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Borghi G, Delacôte C, Delacour-Billon S, Ayrault-Piault S, Dabakuyo-Yonli TS, Delafosse P, Woronoff AS, Trétarre B, Molinié F, Cowppli-Bony A. Socioeconomic Deprivation and Invasive Breast Cancer Incidence by Stage at Diagnosis: A Possible Explanation to the Breast Cancer Social Paradox. Cancers (Basel) 2024; 16:1701. [PMID: 38730653 PMCID: PMC11083525 DOI: 10.3390/cancers16091701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
In this study, we assessed the influence of area-based socioeconomic deprivation on the incidence of invasive breast cancer (BC) in France, according to stage at diagnosis. All women from six mainland French departments, aged 15+ years, and diagnosed with a primary invasive breast carcinoma between 2008 and 2015 were included (n = 33,298). Area-based socioeconomic deprivation was determined using the French version of the European Deprivation Index. Age-standardized incidence rates (ASIR) by socioeconomic deprivation and stage at diagnosis were compared estimating incidence rate ratios (IRRs) adjusted for age at diagnosis and rurality of residence. Compared to the most affluent areas, significantly lower IRRs were found in the most deprived areas for all-stages (0.85, 95% CI 0.81-0.89), stage I (0.77, 95% CI 0.72-0.82), and stage II (0.84, 95% CI 0.78-0.90). On the contrary, for stages III-IV, significantly higher IRRs (1.18, 95% CI 1.08-1.29) were found in the most deprived areas. These findings provide a possible explanation to similar or higher mortality rates, despite overall lower incidence rates, observed in women living in more deprived areas when compared to their affluent counterparts. Socioeconomic inequalities in access to healthcare services, including screening, could be plausible explanations for this phenomenon, underlying the need for further research.
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Affiliation(s)
- Giulio Borghi
- Loire-Atlantique/Vendée Cancer Registry, 44093 Nantes, France
| | - Claire Delacôte
- Loire-Atlantique/Vendée Cancer Registry, 44093 Nantes, France
- SIRIC ILIAD INCa-DGOS-INSERM-ITMO Cancer_18011, CHU Nantes, 44000 Nantes, France
| | - Solenne Delacour-Billon
- Loire-Atlantique/Vendée Cancer Registry, 44093 Nantes, France
- SIRIC ILIAD INCa-DGOS-INSERM-ITMO Cancer_18011, CHU Nantes, 44000 Nantes, France
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
| | - Stéphanie Ayrault-Piault
- Loire-Atlantique/Vendée Cancer Registry, 44093 Nantes, France
- SIRIC ILIAD INCa-DGOS-INSERM-ITMO Cancer_18011, CHU Nantes, 44000 Nantes, France
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
- Côte d’Or Breast and Gynaecologic Cancer Registry, INSERM U1231, 21000 Dijon, France
| | - Patricia Delafosse
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
- Isère Cancer Registry, 38000 Grenoble, France
| | - Anne-Sophie Woronoff
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
- Doubs Cancer Registry, 25000 Besançon, France
| | - Brigitte Trétarre
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
- Hérault Cancer Registry, 34000 Montpellier, France
- EQUITY Research Team (Certified by the French League Against Cancer), CERPOP, UMR 1295, Université Toulouse III Paul Sabatier, 31000 Toulouse, France
| | - Florence Molinié
- Loire-Atlantique/Vendée Cancer Registry, 44093 Nantes, France
- SIRIC ILIAD INCa-DGOS-INSERM-ITMO Cancer_18011, CHU Nantes, 44000 Nantes, France
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
- EQUITY Research Team (Certified by the French League Against Cancer), CERPOP, UMR 1295, Université Toulouse III Paul Sabatier, 31000 Toulouse, France
| | - Anne Cowppli-Bony
- Loire-Atlantique/Vendée Cancer Registry, 44093 Nantes, France
- SIRIC ILIAD INCa-DGOS-INSERM-ITMO Cancer_18011, CHU Nantes, 44000 Nantes, France
- French Network of Cancer Registries (FRANCIM), 31000 Toulouse, France
- EQUITY Research Team (Certified by the French League Against Cancer), CERPOP, UMR 1295, Université Toulouse III Paul Sabatier, 31000 Toulouse, France
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Bammert P, Schüttig W, Novelli A, Iashchenko I, Spallek J, Blume M, Diehl K, Moor I, Dragano N, Sundmacher L. The role of mesolevel characteristics of the health care system and socioeconomic factors on health care use - results of a scoping review. Int J Equity Health 2024; 23:37. [PMID: 38395914 PMCID: PMC10885500 DOI: 10.1186/s12939-024-02122-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Besides macrolevel characteristics of a health care system, mesolevel access characteristics can exert influence on socioeconomic inequalities in healthcare use. These reflect access to healthcare, which is shaped on a smaller scale than the national level, by the institutions and establishments of a health system that individuals interact with on a regular basis. This scoping review maps the existing evidence about the influence of mesolevel access characteristics and socioeconomic position on healthcare use. Furthermore, it summarizes the evidence on the interaction between mesolevel access characteristics and socioeconomic inequalities in healthcare use. METHODS We used the databases MEDLINE (PubMed), Web of Science, Scopus, and PsycINFO and followed the 'Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR)' recommendations. The included quantitative studies used a measure of socioeconomic position, a mesolevel access characteristic, and a measure of individual healthcare utilisation. Studies published between 2000 and 2020 in high income countries were considered. RESULTS Of the 9501 potentially eligible manuscripts, 158 studies were included after a two-stage screening process. The included studies contained a wide spectrum of outcomes and were thus summarised to the overarching categories: use of preventive services, use of curative services, and potentially avoidable service use. Exemplary outcomes were screening uptake, physician visits and avoidable hospitalisations. Access variables included healthcare system characteristics such as physician density or distance to physician. The effects of socioeconomic position on healthcare use as well as of mesolevel access characteristics were investigated by most studies. The results show that socioeconomic and access factors play a crucial role in healthcare use. However, the interaction between socioeconomic position and mesolevel access characteristics is addressed in only few studies. CONCLUSIONS Socioeconomic position and mesolevel access characteristics are important when examining variation in healthcare use. Additionally, studies provide initial evidence that moderation effects exist between the two factors, although research on this topic is sparse. Further research is needed to investigate whether adapting access characteristics at the mesolevel can reduce socioeconomic inequity in health care use.
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Affiliation(s)
- Philip Bammert
- Chair of Health Economics, Technical University of Munich, Munich, Germany.
| | - Wiebke Schüttig
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Anna Novelli
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Iryna Iashchenko
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
- Lausitz Center for Digital Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Miriam Blume
- Department of Epidemiology and Health Monitoring, Robert-Koch-Institute, Berlin, Germany
| | - Katharina Diehl
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Irene Moor
- Institute of Medical Sociology, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, University Hospital and Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University of Munich, Munich, Germany
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Renier M, Hippert J, Louis-Bastien W, Tual S, Meryet-Figuiere M, Vigneron N, Marcotullio E, Baldi I, Lebailly P. Agricultural exposure and risk of ovarian cancer in the AGRIculture and CANcer (AGRICAN) cohort. Occup Environ Med 2024; 81:75-83. [PMID: 38199811 DOI: 10.1136/oemed-2023-109089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Ovarian cancer is rare with a poor prognosis and few established risk factors. Hormones and reproductive factors significantly impact its development, suggesting a potential link with endocrine disrupters. METHODS In the AGRICAN cohort, 59 391 female farmers completed data on lifelong agricultural exposures and reproductive life. Cox models with attained age as timescale (HR and 95% CI) were used. The role of hormonal factors as potential confounders was considered along with specific time windows for exposure (childhood, puberty and menopause). Female farmers were the reference group (for the principal analyses). RESULTS Between enrolment (2005-2007) and the end of follow-up (31 December 2017), 262 incident ovarian cancers were identified. An increased risk was observed for females involved in pigs (HR=2.12 (95% CI 1.27 to 3.52)) including during puberty (HR=1.83 (95% CI 1.13 to 2.94)), fruit-growing (HR=2.17 (95% CI 1.09 to 4.30)) and potato seed treatment (HR=2.81 (95% CI 1.29 to 6.09)). Conversely, females born on farms growing grain cereals (HR=0.64 (95% CI 0.46 to 0.90)) or pig-breeding (HR=0.78 (95% CI 0.55 to 1.12)) presented a reduced risk of ovarian cancer. Triazine herbicide exposure was not associated with ovarian cancer. The effect of agricultural exposures remained unchanged in multivariate models considering contraception, parity, puberty age, menopause age and body mass index. CONCLUSION This study is the first to assess the association between specific agricultural exposures and ovarian cancer comprehensively. Some of the positive associations observed suggest that some pesticide exposure (especially during puberty) could play a role in the development of ovarian cancer. On the other hand, agricultural exposure during early life could have a protective effect, as observed for lung cancer among farmers. Finally, we did not confirm the previous putative effect of exposure to triazine herbicides.
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Affiliation(s)
- Marine Renier
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité mixte de Recherche (UMR) 1086 ANTICIPE, Caen, France
- Centre François Baclesse Centre de Lutte Contre le Cancer, Caen, France
- Université de Caen Normandie, Caen, France
| | - Juliette Hippert
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité mixte de Recherche (UMR) 1086 ANTICIPE, Caen, France
- Centre François Baclesse Centre de Lutte Contre le Cancer, Caen, France
- Université de Caen Normandie, Caen, France
| | - Weiswald Louis-Bastien
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité mixte de Recherche (UMR) 1086 ANTICIPE, Caen, France
- Centre François Baclesse Centre de Lutte Contre le Cancer, Caen, France
- Université de Caen Normandie, Caen, France
| | - Séverine Tual
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité mixte de Recherche (UMR) 1086 ANTICIPE, Caen, France
- Centre François Baclesse Centre de Lutte Contre le Cancer, Caen, France
- Université de Caen Normandie, Caen, France
| | - Matthieu Meryet-Figuiere
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité mixte de Recherche (UMR) 1086 ANTICIPE, Caen, France
- Centre François Baclesse Centre de Lutte Contre le Cancer, Caen, France
- Université de Caen Normandie, Caen, France
| | - Nicolas Vigneron
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité mixte de Recherche (UMR) 1086 ANTICIPE, Caen, France
- Centre François Baclesse Centre de Lutte Contre le Cancer, Caen, France
- Registre général des tumeurs du Calvados, Caen, France
| | | | - Isabelle Baldi
- INSERM, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, Université de Bordeaux, Bordeaux, France
- CHU de Bordeaux, Pôle de Santé Publique, Service de Médecine du Travail et Pathologies Professionnelles, Bordeaux, France
| | - Pierre Lebailly
- Institut National de la Santé et de la Recherche Médicale (INSERM), Unité mixte de Recherche (UMR) 1086 ANTICIPE, Caen, France
- Centre François Baclesse Centre de Lutte Contre le Cancer, Caen, France
- Université de Caen Normandie, Caen, France
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Delacôte C, Ariza JM, Delacour-Billon S, Ayrault-Piault S, Borghi G, Menanteau K, Bouron A, Métais M, Cowppli-Bony A, Molinié F. Socioeconomic and geographic disparities of breast cancer incidence according to stage at diagnosis in France. Cancer Causes Control 2024; 35:241-251. [PMID: 37697113 DOI: 10.1007/s10552-023-01779-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 08/17/2023] [Indexed: 09/13/2023]
Abstract
PURPOSE Low socioeconomic background (SB) has been associated with lower breast cancer (BC) incidence and higher BC mortality. One explanation of this paradox is the higher frequency of advanced BC observed in deprived women. However, it is still unclear if SB affects similarly BC incidence. This study investigated the link between SB and early/advanced BC incidence from Loire-Atlantique/Vendee Cancer registry data (France). MATERIALS AND METHODS Fourteen thousand three hundred fifty three women living in the geographic area covered by the registry and diagnosed with a primary BC in 2008-2015 were included. SB was approached by a combination of two ecological indexes (French European Deprivation Index and urban/rural residence place). Mixed effects logistic and Poisson regressions were used, respectively, to estimate the odds of advanced (stage ≥ II) BC and the ratio of incidence rates of early (stage 0-I) and advanced BC according to SB, overall and by age group (< 50, 50-74, ≥ 75). RESULTS Compared to women living in affluent-urban areas, women living in deprived-urban and deprived-rural areas had a higher proportion of advanced BC [respectively, OR = 1.11 (1.01-1.22), OR = 1.60 (1.25-2.06)] and lower overall (from - 6 to - 15%) and early (from - 9 to - 31%) BC incidences rates Advanced BC incidence rates were not influenced by SB. These patterns were similar in women under 75 years, especially in women living in deprived-rural areas. In the elderly, no association between SB and BC frequency/incidence rates by stage was found. CONCLUSION Although advanced BC was more frequent in women living in deprived and rural areas, SB did not influence advanced BC incidence. Therefore, differences observed in overall BC incidence according to SB were only due to higher incidence of early BC in affluent and urban areas. Future research should confirm these results in other French areas.
