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Seigneurin A, Exbrayat C, Molinié F, Croisier L, Poncet F, Berquet K, Delafosse P, Colonna M. Association of Mammography Screening With a Reduction in Breast Cancer Mortality: A Modeling Study Using Population-Based Data From 2 French Departments. Am J Epidemiol 2021; 190:827-835. [PMID: 33043362 DOI: 10.1093/aje/kwaa218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 10/01/2020] [Accepted: 10/07/2020] [Indexed: 12/24/2022] Open
Abstract
Meta-analyses of randomized controlled trials that started from 1963 to 1991 reported a decrease of breast cancer mortality, associated with mammography screening. However, the effectiveness of population-based screening programs conducted currently might have changed due to the higher effectiveness of treatments for late-stage cancers and the better diagnostic performance of mammography. The main objective of this study was to predict the reduction of breast cancer mortality associated with mammography screening in the current French setting. We compared breast cancer mortality in 2 simulated cohorts of women, which differed from each other solely in a 70% biennial participation in screening from 50 to 74 years old. The microsimulation model used for predictions was calibrated with incidence rates of breast cancer according to stage that were observed in Isère and Loire-Atlantique departments, France, in 2007-2013. The model predicted a decrease of breast cancer mortality associated with mammography screening of 18% (95% CI: 5, 31) and 17% (95% CI: 3, 29) for models calibrated with data from Isère and Loire-Atlantique departments, respectively. Our results highlight the interest in biennial mammography screening from ages 50 to 74 years old to decrease breast cancer mortality in the current setting, despite improvements in treatment effectiveness.
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Gernier F, Joly F, Klein D, Mercier M, Velten M, Licaj I. Cancer-related fatigue among long-term survivors of breast, cervical, and colorectal cancer: a French registry-based controlled study. Support Care Cancer 2020; 28:5839-5849. [PMID: 32253602 DOI: 10.1007/s00520-020-05427-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 03/19/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND While several studies have documented fatigue during and after cancer treatment, long-term cancer survivor fatigue is underreported. In this study, we compare fatigue, quality of life (QoL), and anxiety between relapse-free cancer survivors 15 years after diagnosis and healthy controls. METHODS Cancer survivors (CS) were randomly selected from three large population-based cancer registries (Bas-Rhin, Calvados, and Doubs, France). Cancer-free controls were randomly selected from electoral lists with stratification on age group, residence area, and gender. All participants completed self-reported fatigue (MFI), QoL (EORTC QLQ-C30), and anxiety (STAI) questionnaires. Univariable and multivariable logistic regression were used to study the association between fatigue and cancer status, in three cancer subgroups: breast cancer (BC), cervical cancer (CC), and colorectal cancer (CRC). RESULTS Two hundred sixty-three CS and 688 controls (125/275, 45/153, 93/260 CS/controls for BC, CC, and CRC respectively) were included. The mean age was 66 years. In multivariable analyses, CS had higher general and mental fatigue than controls p = 0.04 and p = 0.02, respectively. No difference in QoL was observed between CS and controls. CS were more anxious than controls (p < 0.01). Anxiety was associated with general fatigue (p < 0.0001) and mental fatigue (p < 0.0001). CONCLUSION Fifteen years after diagnosis, cancer survivors reported more general and mental fatigue compared with controls. Our results reinforce guidelines, identifying fatigue as a persistent symptom.
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Affiliation(s)
- François Gernier
- Clinical Research Departement, François Baclesse Comprehensive Cancer Center, UNICANCER, 3 av General Harris, Caen, 14076, France. .,INSERM, U1086, Caen, France.
| | - Florence Joly
- Clinical Research Departement, François Baclesse Comprehensive Cancer Center, UNICANCER, 3 av General Harris, Caen, 14076, France.,INSERM, U1086, Caen, France.,UMR-S1077, Université de Caen Basse-Normandie, Caen, France.,Department of Oncology, CHU de Caen, Caen, France
| | - Delphine Klein
- Registre des cancers du Bas-Rhin, Inserm IRFAC UMR-S 1113, Université de Strasbourg, Strasbourg, France
| | - Mariette Mercier
- EA3181, University of Franche-Comté, Besançon, France.,INSERM UMR 1098, University of Franche-Comte, Besançon, France.,French National Quality of Life in Oncology Platform, Besançon, France
| | - Michel Velten
- Registre des cancers du Bas-Rhin, Inserm IRFAC UMR-S 1113, Université de Strasbourg, Strasbourg, France.,Service de Santé Publique, Centre Paul Strauss, Strasbourg, France
| | - Idlir Licaj
- Clinical Research Departement, François Baclesse Comprehensive Cancer Center, UNICANCER, 3 av General Harris, Caen, 14076, France.,INSERM, U1086, Caen, France.,Department of Community Medicine, Faculty of Health Sciences, The UiT Arctic University of Norway, Tromsø, Norway
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