[Estimated impact of the current colorectal screening program in France]

[Can computer alerts in general practitioners' software upgrade cancer screening participation? A monocentric randomized study in France]

Colorectal cancer is the third most common cancer in France, and the second regarding mortality with almost 17,100 deaths each year. When screened at an early stage, the five-year survival is around 90 %. Since 2008, a screening program has been introduced in France with the fecal occult blood test. Ten years later, the targeted participation for the screening program is at least 45 % when the actual French average participation is around 30,2 %. We tried to find an efficient way to help general practitioners to recognise patients that did not do the test with a pop-up alert in their informatics files. We built our prospective study in a health center in Val d'Oise (France). We randomized 2230 patients in two equal groups, one control at one with the alert in files. We controlled the patients' status each month for 6 months. At the end of study, 152 (13,6 %) patients did the test in the control group and 179 (16 %) in the intervention group. In intention to treat, we found no difference between the two groups (P=0.11). Multivariate analysis proved that consulting their general practitioner enhanced participation (P=0.02). We showed the positive influence of a consultation with the general practitioner who can improve participation for this screening program. Our study was certainly too short in time and with a too small sample to prove a significant difference, and more investigation could confirm our hypothesis.

Colorectal cancer screening by fecal immunochemical test or colonoscopy in France: how many people are actually covered? Focus on the Provence-Alpes-Côte d'Azur region

BACKGROUND

Colorectal cancer (CRC) screening with fecal immunochemical test (FIT) remains low in France, particularly in the Provence-Alpes-Côte-d'Azur (PACA) region. The aim of this study was to compare insured persons (50-74 years) who had FIT and/or colonoscopy in PACA with the general French population.

METHODS

FIT and colonoscopy rates were calculated according to SP-France and National Health Data System data.

RESULTS

The rate of FIT in 2016-2017 was lower in PACA than in France (25.6 vs. 29.1%, P < 0.001). Conversely, in 2013-2017, the rate of colonoscopy in the past 5 years was higher in PACA than in France (23.1 vs. 20.1%, P < 0.001). Total rate for FIT within 2 years and/or colonoscopy within 5 years was 46.0% in PACA vs. 46.5% in France (P < 0.001). Overuse was higher for diagnostic (1.21) than therapeutic colonoscopies (1.05). Therapeutic colonoscopy occurred more with FIT than without (47.88 vs. 38.7%, P < 0.001). According to USA criteria, persons with FIT within 2 years and/or sigmoidoscopy and/or colonoscopy within 10 years was 59.4% in PACA vs. 54.7% in France (P < 0.001).

CONCLUSION

Low participation in FIT in France must be improved to increase the rate of therapeutic colonoscopies and reduce the incidence of CRC. The higher colonoscopy rate in PACA could explain the lower CRC mortality. Efforts should be focused on the more than 40% of French insured who are not screened by either FIT or colonoscopy.

[Time trends and age-period-cohort effects on the incidence of the most frequent cancers in Oran, Algeria, 1999-2018]

BACKGROUND

Cancer is currently one of the major public health problems in Algeria. The aim of this study was to examine time trends and the effects of age, period and cohort on incidence at the major cancer locations from 1999 to 2018 in Oran, Algeria.

METHODS

Data on the five most frequent primary cancer locations among patients aged 20-79 years were collected from the Oran cancer registry. Annual percentile changes in incidence rates were evaluated using the Joinpoint regression program. Age-period-cohort models were designed to examine the effects of age, period and birth cohort on cancer incidence.

RESULTS

From 1999 to 2018, there were 12,278 incident cases at the five major cancer locations. Unfavorable trends in incidence were observed regarding lung and colorectal cancers in both sexes, as well as breast cancer in women. Age-period-cohort analysis showed that age, period and birth cohort yielded different effects at different cancer locations.

CONCLUSION

The observed trends primarily reflect lifestyle changes in Algeria over the course of recent years.