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Affiliation(s)
- Claire Delacôte
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France.
- SIRIC ILIAD INCa-DGOS-Inserm_12558, Nantes, France.
| | - Juan Manuel Ariza
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France
- SIRIC ILIAD INCa-DGOS-Inserm_12558, Nantes, France
| | - Solenne Delacour-Billon
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France
- French Network of Cancer Registries (FRANCIM), Toulouse, France
| | - Stéphanie Ayrault-Piault
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France
- French Network of Cancer Registries (FRANCIM), Toulouse, France
| | - Giulio Borghi
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France
| | - Katia Menanteau
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France
| | - Aurélie Bouron
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France
| | - Magali Métais
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France
| | - Anne Cowppli-Bony
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France
- SIRIC ILIAD INCa-DGOS-Inserm_12558, Nantes, France
- French Network of Cancer Registries (FRANCIM), Toulouse, France
- Equipe Constitutive du CERPOP, UMR 1295, Inserm, Equipe EQUITY, Université Toulouse III, Toulouse, France
| | - Florence Molinié
- Registre des Cancers de Loire-Atlantique et de Vendée, Nantes, France
- SIRIC ILIAD INCa-DGOS-Inserm_12558, Nantes, France
- French Network of Cancer Registries (FRANCIM), Toulouse, France
- Equipe Constitutive du CERPOP, UMR 1295, Inserm, Equipe EQUITY, Université Toulouse III, Toulouse, France
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Rollet Q, Exarchakou A, Launoy G, Merville O, Rubio FJ, Belot A. Functional forms of socio-territorial inequities in breast cancer screening - A French cross-sectional study using hierarchical generalised additive models. Prev Med 2023; 173:107587. [PMID: 37355102 DOI: 10.1016/j.ypmed.2023.107587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/15/2023] [Accepted: 06/21/2023] [Indexed: 06/26/2023]
Abstract
To reduce the breast cancer burden, the French National Organised Breast Cancer Screening Programme (FNOBCSP) was implemented in 2004. The recommended participation rate has never been achieved and socio-territorial inequities in participation have been reported on several occasions. We investigated the functional forms and consistency of the relationships between neighbourhood deprivation, travel time to the nearest accredited radiology centre and screening uptake. We used two-level hierarchical generalised additive models in 8 types of territories classified by socio-demographic and economic factors. The first level was 368,201 women aged 50-72 invited to the 2013-2014 screening campaign in metropolitan France. They were nested in 41 départements, the level of organisation of the FNOBCSP. The effect of travel time showed two main patterns: it was either linear (with participation decreasing as travel time increased) or participation first increased with increasing travel time to a peak around 5-15 min and decreased afterward. In nearly all types and départements, the probability of participation decreased linearly with increasing deprivation. Territorial inequities in participation were more context-dependent and complex than social inequities. Inequities in participation represent a loss of opportunity for individuals who already have the worst cancer outcomes. Evidence-based public health policies are needed to increase the effectiveness and equity of breast cancer screening.
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Affiliation(s)
- Quentin Rollet
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK; U1086 "ANTICIPE" INSERM, University of Caen Normandie, Centre François Baclesse, 3, Avenue du Général Harris, Caen 14000, France.
| | - Aimilia Exarchakou
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Guy Launoy
- U1086 "ANTICIPE" INSERM, University of Caen Normandie, Centre François Baclesse, 3, Avenue du Général Harris, Caen 14000, France
| | - Ophélie Merville
- U1086 "ANTICIPE" INSERM, University of Caen Normandie, Centre François Baclesse, 3, Avenue du Général Harris, Caen 14000, France
| | - Francisco J Rubio
- Department of Statistical Science, University College London, Gower St, London WC1E 6BT, UK
| | - Aurélien Belot
- Inequalities in Cancer Outcomes Network (ICON), Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Delapierre B, Troussard X, Damaj G, Dejardin O, Tron L. Role of social status and social environment on net survival in patients with chronic lymphocytic leukemia: A high-resolution population-based study. Cancer Epidemiol 2023; 82:102292. [PMID: 36410088 DOI: 10.1016/j.canep.2022.102292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 11/02/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The prognostic roles of social status and social environment in chronic lymphocytic leukemia have been highlighted in some solid tumors but remain unclear in hematological malignancies. The objective of this study was to evaluate the influence of individual social status (with socioprofessional category, SPC) and social environment (with European deprivation index, EDI) on net survival in a high-resolution population with CLL. METHODS We included CLL patients from the Regional Register of Hematological Malignancies in Normandy belonging to the French Network of Cancer Registries (Francim). The SPC variable was divided into 5 categories: farmers, craftsmen, higher employment, intermediate employment, and workers/employees. Net survival was used to estimate the excess of mortality in CLL independent of other possible causes of death using French life tables. Net survival was estimated with a nonparametric method (Pohar-Perme) and with a flexible excess mortality hazard model. Missing data were handled with multiple imputation. RESULTS A total of 780 patients were included. The median follow-up was 7.9 years. The crude survival at 10 years was 50%, and the net survival at 10 years was 80%. In multivariate analysis, a higher age (EHR: 1.04 [1.01-1.07]), being a craftsman (EHRcraftsmen/higher.employment: 4.15 [0.86-20.15]), being a worker or an employee (EHRworkers.employees/higher.employment: 3.57 [1.19-10.7]), having a Binet staging of B or C (EHR: 3.43 [1.84-6.42]) and having a lymphocyte count > 15 G/L (EHR: 3.80 [2.17-6.65]) were statistically associated with a higher risk of excess mortality. EDI was not associated with excess mortality (EHR: 0.97 [0.90-1.04]). CONCLUSION Socioprofessional category was a prognostic factor for an excess of mortality in CLL. Craftsmen and workers/employees shared a worse prognosis than workers with higher employment. The social environment was not a prognostic factor. Further work should be performed to explore causal epidemiologic or biological factors and other hematological malignancies.
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Affiliation(s)
- B Delapierre
- Department of Hematology, Institut d'hématologie de Basse-Normandie, University Hospital, Normandy University, School of Medicine, Caen, France; Department of Research, University Hospital, Caen, France; ANTICIPE U1086 Inserm-University of Caen, Centre François Baclesse, Caen, France.
| | - X Troussard
- Department of Research, University Hospital, Caen, France; Laboratory of Hematology, University Hospital, Caen, France; Registre Régional des Hémopathies malignes de Basse-Normandie, University Hospital of Caen, Caen, France
| | - G Damaj
- Department of Hematology, Institut d'hématologie de Basse-Normandie, University Hospital, Normandy University, School of Medicine, Caen, France; Department of Research, University Hospital, Caen, France
| | - O Dejardin
- Department of Research, University Hospital, Caen, France; ANTICIPE U1086 Inserm-University of Caen, Centre François Baclesse, Caen, France
| | - L Tron
- ANTICIPE U1086 Inserm-University of Caen, Centre François Baclesse, Caen, France
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Poiseuil M, Payet C, Molinié F, Dabakuyo-Yonli TS, Mathoulin-Pelissier S, Amadeo B, Coureau G. Survival after breast cancer according to participation in organised or opportunistic screening and deprivation. Cancer Epidemiol 2023; 82:102312. [PMID: 36508966 DOI: 10.1016/j.canep.2022.102312] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/25/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Many studies have investigated the survival of women by comparing those who participated in organised screening with those who did not. However, among those who do not participate in organised screening, some women undergo opportunistic screening, but these women remain difficult to identify, particularly in France. Therefore, the aim of this study was to identify opportunistic screening, and then to study survival after breast cancer separately according to participation in organised, opportunistic or no screening, and taking into account sociodemographic inequalities. METHODS The study population was identified from 3 French cancer registries, whose data was crossed with the screening coordination centers and the National Health Data System to identify the different type of screening. The European Deprivation Index was used to define the level of deprivation. We estimated net survival using the Pohar-Perme method. RESULTS The 5-year net survival probabilities were higher for women who attended organised screening (97.0 %) than for women with opportunistic screening (94.1 %) or non-attenders (78.1 %). According to the level of deprivation, a significant difference was observed between the groups of women screened by organised and opportunistic screening, compared to the non-attenders. CONCLUSION The identification of opportunistic screening is an important element in identifying women who do not screening. It enables to us to see that women who do not attend any screening have a much higher loss-of-opportunity in terms of survival than those who participate in organised or opportunistic screening, and even more so in the most deprived areas.
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Affiliation(s)
- Marie Poiseuil
- Univ. Bordeaux, Gironde General Cancer Registry, 33000 Bordeaux, France; Inserm, Bordeaux Population Health, Research Center U1219, Team EPICENE, 33000 Bordeaux, France.
| | - Catherine Payet
- Centre Régional de Coordination du Dépistage des Cancers (CRCDC), Nouvelle Aquitaine, France.
| | - Florence Molinié
- Loire-Atlantique/Vendée Cancer Registry, Nantes, France; CERPOP, Université de Toulouse, Toulouse, France; FRANCIM Network of French Cancer Registries, France.
| | - Tienhan Sandrine Dabakuyo-Yonli
- FRANCIM Network of French Cancer Registries, France; Breast and Gynaecologic Cancer Registry of Côte d'Or, Georges Francois Leclerc Comprehensive Cancer Centre, INSERM U1231, 1 rue Professeur Marion, Dijon, France; Epidemiology and Quality of Life Research Unit, INSERM U1231, Dijon, France.
| | - Simone Mathoulin-Pelissier
- Inserm, Bordeaux Population Health, Research Center U1219, Team EPICENE, 33000 Bordeaux, France; Institut Bergonie, Inserm CIC 1401, Clinical and Epidemiological Research Unit, 351 cours de la Libération, 33405 Talence cedex, France.
| | - Brice Amadeo
- Univ. Bordeaux, Gironde General Cancer Registry, 33000 Bordeaux, France; Inserm, Bordeaux Population Health, Research Center U1219, Team EPICENE, 33000 Bordeaux, France; FRANCIM Network of French Cancer Registries, France.
| | - Gaëlle Coureau
- Univ. Bordeaux, Gironde General Cancer Registry, 33000 Bordeaux, France; Inserm, Bordeaux Population Health, Research Center U1219, Team EPICENE, 33000 Bordeaux, France; FRANCIM Network of French Cancer Registries, France.
