise, Hill , Catherine, Epidémiologie des cancers, Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut Gustave Roussy ( IGR ), Institut National de la Santé et de la Recherche Médicale (INSERM), Institut Gustave Roussy (IGR), and Clavel-Chapelon, F.

Subjects
Time Factors, MESH: Menopause, MESH: Lymphatic Metastasis, MESH : Risk, MESH : Aged, MESH : Breast Neoplasms, MESH: Estrogens, Body Mass Index, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, Cohort Studies, MESH: Risk Factors, Risk Factors, MESH : Female, MESH : Progestins, MESH: Cohort Studies, [ SDV.MHEP.GEO ] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, MESH: Aged, MESH: Middle Aged, MESH: Risk, MESH : Estrogen Replacement Therapy, MESH: Hormone Replacement Therapy, Estrogen Replacement Therapy, MESH : Menopause, MESH : Lymphatic Metastasis, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, MESH: Follow-Up Studies, Middle Aged, MESH : Adult, MESH : Maternal Age, MESH: Case-Control Studies, MESH : Risk Factors, Parity, enquête épidémiologique, Lymphatic Metastasis, Drug Therapy, Combination, Female, Menopause, Maternal Age, MESH : Time Factors, Adult, Risk, MESH : Case-Control Studies, Hormone Replacement Therapy, MESH: Meta-Analysis, MESH : Cohort Studies, [SDV.CAN]Life Sciences [q-bio]/Cancer, Breast Neoplasms, MESH : Hormone Replacement Therapy, [SDV.MHEP.GEO]Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, MESH: Body Mass Index, [SDV.CAN] Life Sciences [q-bio]/Cancer, Meta-Analysis as Topic, Humans, MESH : Middle Aged, MESH : Parity, Aged, MESH: Humans, cancer du sein, MESH : Drug Therapy, Combination, MESH: Parity, MESH: Time Factors, MESH : Humans, ménopause, MESH: Adult, Estrogens, MESH : Follow-Up Studies, Traitement hormonal substitutif, MESH: Estrogen Replacement Therapy, MESH : Meta-Analysis, MESH: Drug Therapy, Combination, [SDV.MHEP.GEO] Life Sciences [q-bio]/Human health and pathology/Gynecology and obstetrics, MESH : Body Mass Index, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Case-Control Studies, MESH: Progestins, MESH: Maternal Age, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, MESH : Estrogens, Progestins, MESH: Female, MESH: Breast Neoplasms, Follow-Up Studies
Abstract

International audience; OBJECTIVES: Many epidemiological studies have analysed the relation between hormonal replacement therapy and risk of breast cancer. We present here a synthesis of the available results. MATERIAL AND METHODS: In 1997, a meta-analysis synthesised 90% of the data available at the time, obtained from 15 cohort and 36 case-control studies. This meta-analysis collected 53,000 breast cancers, 22% of these breast cancers having been observed in cohort studies. Since the publication of this meta-analysis, six studies totalling 8,000 cases (32% from cohort studies) have been published: two of these studies were partially included in the meta-analysis and the other four provided entirely new data. RESULTS: The conclusion, based on the available evidence, is that the risk of breast cancer diagnosis is higher among women who have used hormonal replacement therapy than among women who have not. The risk increases with treatment duration, is reduced when treatment is stopped and disappears almost completely a few years (5 in the meta-analysis) after the end of the treatment. The increase in the risk of breast cancer may be larger with estrogen-progestogen therapy than with estrogen alone. What are the consequences in terms of public health? From the results of the meta-analysis, one can estimate that the use of replacement therapy for 10 years between age 50 and 60 by 1,000 women will lead to the diagnosis of 6 extra breast cancers. This corresponds to the observation of 69 cases per 1,000 treated women after 20 years follow-up, as compared to the 63 cases expected among 1,000 untreated women. DISCUSSION: These results require confirmation. The observed increase in the risk of breast cancer is open to biases, particularly to a screening bias if women receiving hormonal replacement therapy have a more intensive surveillance than other women. Overall, the total number of women, across studies, who have received estrogen-progestogen therapy is small and their treatment was usually a combination of natural estrogens and medroxy progesterone acetate; therefore, the long term consequences of the treatments commonly used in France (synthetic estrogens and a variety of progestogens) have not been evaluated, this evaluation is much needed. CONCLUSION: What is needed is a global view of the risks and benefits of hormonal replacement therapy, and more epidemiologic data are required to reach this goal. In the present state of knowledge, the moderate excess risk of breast cancer observed does not justify a change in medical practice, neither in the selection of women to whom hormonal replacement therapy should be offered nor in the duration of their treatment.

Published
2000

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