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Delacôte C, Delacour-Billon S, Ayrault-Piault S, Tagri AD, Rousseau G, Vincent M, Amossé S, Delpierre C, Cowppli-Bony A, Molinié F. Is survival rate lower after breast cancer in deprived women according to disease stage? Br J Cancer 2023; 128:63-70. [PMID: 36319847 PMCID: PMC9814909 DOI: 10.1038/s41416-022-02024-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 10/04/2022] [Accepted: 10/12/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Socioeconomic deprivation has been associated with lower breast cancer (BC) survival, but the influence of stage at diagnosis on this association merits further study. Our aim was to investigate this association using the Loire-Atlantique/Vendee Cancer Registry (France). METHODS Twelve-thousand seven-hundred thirty-eight women living in the area covered by the registry and diagnosed with invasive breast carcinoma between 2008 and 2015 were included in the study. They were censored at maximal 6 years. Deprivation was measured by the French European Deprivation Index. Excess hazard and net survival were estimated for deprivation level, stage and age at diagnosis using a flexible excess mortality hazard model. RESULTS After adjustment by stage, women living in the most deprived areas had a borderline non-significant higher excess mortality hazard (+25% (95% CI: -3%; +62%)) compared to those living in the least deprived areas. Stage-adjusted 5-year net survival differed significantly between these two subgroups (respectively, 88.2% (95% CI:85.2%-90.5%) and 92.5% (95% CI:90.6%-93.9%)). CONCLUSION BC survival remained lower in deprived areas in France, despite universal access to cancer care. Intensification of prevention measures could help to reduce advanced BC, responsible for the majority of deaths from BC. A better understanding of remaining social disparities is crucial to implement specific interventions.
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Affiliation(s)
- Claire Delacôte
- Loire-Atlantique/Vendée Cancer Registry, Nantes, France. .,SIRIC ILIAD INCa-DGOS-Inserm_12558, Nantes, France. .,SIRIC ILIAD INCa-DGOS-Inserm_12558, Angers, France.
| | - Solenne Delacour-Billon
- Loire-Atlantique/Vendée Cancer Registry, Nantes, France ,French Network of Cancer Registries (FRANCIM), Toulouse, France
| | - Stéphanie Ayrault-Piault
- Loire-Atlantique/Vendée Cancer Registry, Nantes, France ,French Network of Cancer Registries (FRANCIM), Toulouse, France
| | | | | | | | - Sophie Amossé
- Loire-Atlantique/Vendée Cancer Registry, Nantes, France
| | - Cyrille Delpierre
- grid.15781.3a0000 0001 0723 035XCERPOP, UMR 1295, Université Toulouse III, Inserm, Equipe EQUITY, Toulouse, France
| | - Anne Cowppli-Bony
- Loire-Atlantique/Vendée Cancer Registry, Nantes, France ,SIRIC ILIAD INCa-DGOS-Inserm_12558, Nantes, France ,SIRIC ILIAD INCa-DGOS-Inserm_12558, Angers, France ,French Network of Cancer Registries (FRANCIM), Toulouse, France ,grid.15781.3a0000 0001 0723 035XCERPOP, UMR 1295, Université Toulouse III, Inserm, Equipe EQUITY, Toulouse, France
| | - Florence Molinié
- Loire-Atlantique/Vendée Cancer Registry, Nantes, France ,SIRIC ILIAD INCa-DGOS-Inserm_12558, Nantes, France ,SIRIC ILIAD INCa-DGOS-Inserm_12558, Angers, France ,French Network of Cancer Registries (FRANCIM), Toulouse, France ,grid.15781.3a0000 0001 0723 035XCERPOP, UMR 1295, Université Toulouse III, Inserm, Equipe EQUITY, Toulouse, France
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9
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Prajapati N, Soler-Michel P, Vieira VM, Padilla CM. Role of mammography accessibility, deprivation and spatial effect in breast cancer screening participation in France: an observational ecological study. Int J Health Geogr 2022; 21:21. [PMID: 36566241 PMCID: PMC9789573 DOI: 10.1186/s12942-022-00320-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The detection of cancer in its early latent stages can improve patients' chances of recovery and thereby reduce the overall burden of the disease. Our objectives were to investigate factors (geographic accessibility and deprivation level) affecting mammography screening participation variation and to determine how much geographic variation in participation rates can be explained by spillover effects between adjacent areas, while controlling for covariates. METHODS Mammography screening participation rates between 2015 and 2016 were calculated by census blocks (CB), for women aged 50-74 years, residing in Lyon metropolitan area. Global spatial autocorrelation tests were applied to identify the geographic variation of participation. Spatial regression models were used to incorporate spatial structure to estimate associations between mammography participation rate and the combined effect (geographic accessibility and deprivation level) adjusting for modes of travel and social cohesion. RESULTS The mammography participation rate was found to have a statistically significant and positive spatial correlation. The participation rate of one CB was significantly and positively associated with the participation rates of neighbouring CB. The participation was 53.2% in residential and rural areas and 46.6% in urban areas, p < 0.001. Using Spatial Lag models, whereas the population living in most deprived CBs have statistically significantly lower mammography participation rates than lower deprived ones, significant interaction demonstrates that the relation differs according to the degree of urbanization. CONCLUSIONS This study makes an important methodological contribution in measuring geographical access and understanding better the combined effect of deprivation and the degree of urbanization on mammography participation and other contextual factors that affect the decision of using mammography screening services -which is a critical component of healthcare planning and equity.
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Affiliation(s)
- Nirmala Prajapati
- grid.410368.80000 0001 2191 9284Univ Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS-U 1309, 35000 Rennes, France
| | - Patricia Soler-Michel
- Centre Régional de Coordination des Dépistages des Cancers Auvergne Rhône Alpes, Lyon, France
| | - Verónica M. Vieira
- grid.266093.80000 0001 0668 7243Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA USA
| | - Cindy M. Padilla
- grid.410368.80000 0001 2191 9284Univ Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS-U 1309, 35000 Rennes, France
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10
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Bailly L, Jobert T, Petrovic M, Pradier C. Factors influencing participation in breast cancer screening in an urban setting. A study of organized and individual opportunistic screening among potentially active and retired women in the city of Nice. Prev Med Rep 2022; 31:102085. [PMID: 36820373 PMCID: PMC9938307 DOI: 10.1016/j.pmedr.2022.102085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Participation in breast cancer screening in urban settings is poor. Identifying factors accounting for participation and non-participation is essential to target priority areas, tackle health inequalities and suggest innovative approaches. We studied organized and individual opportunistic participation in breast cancer screening within the 144 aggregated units for statistical information (Ilôts regroupés pour l'information statistique: IRIS) of the city of Nice from 2019 to 2021. In each IRIS was assessed a local human development index, among potentially active women aged 50 to 59 years and retired women aged 60 to 74 years. Modelling participation and non-participation in screening according to the IRIS units' socio-economical characteristics was performed using the SURE method (Seemingly Unrelated Regression Equations). Over a 2-year period, 24,396 breast screening tests were conducted (11,173 as organised screening, 13,223 as individual opportunistic screening). The local human development index was positively correlated with the two types of screening, respectively. Access to public transport facilitated participation. Managerial status was negatively correlated with organised screening. Single working women had a higher risk of non-participation. With regard to their socio-economic characteristics, screening rates were lower than expected in 16 IRIS units in the city of Nice. Local human development index, access to public transport, family and professional context appear to be associated with breast cancer screening in an urban setting. An innovative approach targeting these factors is called for to reduce health inequalities.
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Affiliation(s)
- Laurent Bailly
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Public Health, UR2CA, Nice, France
- Corresponding author.
| | - Thomas Jobert
- Université Côte d'Azur, CNRS, GREDEG, 250 rue Albert Einstein, Valbonne 06560, France
| | - Mirko Petrovic
- Université Côte d’Azur, EUR ELMI, Rue du 22ème B.C.A., Nice 06300, France
| | - Christian Pradier
- Université Côte d'Azur, Centre Hospitalier Universitaire de Nice, Department of Public Health, UR2CA, Nice, France
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11
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Quintin C, Chatignoux E, Plaine J, Hamers FF, Rogel A. Coverage rate of opportunistic and organised breast cancer screening in France: Department-level estimation. Cancer Epidemiol 2022; 81:102270. [PMID: 36215917 DOI: 10.1016/j.canep.2022.102270] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE In France, the national breast cancer screening programme (NBCSP), targeting women aged 50-74 years was rolled out nationwide in 2004. It aims at reducing breast cancer mortality. In addition to the NBCSP, the use of opportunistic screening is permitted in France. The objective of this study is to estimate both opportunistic use and overall coverage rates of breast cancer screening, among women 40-84 years of age, in France. METHODS The French medico-administrative health data system (SNDS) was used to identify women performing an opportunistic or organised mammography screening in France in 2016-2017. RESULTS The two-yearly opportunistic mammography screening is 18 % among women aged 40-84; it is 11 % among women aged 50-74, i.e., the target age range for organised screening, 36 % among women aged 40-49 and 13 % among women aged 75-84. The overall two-yearly screening coverage is 48 % for all women aged 40-84; it is 60 % among women aged 50-74, 36 % among women 40-49 and 16 % for those aged 75-84. Geographical variations in screening are lessened when the two screening strategies are considered, as they balance each other. CONCLUSION Although coverage in the NBCSP is around 50 % in France, more than one third of the women make use of opportunistic screening within and outside the target age range. Organized screening appears to improve equity of access to mammography screening service. The lack of data on opportunistic screening practices hinders the evaluation of French screening practices as a whole.
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Affiliation(s)
- Cécile Quintin
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France.
| | - Edouard Chatignoux
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Julie Plaine
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Françoise F Hamers
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Agnès Rogel
- National public health agency (Santé publique France), 12 rue du Val d'Osne, 94410 Saint Maurice, France
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12
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Bysted S, Overgaard C, Simpson SA, Curtis T, Bøggild H. Recruiting residents from disadvantaged neighbourhoods for community-based health promotion and disease prevention services in Denmark-How, why and under what circumstances does an active door-to-door recruitment approach work? HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:937-948. [PMID: 33406289 DOI: 10.1111/hsc.13246] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 10/16/2020] [Accepted: 11/04/2020] [Indexed: 06/12/2023]
Abstract
Residents living in disadvantaged neighbourhoods have higher mortality and morbidity and participate less in health services than people living in more prosperous areas. Studies on how and why different approaches work for recruiting residents from disadvantaged neighbourhoods to health services are needed. Conducting face-to-face meetings with obliging health professionals (HPs) as part of an active recruitment strategy increases interest in service use, particularly among the most vulnerable residents. The services offered must be free, flexible and easily accessible for residents from disadvantaged neighbourhoods to consider their use. Residents immediately consider and 'translate' the relevance and acceptability of health services presented to them in light of their current situation, which affects their response. Individual contextual circumstances such as current health issues or difficult life circumstances, either promote or dampen their interest in using the services. This study is a realist evaluation of active face-to-face recruitment where HPs go from door-to-door to visit residents in disadvantaged neighbourhoods and offer them community-based health promotion and disease prevention services. A programme theory explicating the assumptions behind this recruitment approach was tested empirically in the present study. Eight direct observations of the active recruitment process in three different neighbourhoods and 17 realist interviews with residents were conducted. Sampling of residents was purposeful and opportunistic. Data were collected between March and August 2018. The findings support the use of active face-to-face recruitment in disadvantaged neighbourhoods to increase participation in health interventions. A broad range of health services should be presented to residents to accommodate their different needs and interests. Refusal to have services presented during active recruitment was rare, but more knowledge about these reasons for declining services is needed.
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Affiliation(s)
- Sofie Bysted
- Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Charlotte Overgaard
- Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | | | - Tine Curtis
- Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
| | - Henrik Bøggild
- Department of Health Science and Technology, Aalborg University, Aalborg East, Denmark
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13
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Ding L, Wang J, Greuter MJW, Goossens M, Van Hal G, de Bock GH. Determinants of Non-Participation in Population-Based Breast Cancer Screening: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:817222. [PMID: 35311110 PMCID: PMC8924365 DOI: 10.3389/fonc.2022.817222] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/09/2022] [Indexed: 12/24/2022] Open
Abstract
Background Breast cancer (BC) screening can be performed in a screening program (BCSP) or in opportunistic screening. The existing reviews on the determinants of non-participation depend on self-reported data which may be biased. Furthermore, no distinction was made between the probably different determinants of both screening strategies. Objective To find the determinants of non-participation in BCSP by means of a meta-analysis. Methods PubMed, Embase, and Web of Science were searched for observational studies which quantified factors associated with non-participation in BCSP in a general population. Studies on opportunistic screening and studies using self-reported data were excluded. A random-effect model was used to calculate pooled odds ratios (ORs) and 95% confidence intervals (CIs). Potential sources of heterogeneity were explored by stratification of the results. Results Twenty-nine studies with in a total of 20,361,756 women were included. Low income (OR: 1.20, 95% CI: 1.10–1.30), low education (OR: 1.18, 95% CI: 1.05–1.32), living far from an assigned screening unit (OR: 1.15, 95% CI: 1.07–1.24), being immigrant (OR: 2.64, 95% CI: 2.48–2.82), and having a male family doctor (OR: 1.43, 95% CI: 1.20–1.61) was associated with higher non-participation in screening. Reminders sent to non-attenders and estimations of ORs (adjusted or not) partly explained substantial heterogeneity. Conclusion In this meta-analysis excluding studies on the non-participation in opportunistic screening, or with self-reported data on non-participation, the well-known determinants for non-participation are still significant, but less strong. This analysis only supports the relevance of meta-analysis of studies with registered non-participation in a BCSP. Systematic Review Registration PROSPERO, CRD42020154016.
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Affiliation(s)
- Lilu Ding
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - J Wang
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - M J W Greuter
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Department of Robotics and Mechatronics, University of Twente, Enschede, Netherlands
| | - M Goossens
- Center for Cancer Detection, Flanders, Belgium
| | - Guido Van Hal
- Center for Cancer Detection, Flanders, Belgium.,Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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14
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Ouanhnon L, Rougé Bugat ME, Lamy S, Druel V, Delpierre C, Grosclaude P. Social and territorial inequalities in breast and cervical cancers screening uptake: a cross-sectional study in France. BMJ Open 2022; 12:e055363. [PMID: 35193917 PMCID: PMC8867371 DOI: 10.1136/bmjopen-2021-055363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 01/04/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The objective of this cross-sectional study was to investigate the impact of socio-territorial characteristics on mammography and pap smear uptake according to the place of residence in the recommended age groups, and second outside the recommended age groups. SETTING AND PARTICIPANTS We used an existing dataset of 1 027 039 women which combines data from the Health Insurance information systems, with census data from Midi-Pyrénées, France. PRIMARY AND SECONDARY OUTCOME MEASURES Our outcome was, for each woman, the uptake of the pap smear and the uptake of the mammography during the year. RESULTS A social gradient of screening uptake was found in the recommended age groups. This gradient was stronger in large urban areas:(1) For mammography: decile 10 (the most deprived) vs 1 (the least deprived), adjusted OR 0.777, 95% CI (0.748 to 0.808) in large urban area; adjusted OR= 0.808 for decile 1 to 0.726 for decile 10 in other areas vs decile 1 in urban areas;(2) For pap smear: decile 10 vs 1 adjusted OR 0.66, 95%CI (0.642 to 0.679) in large urban areas; adjusted OR= 0.747 for decile 1 to 0.562 for decile 10 in other areas vs decile 1 in urban areas).Screening rates were globally higher in large urban areas.For mammography, the social and territorial disparities were higher outside the recommended age group. CONCLUSIONS Offering a universal approach to every woman, as it is often the case in nationally organised screening programmes, is likely to be insufficient to ensure real equity in access. Developing global dataset combining health data and diverse socioeconomic data, at individual and contextual levels, could enable a better understanding of the mechanisms involved in this social gradient, and therefore, the development of targeted territorial actions to improve equity of access to healthcare.
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Affiliation(s)
- Lisa Ouanhnon
- DUMG (Département Universitaire de Médecine Générale), Université Toulouse III Paul Sabatier, Toulouse, France
- CERPOP, INSERM UMR_S 1027, Toulouse, France
| | - Marie-Eve Rougé Bugat
- DUMG (Département Universitaire de Médecine Générale), Université Toulouse III Paul Sabatier, Toulouse, France
- CERPOP, INSERM UMR_S 1027, Toulouse, France
| | - Sebastien Lamy
- CERPOP, INSERM UMR_S 1027, Toulouse, France
- Registre des cancers du Tarn, Institute Claudius Regaud, Toulouse, France
| | - Vladimir Druel
- DUMG (Département Universitaire de Médecine Générale), Université Toulouse III Paul Sabatier, Toulouse, France
- CERPOP, INSERM UMR_S 1027, Toulouse, France
| | - Cyrille Delpierre
- CERPOP, INSERM UMR_S 1027, Toulouse, France
- LEASP, Université Toulouse III Paul Sabatier, Toulouse, France
| | - Pascale Grosclaude
- CERPOP, INSERM UMR_S 1027, Toulouse, France
- Registre des cancers du Tarn, Institute Claudius Regaud, Toulouse, France
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15
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Mottram R, Knerr WL, Gallacher D, Fraser H, Al-Khudairy L, Ayorinde A, Williamson S, Nduka C, Uthman OA, Johnson S, Tsertsvadze A, Stinton C, Taylor-Phillips S, Clarke A. Factors associated with attendance at screening for breast cancer: a systematic review and meta-analysis. BMJ Open 2021; 11:e046660. [PMID: 34848507 PMCID: PMC8634222 DOI: 10.1136/bmjopen-2020-046660] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Attendance at population-based breast cancer (mammographic) screening varies. This comprehensive systematic review and meta-analysis assesses all identified patient-level factors associated with routine population breast screening attendance. DESIGN CINAHL, Cochrane Library, Embase, Medline, OVID, PsycINFO and Web of Science were searched for studies of any design, published January 1987-June 2019, and reporting attendance in relation to at least one patient-level factor. DATA SYNTHESIS Independent reviewers performed screening, data extraction and quality appraisal. OR and 95% CIs were calculated for attendance for each factor and random-effects meta-analysis was undertaken where possible. RESULTS Of 19 776 studies, 335 were assessed at full text and 66 studies (n=22 150 922) were included. Risk of bias was generally low. In meta-analysis, increased attendance was associated with higher socioeconomic status (SES) (n=11 studies; OR 1.45, 95% CI: 1.20 to 1.75); higher income (n=5 studies; OR 1.96, 95% CI: 1.68 to 2.29); home ownership (n=3 studies; OR 2.16, 95% CI: 2.08 to 2.23); being non-immigrant (n=7 studies; OR 2.23, 95% CI: 2.00 to 2.48); being married/cohabiting (n=7 studies; OR 1.86, 95% CI: 1.58 to 2.19) and medium (vs low) level of education (n=6 studies; OR 1.24, 95% CI: 1.09 to 1.41). Women with previous false-positive results were less likely to reattend (n=6 studies; OR 0.77, 95% CI: 0.68 to 0.88). There were no differences by age group or by rural versus urban residence. CONCLUSIONS Attendance was lower in women with lower SES, those who were immigrants, non-homeowners and those with previous false-positive results. Variations in service delivery, screening programmes and study populations may influence findings. Our findings are of univariable associations. Underlying causes of lower uptake such as practical, physical, psychological or financial barriers should be investigated. TRIAL REGISTRATION NUMBER CRD42016051597.
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Affiliation(s)
- Rebecca Mottram
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Wendy Lynn Knerr
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Daniel Gallacher
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hannah Fraser
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Lena Al-Khudairy
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Abimbola Ayorinde
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sian Williamson
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chidozie Nduka
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Olalekan A Uthman
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Samantha Johnson
- University of Warwick Library, University of Warwick, Coventry, West Midlands, UK
| | - Alexander Tsertsvadze
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Christopher Stinton
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sian Taylor-Phillips
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Aileen Clarke
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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16
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Poiseuil M, Tron L, Woronoff AS, Trétarre B, Dabakuyo-Yonli TS, Fauvernier M, Roche L, Dejardin O, Molinié F, Launoy G. How do age and social environment affect the dynamics of death hazard and survival in patients with breast or gynecological cancer in France? Int J Cancer 2021; 150:253-262. [PMID: 34520579 DOI: 10.1002/ijc.33803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/22/2021] [Accepted: 08/04/2021] [Indexed: 11/07/2022]
Abstract
Several studies have investigated the association between net survival (NS) and social inequalities in people with cancer, highlighting a varying influence of deprivation depending on the type of cancer studied. However, few of these studies have accounted for the effect of social inequalities over the follow-up period, and/or according to the age of the patients. Thus, using recent and more relevant statistical models, we investigated the effect of social environment on NS in women with breast or gynecological cancer in France. The data were derived from population-based cancer registries, and women diagnosed with breast or gynecological cancer between 2006 and 2009 were included. We used the European deprivation index (EDI), an aggregated index, to define the social environment of the women included. Multidimensional penalized splines were used to model excess mortality hazard. We observed a significant effect of the EDI on NS in women with breast cancer throughout the follow-up period, and especially at 1.5 years of follow-up in women with cervical cancer. Regarding corpus uteri and ovarian cancer patients, the effect of deprivation on NS was less pronounced. These results highlight the impact of social environment on NS in women with breast or gynecological cancer in France thanks to a relevant statistical approach, and identify the follow-up periods during which the social environment may have a particular influence. These findings could help investigate targeted actions for each cancer type, particularly in the most deprived areas, at the time of diagnosis and during follow-up.
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Affiliation(s)
- Marie Poiseuil
- Univ. Bordeaux, Gironde General Cancer Registry, Bordeaux, France.,Inserm, Bordeaux Population Health, Research Center U1219, Team EPICENE, Bordeaux, France
| | - Laure Tron
- 'ANTICIPE' U1086 INSERM-UCN, Normandie Université UNICAEN, Centre François Baclesse, Caen, France
| | - Anne-Sophie Woronoff
- Doubs Cancer Registry, Besançon University Hospital, Besançon, France.,Research Unit EA3181, University of Burgundy Franche-Comté, Besançon, France.,French Network of Cancer Registries (FRANCIM), Toulouse, France
| | - Brigitte Trétarre
- French Network of Cancer Registries (FRANCIM), Toulouse, France.,Hérault Cancer Registry, Montpellier, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- French Network of Cancer Registries (FRANCIM), Toulouse, France.,Breast and Gynecologic Cancer Registry of Côte d'Or, Georges Francois Leclerc Comprehensive Cancer Centre, Dijon, France.,Epidemiology and Quality of Life Research Unit, INSERM U1231, Dijon, France
| | - Mathieu Fauvernier
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique - Bioinformatique, Lyon, France.,Lyon University, Lyon 1 University, CNRS, UMR 5558, Biometrics and Evolutionary Biology Laboratory, Biostatistics and Health Team, Villeurbanne, France
| | - Laurent Roche
- Hospices Civils de Lyon, Pôle Santé Publique, Service de Biostatistique - Bioinformatique, Lyon, France.,Lyon University, Lyon 1 University, CNRS, UMR 5558, Biometrics and Evolutionary Biology Laboratory, Biostatistics and Health Team, Villeurbanne, France
| | - Olivier Dejardin
- 'ANTICIPE' U1086 INSERM-UCN, Normandie Université UNICAEN, Centre François Baclesse, Caen, France.,Research Department, Caen University Hospital Centre, Caen, France
| | - Florence Molinié
- French Network of Cancer Registries (FRANCIM), Toulouse, France.,Loire-Atlantique/Vendée Cancer Registry, Nantes, France.,SIRIC-ILIAD, INCA-DGOS-Inserm_12558, CHU Nantes, Nantes, France
| | - Guy Launoy
- 'ANTICIPE' U1086 INSERM-UCN, Normandie Université UNICAEN, Centre François Baclesse, Caen, France.,French Network of Cancer Registries (FRANCIM), Toulouse, France.,Research Department, Caen University Hospital Centre, Caen, France
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17
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Rollet Q, Guillaume É, Launay L, Launoy G. Socio-Territorial Inequities in the French National Breast Cancer Screening Programme-A Cross-Sectional Multilevel Study. Cancers (Basel) 2021; 13:cancers13174374. [PMID: 34503184 PMCID: PMC8430540 DOI: 10.3390/cancers13174374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 12/29/2022] Open
Abstract
Simple Summary France implemented a national breast cancer screening programme in 2004, which, despite recommendations, still coexists with opportunistic screening practices. We aimed to study socio-territorial inequities in participation in the 2013–2014 screening campaign, using multilevel models. With a representative sample of 42% of the estimated eligible population, we found that the organized programme does not erase social or territorial inequities in participation. Social inequities, at multiple levels, were found in nearly all départements, whereas territorial inequities seemed more context dependent. The impact of the coexistence with opportunistic screening, beyond any control and evaluation, is adding more risks (over-diagnosis, over-treatment) and leads to underestimating the true coverage of the population, mainly in the wealthiest, therefore leading to an underestimation of the true social gradient in participation. The French breast cancer screening programme needs to evolve to be more efficient in coverage, notably through the reduction of the unfair inequities in participation. Abstract Background. France implemented in 2004 the French National Breast Cancer Screening Programme (FNBCSP). Despite national recommendations, this programme coexists with non-negligible opportunistic screening practices. Aim. Analyse socio-territorial inequities in the 2013–2014 FNBCSP campaign in a large sample of the eligible population. Method. Analyses were performed using three-level hierarchical generalized linear model. Level one was a 10% random sample of the eligible population in each département (n = 397,598). For each woman, age and travel time to the nearest accredited radiology centre were computed. These observations were nested within 22,250 residential areas called “Îlots Regroupés pour l’Information Statistique” (IRIS), for which the European Deprivation Index (EDI) is defined. IRIS were nested within 41 départements, for which opportunistic screening rates and gross domestic product based on purchasing power parity were available, deprivation and the number of radiology centres for 100,000 eligible women were computed. Results. Organized screening uptake increased with age (OR1SD = 1.05 [1.04–1.06]) and decreased with travel time (OR1SD = 0.94 [0.93–0.95]) and EDI (OR1SD = 0.84 [0.83–0.85]). Between départements, organized screening uptake decreased with opportunistic screening rate (OR1SD = 0.84 [0.79–0.87]) and départements deprivation (OR1SD = 0.91 [0.88–0.96]). Association between EDI and organized screening uptake was weaker as opportunistic screening rates and as département deprivation increased. Heterogeneity in FNBCSP participation decreased between IRIS by 36% and between départements by 82%. Conclusion. FNBCSP does not erase socio-territorial inequities. The population the most at risk of dying from breast cancer is thus the less participating. More efforts are needed to improve equity.
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Walji LT, Murchie P, Lip G, Speirs V, Iversen L. Exploring the influence of rural residence on uptake of organized cancer screening - A systematic review of international literature. Cancer Epidemiol 2021; 74:101995. [PMID: 34416545 DOI: 10.1016/j.canep.2021.101995] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/14/2021] [Accepted: 07/16/2021] [Indexed: 12/12/2022]
Abstract
Lower screening uptake could impact cancer survival in rural areas. This systematic review sought studies comparing rural/urban uptake of colorectal, cervical and breast cancer screening in high income countries. Relevant studies (n = 50) were identified systematically by searching Medline, EMBASE and CINAHL. Narrative synthesis found that screening uptake for all three cancers was generally lower in rural areas. In meta-analysis, colorectal cancer screening uptake (OR 0.66, 95 % CI = 0.50-0.87, I2 = 85 %) was significantly lower for rural dwellers than their urban counterparts. The meta-analysis found no relationship between uptake of breast cancer screening and rural versus urban residency (OR 0.93, 95 % CI = 0.80-1.09, I2 = 86 %). However, it is important to note the limitation of the significant statistical heterogeneity found which demonstrates the lack of consistency between the few studies eligible for inclusion in the meta-analyses. Cancer screening uptake is apparently lower for rural dwellers which may contribute to poorer survival. National screening programmes should consider geography in planning.
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Affiliation(s)
- Lauren T Walji
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Peter Murchie
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Gerald Lip
- North East Scotland Breast Screening Programme, NHS Grampian, Aberdeen, UK
| | - Valerie Speirs
- Institute of Medical Sciences, University of Aberdeen, Aberdeen, UK
| | - Lisa Iversen
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK
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19
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Perrin A, Freyssenge J, Haesebaert J, Tazarourte K, Termoz A, Grimaud O, Derex L, Viprey M, Schott AM. Are there socio-economic inequities in access to reperfusion therapy: The stroke 69 cohort. Rev Neurol (Paris) 2021; 177:1168-1175. [PMID: 34274130 DOI: 10.1016/j.neurol.2021.02.394] [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: 07/23/2020] [Revised: 01/20/2021] [Accepted: 02/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE Low socio-economic status of individuals has been reported to be associated with a higher incidence of stroke and influence the diagnosis after revascularization. However, whether it is associated with poorer acute stroke management is less clear. To determine whether social deprivation was associated with a poorer access to reperfusion therapy, either intravenous thrombolysis (IVT) and/or endovascular thrombectomy (EVT) in a population-based cohort. METHODS Over a 14-month period, all consecutive adult patients admitted to any emergency department or a comprehensive or primary stroke center (CSC/PSC) of the Rhône county with a confirmed ischemic stroke were included. The socioeconomic status of each patient was measured using the European Deprivation Index (EDI). The association between EDI and access to reperfusion therapy was assessed in univariate and multivariate logistic regression analyses. RESULTS Among the 1226 consecutive IS patients, 316 (25%) were admitted directly in a PSC or CSC, 241 (19.7%) received a reperfusion therapy; 155 IVT alone, 20 EVT alone, and 66 both therapies. Median age was 79 years, 1030 patients had an EDI level of 1 to 4, and 196 an EDI of 5 (the most deprived group). The most deprived patients (EDI level 5) did not have a poorer access to reperfusion therapy compared to all other patients in univariate (OR 1.22, 95%CI [0.85; 1.77]) nor in multivariate analyses (adjOR 0.97, 95%CI [0.57; 1.66]). CONCLUSIONS We did not find any significant association between socioeconomic deprivation and access to reperfusion therapy. This suggests that the implementation of EVT was not associated with increased access inequities.
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Affiliation(s)
- A Perrin
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France.
| | - J Freyssenge
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; RESUVal - Réseau des Urgences de la Vallée du Rhône, 38200 Vienne, France
| | - J Haesebaert
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Pôle de santé publique, hospices civils de Lyon, 69003 Lyon, France
| | - K Tazarourte
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Service des urgences, hospices civils de Lyon, 69003 Lyon, France
| | - A Termoz
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Pôle de santé publique, hospices civils de Lyon, 69003 Lyon, France
| | - O Grimaud
- EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) - EA 7449, université de Rennes, 35000 Rennes, France
| | - L Derex
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Service de neurologie vasculaire, hospices civils de Lyon, 69500 Bron, France
| | - M Viprey
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Pôle de santé publique, hospices civils de Lyon, 69003 Lyon, France
| | - A M Schott
- Université Claude Bernard Lyon 1, Research on Healthcare Performance (RESHAPE), INSERM U1290, Lyon, France; Pôle de santé publique, hospices civils de Lyon, 69003 Lyon, France
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20
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De Jesus M, Rodrigue CM, Rahmani S, Balamou C. Addressing Cancer Screening Inequities by Promoting Cancer Prevention Knowledge, Awareness, Self-Efficacy, and Screening Uptake Among Low-Income and Illiterate Immigrant Women in France. Int J Public Health 2021; 66:1604055. [PMID: 34744595 PMCID: PMC8565258 DOI: 10.3389/ijph.2021.1604055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 05/28/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Cancer screening rates are suboptimal for disadvantaged populations in France, yet little evidence exists on their cancer-related knowledge and screening barriers. The main objective of this study was to examine cancer-related knowledge, awareness, self-efficacy, and perceptions of screening barriers among low-income, illiterate immigrant women in France following an 8-weeks cancer educational intervention. Methods: Semi-structured qualitative interviews were conducted with 164 female participants in the Ain department of France between January 2019 and March 2020. Adopting the Health Belief Model as an intervention and analytic framework, salient themes were identified using qualitative thematic analysis. Results: Increased levels of perceived susceptibility to and perceived severity of cancer contributed to higher motivation to get screened. Barriers to screening included low French proficiency, shame surrounding illiteracy, and constant worries due to precarious living conditions. Perceived benefits (e.g., valuing one's health and health-promoting behaviors), cues to action from a trusted source, and greater self-efficacy (e.g., more autonomous in healthcare-seeking) outweighed perceived barriers, including cultural barriers. Conclusions: Implications include developing audience-responsive targeted cancer screening communication strategies and educational materials to increase screening rates and reduce cancer and cancer screening inequities.
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Affiliation(s)
- Maria De Jesus
- Collegium de Lyon, Université de Lyon, Lyon, France
- School of International Service, American University, Washington, DC, United States
- Center on Health, Risk, and Society, American University, Washington, DC, United States
| | - Christelle M. Rodrigue
- Centre Régional de Coordination des Dépistages des Cancers Auvergne-Rhône-Alpes (CRCDC AuRA), Site de l’Ain Bourg-en-Bresse, France
| | - Sarah Rahmani
- Centre Régional de Coordination des Dépistages des Cancers Auvergne-Rhône-Alpes (CRCDC AuRA), Site de l’Ain Bourg-en-Bresse, France
| | - Christian Balamou
- Centre Régional de Coordination des Dépistages des Cancers Auvergne-Rhône-Alpes (CRCDC AuRA), Site de l’Ain Bourg-en-Bresse, France
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21
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Menahem B, Dejardin O, Alves A, Launay L, Lubrano J, Duvoux C, Laurent A, Launoy AG. Socioeconomic Deprivation Does Not Impact Liver Transplantation Outcome for HCC: A Survival Analysis From a National Database. Transplantation 2021; 105:1061-1068. [PMID: 32541559 DOI: 10.1097/tp.0000000000003340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND To investigate the value of European deprivation index (EDI) and hepatocellular carcinoma (HCC) characteristics and their relationships with outcome after liver transplantation (LT). METHODS Patients undergoing LT for HCC were included from a national database (from "Agence de la Biomédecine" between 2006 and 2016. Characteristics of the patients were blindly extracted from the database. Thus, EDI was calculated in 5 quintiles and prognosis factors of survival were determined according to a Cox model. RESULTS Among the 3865 included patients, 33.9% were in the fifth quintile (quintile 1, N = 562 [14.5%]; quintile 2, N = 647 [16.7%]; quintile 3, N = 654 [16.9%]; quintile 4, N = 688 [17.8%]). Patients in each quintile were comparable regarding HCC history, especially median size of HCC, number of nodules of HCC and alpha-fetoprotein score. In the univariate analysis of the crude survival, having >2 nodules of HCC before LT and time on waiting list were associated with a higher risk of death (P < 0.0001 and P = 0.03, respectively). EDI, size of HCC, model for end-stage liver disease score, Child-Pugh score were not statistically significant in the crude and net survival. In both survival, time on waiting list and number of HCC ≥2 were independent factor of mortality after LT for HCC (P = 0.009 and 0.001, respectively, and P = 0.03 and 0.02, respectively). CONCLUSIONS EDI does not impact overall survival after LT for HCC. Number of HCC and time on waiting list are independent prognostic factors of survival after LT for HCC.
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Affiliation(s)
- Benjamin Menahem
- Department of Digestive Surgery, CHU de Caen, Caen cedex, France
- Anticipe, INSERM U1086, Pôle de Recherche du CHU de Caen, Centre François Baclesse, Caen cedex, France
| | - Olivier Dejardin
- Anticipe, INSERM U1086, Pôle de Recherche du CHU de Caen, Centre François Baclesse, Caen cedex, France
- Department of Research, CHU de Caen, Caen cedex, France
| | - Arnaud Alves
- Department of Digestive Surgery, CHU de Caen, Caen cedex, France
- Anticipe, INSERM U1086, Pôle de Recherche du CHU de Caen, Centre François Baclesse, Caen cedex, France
| | - Ludivine Launay
- Anticipe, INSERM U1086, Pôle de Recherche du CHU de Caen, Centre François Baclesse, Caen cedex, France
| | - Jean Lubrano
- Department of Digestive Surgery, CHU de Caen, Caen cedex, France
- Anticipe, INSERM U1086, Pôle de Recherche du CHU de Caen, Centre François Baclesse, Caen cedex, France
| | - Christophe Duvoux
- Department of Hepatology, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Alexis Laurent
- Department of Hepatobiliary, Pancreatic Surgery and Liver Transplantation, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
- INSERM, UMR 955, Créteil, France
| | - And Guy Launoy
- Anticipe, INSERM U1086, Pôle de Recherche du CHU de Caen, Centre François Baclesse, Caen cedex, France
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22
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Ding L, Jidkova S, Greuter MJW, Van Herck K, Goossens M, De Schutter H, Martens P, Van Hal G, de Bock GH. The Role of Socio-Demographic Factors in the Coverage of Breast Cancer Screening: Insights From a Quantile Regression Analysis. Front Public Health 2021; 9:648278. [PMID: 33937176 PMCID: PMC8082021 DOI: 10.3389/fpubh.2021.648278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background: In Flanders, breast cancer (BC) screening is performed in a population-based breast cancer screening program (BCSP), as well as in an opportunistic setting. Women with different socio-demographic characteristics are not equally covered by BC screening. Objective: To evaluate the role of socio-demographic characteristics on the lowest 10th and highest 90th quantile levels of BC screening coverage. Methods: The 2017 neighborhood-level coverage rates of 8,690 neighborhoods with women aged 50–69 and eligible for BCSP and opportunistic screening were linked to socio-demographic data. The association between socio-demographic characteristics and the coverage rates of BCSP and opportunistic screening was evaluated per quantile of coverage using multivariable quantile regression models, with specific attention to the lowest 10th and highest 90th quantiles. Results: The median coverage in the BCSP was 50%, 33.5% in the 10th quantile, and 64.5% in the 90th quantile. The median coverage of the opportunistic screening was 12, 4.2, and 24.8% in the 10th and 90th quantile, respectively. A lower coverage of BCSP was found in neighborhoods with more foreign residents and larger average household size, which were considered indicators for a lower socioeconomic status (SES). However, a higher average personal annual income, which was considered an indicator for a higher SES, was also found in neighborhoods with lower coverage of BCSP. For these neighborhoods, that have a relatively low and high SES, the negative association between the percentage of foreign residents, average household size, and average personal annual income and the coverage in the BCSP had the smallest regression coefficient and 95% confidence interval (CI) values were −0.75 (95% CI: −0.85, −0.65), −13.59 (95% CI: −15.81, −11.37), and −1.05 (95% CI: −1.18, −0.92), respectively, for the 10th quantile. The neighborhoods with higher coverage of opportunistic screening had a relatively higher average personal annual income, with the largest regression coefficient of 1.72 (95% CI: 1.59, 1.85) for the 90th quantile. Conclusions: Women from relatively low and high SES neighborhoods tend to participate less in the BCSP, whereas women with a relatively high SES tend to participate more in opportunistic screening. For women from low SES neighborhoods, tailored interventions are needed to improve the coverage of BCSP.
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Affiliation(s)
- Lilu Ding
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - Svetlana Jidkova
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Center for Cancer Detection, Flanders, Belgium
| | - Marcel J W Greuter
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Department of Robotics and Mechatronics, University of Twente, Enschede, Netherlands
| | - Koen Van Herck
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Center for Cancer Detection, Flanders, Belgium
| | | | | | | | - Guido Van Hal
- Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium.,Center for Cancer Detection, Flanders, Belgium
| | - Geertruida H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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23
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Adekpedjou A, Dabo‐Niang S. Semiparametric estimation with spatially correlated recurrent events. Scand Stat Theory Appl 2020. [DOI: 10.1111/sjos.12480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Akim Adekpedjou
- Department of Mathematics and Statistics Missouri University of Science and Technology
| | - Sophie Dabo‐Niang
- Laboratoire Paul Painvelé UMR CNRS 8524, INRIA‐MODAL University of Lille
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24
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National organization of uterine cervical cancer screening and social inequality in France. Eur J Cancer Prev 2020; 29:458-465. [PMID: 32740172 DOI: 10.1097/cej.0000000000000557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Some of the inequality in uterine cervical cancer (UCC) screening uptake are due to the socioeconomic deprivation of women. A national organized screening programme has proven to be effective in increasing the uptake, but may increase socioeconomic inequality. Therefore, we compared inequality in uptake of UCC screening between two French departments, one of which is experimenting an organized screening programme. We used reimbursement data from the main French health insurance scheme to compare screening rates in the municipalities of the two departments over a three-year period. The experimental department had higher screening rates, but the increase in deprivation in municipalities had a greater effect on the decrease in participation in this department. Moreover, while screening rates were higher in urban areas, the negative effect of deprivation on participation was greater in rural areas. Although these departments were compared at the same time under different conditions, socioeconomic inequality between them may have been greater before the experimentation started. However, screening may have led to an increase in socioeconomic inequality between women screened. Special attention must be paid to changes in socioeconomic and geographic inequality in the uptake of UCC screening when the programme is rolled out nationally.
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25
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De Mil R, Guillaume E, Launay L, Guittet L, Dejardin O, Bouvier V, Notari A, Launoy G, Berchi C. Cost-Effectiveness Analysis of a Mobile Mammography Unit for Breast Cancer Screening to Reduce Geographic and Social Health Inequalities. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1111-1118. [PMID: 31563253 DOI: 10.1016/j.jval.2019.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/02/2019] [Accepted: 06/04/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Breast cancer is the leading cancer in terms of incidence and mortality among women in France. Effective organized screening does exist, however, the participation rate is low, and negatively associated with a low socioeconomic status and remoteness. OBJECTIVES To determine the cost-effectiveness of a mobile mammography (MM) program to increase participation in breast cancer screening and reduce geographic and social inequalities. METHODS A cost-effectiveness analysis from retrospective data was conducted from the payer perspective, comparing an invitation to a mobile mammography unit (MMU) or to a radiologist's office (MM or RO group) with an invitation to a radiologist's office only (RO group) (n = 37 461). Medical and nonmedical direct costs were estimated. Outcome was screening participation. The mean incremental cost and effect, the incremental cost-effectiveness ratio, and the cost-effectiveness acceptability curve were estimated. RESULTS The mean incremental cost for invitation to MM or RO was estimated to be €23.21 (95% CI, 22.64-23.78) compared with RO only, and with a point of participation gain of 3.8% (95% CI, 2.8-4.8), resulting in an incremental cost per additional screen of €610.69 (95% CI, 492.11-821.01). The gain of participation was more important in women living in deprived areas and for distances exceeding 15 km from an RO. CONCLUSION Screening involving a MMU can increase participation in breast cancer screening and reduce geographic and social inequalities while being more cost-effective in remote areas and in deprived areas. Because of the retrospective design, further research is needed to provide more evidence of the effectiveness and cost-effectiveness of using a MMU for organized breast cancer screening and to determine the optimal conditions for implementing it.
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Affiliation(s)
- Rémy De Mil
- Normandie Univ, UNICAEN, INSERM, Anticipe, Caen, France.
| | | | | | - Lydia Guittet
- Normandie Univ, UNICAEN, INSERM, Anticipe, Caen, France
| | | | | | | | - Guy Launoy
- Normandie Univ, UNICAEN, INSERM, Anticipe, Caen, France
| | - Célia Berchi
- Normandie Univ, UNICAEN, INSERM, Anticipe, Caen, France
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26
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Padilla CM, Painblanc F, Soler-Michel P, Vieira VM. Mapping Variation in Breast Cancer Screening: Where to Intervene? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2274. [PMID: 31252599 PMCID: PMC6651541 DOI: 10.3390/ijerph16132274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/07/2019] [Accepted: 06/22/2019] [Indexed: 11/24/2022]
Abstract
Small geographic areas with lower mammography screening participation rates may reflect gaps in screening efforts. Our objective was to use spatial analyses to understand disparities in mammography screening use and to identify factors to increase its uptake in areas that need it in Lyon metropolitan area, France. Data for screened women between the ages of 50 and 74 were analyzed. Census blocks of screened and non screened women were extracted from the mammography screening programme 2015-2016 dataset. We used spatial regression models, within a generalized additive framework to determine clusters of census blocks with significantly higher prevalence of non-participation of mammography screening. Smoothed risk maps were crude and adjusted on the following covariates: deprivation index and opportunistic screening. Among 178,002 women aged 50 to 74, 49.9% received mammography screening. As hypothesized, women living in highly deprived census blocks had lower participation rates compared to less deprived blocks, 45.2% vs. 51.4% p < 0.001. Spatial analyses identified four clusters, one located in an urban area and three in suburban areas. Moreover, depending on the location of the cluster, the influence came from different variables. Knowing the impact of site-specific risk factors seems to be important for implementing an appropriate prevention intervention.
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Affiliation(s)
- Cindy M Padilla
- Université Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449 Rennes, France.
| | - François Painblanc
- Université Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449 Rennes, France
| | - Patricia Soler-Michel
- Centre régional de coordination des dépistages des cancers Auvergne Rhône Alpes, 5 bis, rue Cléberg, 69322 Lyon CEDEX 05, France
| | - Veronica M Vieira
- Program in Public Health, University of California, Irvine, CA 92697, USA
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27
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Deprivation and mass screening: Survival of women diagnosed with breast cancer in France from 2008 to 2010. Cancer Epidemiol 2019; 60:149-155. [DOI: 10.1016/j.canep.2019.03.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/22/2019] [Accepted: 03/29/2019] [Indexed: 02/06/2023]
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28
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Smith D, Thomson K, Bambra C, Todd A. The breast cancer paradox: A systematic review of the association between area-level deprivation and breast cancer screening uptake in Europe. Cancer Epidemiol 2019; 60:77-85. [PMID: 30927689 PMCID: PMC6547165 DOI: 10.1016/j.canep.2019.03.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 12/21/2022]
Abstract
Breast cancer rates are lower amongst women from more socio-economically deprived areas. However, their mortality rates are higher. One explanation of this breast cancer paradox is that women from more deprived areas are less likely to attend breast cancer screening programmes. This systematic review is the first to examine this issue in Europe. A systematic review of Embase, Medline and PsychINFO (from 2008 to 2019) was undertaken (PROSPERO registration number: CRD42018083703). Observational studies were included if they were based in Europe, measured breast cancer screening uptake, compared at least two areas, included an area-level measure of socio-economic deprivation and were published in the English language. The Joanna Briggs Institute critical appraisal checklist was used to assess study quality and risk of bias. Thirteen studies from seven different European countries met our inclusion criteria and were included in the review. In ten of the thirteen studies, there was a significant negative association between screening uptake and area-level socio-economic deprivation - with women living in more socio-economically deprived neighbourhoods less likely to attend breast cancer screening. Although universal screening programmes were provided in most studies, there were still strong negative associations between screening uptake and area-level socio-economic deprivation. Future breast cancer screening strategies should acknowledge these challenges, and consider developing targeted interventions in more deprived areas to increase screening participation.
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Affiliation(s)
- Dinah Smith
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle 14 upon Tyne, NE1 7RU, UK
| | - Katie Thomson
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Clare Bambra
- Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK
| | - Adam Todd
- School of Pharmacy, Faculty of Medical Sciences, Newcastle University, King George VI Building, Newcastle 14 upon Tyne, NE1 7RU, UK; Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK.
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Variations in the breast reconstruction rate in France: A nationwide study of 19,466 patients based on the French medico-administrative database. Breast 2018; 42:74-80. [DOI: 10.1016/j.breast.2018.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/02/2018] [Accepted: 07/22/2018] [Indexed: 01/29/2023] Open
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Deborde T, Chatignoux E, Quintin C, Beltzer N, Hamers FF, Rogel A. Breast cancer screening programme participation and socioeconomic deprivation in France. Prev Med 2018; 115:53-60. [PMID: 30099047 DOI: 10.1016/j.ypmed.2018.08.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/18/2018] [Accepted: 08/04/2018] [Indexed: 11/17/2022]
Abstract
The objective was to quantify the relationship between deprivation and national breast cancer screening programme (NBCSP) participation at an ecological level in mainland France. Data from 4,805,390 women-living in 36,209 municipalities within 95 departments-participating in the 2013-2014 NBCSP were analysed using the French Deprivation Index (FDep). FDep population quintiles by municipality were computed to describe NBCSP participation according to deprivation. To better examine the relationship between continuous value of deprivation index and participation rates at the municipality level, we built a generalized linear mixed model. Geographical variations in participation rates were marked. The national standardized participation rate was higher in the intermediate quintiles (55%), 45% for the least deprived one and 52% for the most deprived one. Using our model, we also obtained an inverted U-curve for the relationship between NBCSP participation and municipality deprivation: participation was lower for both the least and most deprived municipalities. This relationship was also observed for each of the two subpopulations-urban municipalities and rural ones-considered separately. Introducing the FDep in the model reduced slightly the unexplained variations in participation rates between departments and between municipalities (with a proportional change in variance of 14% and 12% respectively). We highlight major disparities in departmental participation rates and FDep/participation profiles. However, deprivation appears to have only little influence on geographical variation in participation rates. There is a need to further understand the factors affecting geographical variation in participation rates, in particular the use of opportunistic screening.
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Affiliation(s)
- Thérèse Deborde
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Edouard Chatignoux
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Cécile Quintin
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Nathalie Beltzer
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Françoise F Hamers
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Agnès Rogel
- French National Public Health Agency, Non-communicable diseases and trauma directorate, 12 rue du Val d'Osne, 94410 Saint Maurice, France.
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Small-area geographic and socioeconomic inequalities in colorectal tumour detection in France. Eur J Cancer Prev 2018; 25:269-74. [PMID: 26067032 DOI: 10.1097/cej.0000000000000175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to assess the impact of area deprivation and primary care facilities on colorectal adenoma detection and on colorectal cancer (CRC) incidence in a French well-defined population before mass screening implementation. The study population included all patients aged 20 years or more living in Côte d'Or (France) with either colorectal adenoma or invasive CRC first diagnosed between 1995 and 2002 and who were identified from the Burgundy Digestive Cancer Registry and the Côte d'Or Polyp Registry. Area deprivation was assessed using the European deprivation index on the basis of the smallest French area available (Ilots Regroupés pour l'Information Statistique). Healthcare access was assessed using medical density of general practitioners (GPs) and road distance to the nearest GP and gastroenterologist. Bayesian regression analyses were used to estimate influential covariates on adenoma detection and CRC incidence rates. The results were expressed as relative risks (RRs) with their 95% credibility interval. In total, 5399 patients were diagnosed with at least one colorectal adenoma and 2125 with invasive incident CRC during the study period. Remoteness from GP [RR=0.71 (0.61-0.83)] and area deprivation [RR=0.98 (0.96-1.00)] independently reduced the probability of adenoma detection. CRC incidence was only slightly affected by GP medical density [RR=1.05 (1.01-1.08)] without any area deprivation effect [RR=0.99 (0.96-1.02)]. Distance to gastroenterologist had no impact on the rates of adenoma detection or CRC incidence. This study highlighted the prominent role of access to GPs in the detection of both colorectal adenomas and overall cancers. Deprivation had an impact only on adenoma detection.
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Di Salvo F, Caranci N, Spadea T, Zengarini N, Minicozzi P, Amash H, Fusco M, Stracci F, Falcini F, Cirilli C, Candela G, Cusimano R, Tumino R, Sant M. Socioeconomic deprivation worsens the outcomes of Italian women with hormone receptor-positive breast cancer and decreases the possibility of receiving standard care. Oncotarget 2017; 8:68402-68414. [PMID: 28978126 PMCID: PMC5620266 DOI: 10.18632/oncotarget.19447] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 04/26/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Socioeconomic factors influence access to cancer care and survival. This study investigated the role of socioeconomic status on the risk of breast cancer recurrence and on the delivery of appropriate cancer care (sentinel lymph node biopsy and breast-conserving surgery plus radiotherapy), by patients' age and hormone receptor status. METHODS 3,462 breast cancer cases diagnosed in 2003-2005 were selected from 7 Italian cancer registries and assigned to a socioeconomic tertile on the basis of the deprivation index of their census tract. Multivariable models were applied to assess the delivery of sentinel lymph node biopsy and of breast-conserving surgery plus radiotherapy within socioeconomic tertiles. RESULTS In the 1,893 women younger than 65 years, the 5-year risk of recurrence was higher in the most deprived group than in the least deprived, but this difference was not significant (16.4% vs. 12.9%, log-rank p=0.08); no difference was seen in women ≥65 years. Among the 2,024 women with hormone receptor-positive cancer, the 5-year risk was significantly higher in the most deprived group than in the least deprived one (13.0% vs. 8.9%, p=0.04); no difference was seen in cases of hormone receptor-negative cancer. The most deprived women were less likely than the least deprived women to receive sentinel lymph node biopsy (adjusted odds ratio (ORa), 0.69; 95% CI, 0.56-0.86) and to undergo breast-conserving surgery plus radiotherapy (ORa=0.66; 95% CI, 0.51-0.86). Conclusions: Socioeconomic inequalities affect the risk of recurrence, among patients with hormone receptor-positive cancer, and the opportunity to receive standard care.
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Affiliation(s)
- Francesca Di Salvo
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Nicola Caranci
- Agenzia Sanitaria e Sociale Regione Emilia Romagna, Bologna, Italy
| | - Teresa Spadea
- Servizio Sovrazonale di Epidemiologia ASL Torino 3, Grugliasco, Italy
| | - Nicolas Zengarini
- Servizio Sovrazonale di Epidemiologia ASL Torino 3, Grugliasco, Italy
| | - Pamela Minicozzi
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Hade Amash
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Mario Fusco
- Naples Cancer Registry, ASL Napoli 3 Sud, Brusciano, Italy
| | - Fabrizio Stracci
- Umbria Cancer Registry, Public Health Department, University of Perugia, Perugia, Italy
| | - Fabio Falcini
- Romagna Cancer Registry, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Claudia Cirilli
- Modena Cancer Registry, Public Health Department AUSL Modena, Modena, Italy
| | - Giuseppina Candela
- Trapani Cancer Registry, Health Prevention Department ASL 9 Trapani, Trapani, Italy
| | - Rosanna Cusimano
- Palermo Cancer Registry, Health Science Department University of Palermo, Palermo, Italy
| | - Rosario Tumino
- Ragusa Cancer Registry, Health Prevention Department ASP Ragusa, Ragusa, Italy
| | - Milena Sant
- Analytical Epidemiology and Health Impact Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Lemarchand C, Tual S, Levêque-Morlais N, Perrier S, Belot A, Velten M, Guizard AV, Marcotullio E, Monnereau A, Clin B, Baldi I, Lebailly P. Cancer incidence in the AGRICAN cohort study (2005-2011). Cancer Epidemiol 2017; 49:175-185. [PMID: 28709062 PMCID: PMC6200131 DOI: 10.1016/j.canep.2017.06.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/22/2017] [Accepted: 06/06/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Numerous studies have been conducted among farmers, but very few of them have involved large prospective cohorts, and few have included a significant proportion of women and farm workers. Our aim was to compare cancer incidence in the cohort (overall, by sex, and by work on farm, occupational status and pesticide use) within the general population. METHODS More than 180,000 participants in the AGRICAN cohort were matched to cancer registries to identify cancer cases diagnosed from enrolment (2005-2007) to 31st December 2011. We calculated standardized incidence ratios (SIRs) and 95% confidence intervals (95%CIs). RESULTS Over the period, 11,067 incident cancer cases were identified (7304 men and 3763 women). Overall cancer incidence did not differ between the cohort and the general population. Moreover, SIRs were significantly higher for prostate cancer (SIR=1.07, 95%CI 1.03-1.11) and non-Hodgkin lymphoma (SIR=1.09, 95%CI 1.01-1.18) among men, skin melanoma among women (SIR=1.23, 95%CI 1.05-1.43) and multiple myeloma (men: SIR=1.38, 95%CI 1.18-1.62; women: SIR=1.26, 95%CI 1.02-1.54). In contrast, SIRs were lower for upper aerodigestive tract and respiratory cancers. Increase in risk was greater in male farm workers for prostate and lip cancer, in female farm workers for skin melanoma, and in male farm owners for multiple myeloma. Moreover, incidence of multiple myeloma and skin melanoma was higher among male and female pesticide users respectively. CONCLUSION We found a decreased incidence for tobacco-related cancers and an increased incidence of prostate cancers, skin melanoma and multiple myeloma. Specific subgroups had a higher cancer incidence related to occupational status and pesticide use.
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Affiliation(s)
- Clémentine Lemarchand
- INSERM, UMR 1086 Cancers et Préventions, F-14076, Caen, France; Université de Caen Normandie, F-14032, Caen, France; Centre de Lutte Contre le Cancer François Baclesse, F-14076, Caen, France.
| | - Séverine Tual
- INSERM, UMR 1086 Cancers et Préventions, F-14076, Caen, France; Université de Caen Normandie, F-14032, Caen, France; Centre de Lutte Contre le Cancer François Baclesse, F-14076, Caen, France
| | - Noémie Levêque-Morlais
- INSERM, UMR 1086 Cancers et Préventions, F-14076, Caen, France; Université de Caen Normandie, F-14032, Caen, France; Centre de Lutte Contre le Cancer François Baclesse, F-14076, Caen, France
| | - Stéphanie Perrier
- INSERM, UMR 1086 Cancers et Préventions, F-14076, Caen, France; Université de Caen Normandie, F-14032, Caen, France; Centre de Lutte Contre le Cancer François Baclesse, F-14076, Caen, France
| | - Aurélien Belot
- Hospices Civils de Lyon, Service de Biostatistique, F-69003, Lyon, France
| | - Michel Velten
- Registre des Cancers du Bas-Rhin, Faculté de Médecine, Université de Strasbourg, F-67085, Strasbourg, France
| | - Anne-Valérie Guizard
- INSERM, UMR 1086 Cancers et Préventions, F-14076, Caen, France; Registre Général des Tumeurs du Calvados, Centre François Baclesse, F-14076, Caen, France
| | - Elisabeth Marcotullio
- Caisse Centrale de la Mutualité Sociale Agricole, Direction de la santé sécurité au travail, F-93547, Bagnolet, France
| | - Alain Monnereau
- Registre des hémopathies malignes de la Gironde, F-33076, Bordeaux, France; INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health Center, EPICENE team, F-33076, Bordeaux, France; Université de Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health Center, EPICENE Team, F-33000, Bordeaux, France
| | - Bénédicte Clin
- INSERM, UMR 1086 Cancers et Préventions, F-14076, Caen, France; Université de Caen Normandie, F-14032, Caen, France; CHU de Caen, Service de Pathologie Professionnelle, F-14033, Caen, France
| | - Isabelle Baldi
- INSERM, ISPED, Centre INSERM U1219-Bordeaux Population Health Center, EPICENE team, F-33076, Bordeaux, France; Service de Médecine du Travail et Pathologies professionnelles, CHU de Bordeaux, F-33000, Bordeaux, France; Université de Bordeaux, ISPED, Centre INSERM U1219-Bordeaux Population Health Center, EPICENE Team, F-33000, Bordeaux, France
| | - Pierre Lebailly
- INSERM, UMR 1086 Cancers et Préventions, F-14076, Caen, France; Université de Caen Normandie, F-14032, Caen, France; Centre de Lutte Contre le Cancer François Baclesse, F-14076, Caen, France
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Giorgi Rossi P, Carrozzi G, Federici A, Mancuso P, Sampaolo L, Zappa M. Invitation coverage and participation in Italian cervical, breast and colorectal cancer screening programmes. J Med Screen 2017; 25:17-23. [DOI: 10.1177/0969141317704476] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives In Italy, regional governments organize cervical, breast and colorectal cancer screening programmes, but there are difficulties in regularly inviting all the target populations and participation remains low. We analysed the determinants associated with invitation coverage of and participation in these programmes. Methods We used data on screening programmes from annual Ministry of Health surveys, 1999–2012 for cervical, 1999–2011 for breast and 2005–2011 for colorectal cancer. For recent years, we linked these data to the results of the national routine survey on preventive behaviours to evaluate the effect of spontaneous screening at Province level. Invitation and participation relative risk were calculated using Generalized Linear Models. Results There is a strong decreasing trend in invitation coverage and participation in screening programmes from North to South Italy. In metropolitan areas, both invitation coverage (rate ratio 0.35–0.96) and participation (rate ratio 0.63–0.88) are lower. An inverse association exists between spontaneous screening and both screening invitation coverage (1–3% decrease in invitation coverage per 1% spontaneous coverage increase) and participation (2% decrease in participation per 1% spontaneous coverage increase) for the three programmes. High recall rate has a negative effect on invitation coverage in the next round for breast cancer (1% decrease in invitation per 1% recall increase). Conclusions Organizational and cultural changes are needed to better implement cancer screening in southern Italy.
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Affiliation(s)
- Paolo Giorgi Rossi
- Servizio Interaziendale di Epidemiologia, AUSL, Reggio Emilia, Italy
- Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Giuliano Carrozzi
- Servizio di Epidemiologia e Comunicazione del rischio, AUSL, Modena, Italy
- PASSI Survey Technical Group, Istituto Superiore di Sanità, Rome, Italy
| | | | - Pamela Mancuso
- Servizio Interaziendale di Epidemiologia, AUSL, Reggio Emilia, Italy
- Arcispedale Santa Maria Nuova, IRCCS, Reggio Emilia, Italy
| | - Letizia Sampaolo
- Servizio di Epidemiologia e Comunicazione del rischio, AUSL, Modena, Italy
| | - Marco Zappa
- Istituto per lo Studio e la Prevenzione Oncologica, Florence, Italy
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de Groot F, Capri S, Castanier JC, Cunningham D, Flamion B, Flume M, Herholz H, Levin LÅ, Solà-Morales O, Rupprecht CJ, Shalet N, Walker A, Wong O. Ethical Hurdles in the Prioritization of Oncology Care. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:119-126. [PMID: 27766548 PMCID: PMC5343076 DOI: 10.1007/s40258-016-0288-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
With finite resources, healthcare payers must make difficult choices regarding spending and the ethical distribution of funds. Here, we describe some of the ethical issues surrounding inequity in healthcare in nine major European countries, using cancer care as an example. To identify relevant studies, we conducted a systematic literature search. The results of the literature review suggest that although prevention, access to early diagnosis, and radiotherapy are key factors associated with good outcomes in oncology, public and political attention often focusses on the availability of pharmacological treatments. In some countries this focus may divert funding towards cancer drugs, for example through specific cancer drugs funds, leading to reduced expenditure on other areas of cancer care, including prevention, and potentially on other diseases. In addition, as highly effective, expensive agents are developed, the use of value-based approaches may lead to unacceptable impacts on health budgets, leading to a potential need to re-evaluate current cost-effectiveness thresholds. We anticipate that the question of how to fund new therapies equitably will become even more challenging in the future, with the advent of expensive, innovative, breakthrough treatments in other therapeutic areas.
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Affiliation(s)
- Folkert de Groot
- ToendersdeGroot B.V, Boomstede 281, 3608 AN, Maarssen, The Netherlands.
| | - Stefano Capri
- School of Economics and Management, LIUC University, Castellanza, Italy
| | | | | | | | - Mathias Flume
- Kassenärztliche Vereinigung Westfalen Lippe, Dortmund, Germany
| | | | - Lars-Åke Levin
- Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Tuppin P, Pestel L, Samson S, Cuerq A, Rivière S, Tala S, Denis P, Drouin J, Gissot C, Gastaldi-Ménager C, Fagot-Campagna A. [The human and economic burden of cancer in France in 2014, based on the Sniiram national database]. Bull Cancer 2017; 104:524-537. [PMID: 28285755 DOI: 10.1016/j.bulcan.2017.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/06/2016] [Accepted: 01/26/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The national health insurance information system (Sniiram) can be used to estimate the national medical and economic burden of cancer. This study reports the annual rates, characteristics and expenditure of people reimbursed for cancer. METHODS Among 57 million general health scheme beneficiaries (86% of the French population), people managed for cancer were identified using algorithms based on hospital diagnoses and full refund for long-term cancer. The reimbursed costs (euros) related to the cancer, paid off by the health insurance, were estimated. RESULTS In 2014, 2.491 million people (4.4%) covered by the general health scheme had a cancer managed (men 1.1 million, 5.1%; women 1.3 million, 4.9%). The annual (2012-2014) average growth rate of patients was 0.8%. The spending related to the cancer was 13.5 billion: 5 billion for primary health care (drugs 2.3 billion), 7.5 billion for the hospital (drugs 1.3 billions) and 900 million for sick leave and invalidity pensions. Spending annual average growth rate (2012-2014) was 4% (drugs 2%). The rates of patients and the relative spending were 1.8% and 2.5 billion for the breast cancer (women), 1.5% and 1.0 billion for prostate cancer, 0.9% and 1.5 billion for the colon cancer, and 0.19% and 1.3 billion for lung cancer. DISCUSSION Cancers establish one of the first groups of chronic diseases pathologies in terms of patients and spending. If the numbers of patients remain stables, the spending increases, mainly for medicines.
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Affiliation(s)
- Philippe Tuppin
- Caisse nationale d'assurance maladie des travailleurs salariés (CNAMTS), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris, France.
| | - Laurence Pestel
- Caisse nationale d'assurance maladie des travailleurs salariés (CNAMTS), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris, France
| | - Solène Samson
- Caisse nationale d'assurance maladie des travailleurs salariés (CNAMTS), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris, France
| | - Anne Cuerq
- Caisse nationale d'assurance maladie des travailleurs salariés (CNAMTS), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris, France
| | - Sébastien Rivière
- Caisse nationale d'assurance maladie des travailleurs salariés (CNAMTS), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris, France
| | - Stéphane Tala
- Caisse nationale d'assurance maladie des travailleurs salariés (CNAMTS), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris, France
| | - Pierre Denis
- Caisse nationale d'assurance maladie des travailleurs salariés (CNAMTS), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris, France
| | - Jérôme Drouin
- Caisse nationale d'assurance maladie des travailleurs salariés (CNAMTS), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris, France
| | - Claude Gissot
- Caisse nationale d'assurance maladie des travailleurs salariés (CNAMTS), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris, France
| | - Christelle Gastaldi-Ménager
- Caisse nationale d'assurance maladie des travailleurs salariés (CNAMTS), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris, France
| | - Anne Fagot-Campagna
- Caisse nationale d'assurance maladie des travailleurs salariés (CNAMTS), 26-50, avenue du Professeur-André-Lemierre, 75986 Paris, France
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Auguste A, Cortet M, Dabakuyo-Yonli TS, Launay L, Arnould L, Desmoulins I, Roignot P, Darut-Jouve A, Poillot ML, Bertaut A, Arveux P. Breast cancer subtype of French women is not influenced by socioeconomic status: A population-based-study. PLoS One 2017; 12:e0170069. [PMID: 28199325 PMCID: PMC5310911 DOI: 10.1371/journal.pone.0170069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 12/28/2016] [Indexed: 01/08/2023] Open
Abstract
Context The molecular subtype of breast tumours plays a major role in cancer prognosis and treatment options. Triple negative tumours (TN) carry the worst prognosis and affects most frequently women of low socioeconomic status (SES). Studies have shown that non-biologic factors, such as the socioeconomic status could have an influence on tumour biology. To this date no study has been done investigating this association in French women. The objective is to study the association between the SES and the molecular tumour subtype of breast cancer patients in the French county of Côte d’Or. This study benefits from the population data from the Côte d’Or breast cancer registry known for its strict quality control policy. Methods Invasive breast cancer cases between 2003 and 2013 were extracted from the Breast cancer registry database in Côte d’Or. A multivariate analysis was conducted using a hierarchical polytomous regression for the multinomial outcomes for the cancer subtype with HR+/HER2 as reference category. Results A total of 4553 cases were included in our study. There was no significant association found between SES and tumour subtype in French women at diagnosis. Women older than 75 years were less likely to have a TN and HR+/HER2+ breast cancer (OR = 0.66; CI95% = [0.46–0.94] and OR = 0.51; CI95% = [0.37–0.70] respectively). Women with TN tumour subtype had significantly less lymph node invasion when compared to HR+/HER2- subtype (OR = 0.71; CI95% = [0.54–0.92]). Conclusion No significant association was found between socioeconomic status and molecular subtype. Further studies are needed to clarify the mechanisms associated with developing each tumour subtype.
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Affiliation(s)
- Aviane Auguste
- Breast and Gynaecologic Cancer Registry of Côte d’Or, Georges-François Leclerc Comprehensive Cancer Care Centre, 1 rue du Professeur Marion, Dijon, France
- EA 4184, Medical School, University of Burgundy, 7 boulevard Jeanne d’Arc, Dijon, France
| | - Marion Cortet
- Breast and Gynaecologic Cancer Registry of Côte d’Or, Georges-François Leclerc Comprehensive Cancer Care Centre, 1 rue du Professeur Marion, Dijon, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- Breast and Gynaecologic Cancer Registry of Côte d’Or, Georges-François Leclerc Comprehensive Cancer Care Centre, 1 rue du Professeur Marion, Dijon, France
- EA 4184, Medical School, University of Burgundy, 7 boulevard Jeanne d’Arc, Dijon, France
| | - Ludivine Launay
- Plateforme ERISC, U 1086 INSERM "Cancers and Preventions", François Baclesse Comprehensive Cancer Care Centre, 3 avenue du Général Harris, CAEN, France
| | - Laurent Arnould
- Breast and Gynaecologic Cancer Registry of Côte d’Or, Georges-François Leclerc Comprehensive Cancer Care Centre, 1 rue du Professeur Marion, Dijon, France
| | - Isabelle Desmoulins
- Breast and Gynaecologic Cancer Registry of Côte d’Or, Georges-François Leclerc Comprehensive Cancer Care Centre, 1 rue du Professeur Marion, Dijon, France
| | | | | | - Marie-Laure Poillot
- Breast and Gynaecologic Cancer Registry of Côte d’Or, Georges-François Leclerc Comprehensive Cancer Care Centre, 1 rue du Professeur Marion, Dijon, France
| | - Aurélie Bertaut
- EA 4184, Medical School, University of Burgundy, 7 boulevard Jeanne d’Arc, Dijon, France
- Biostatistics Unit, Georges-François Leclerc Comprehensive Cancer Care Centre, 1 rue du Professeur Marion, Dijon, France
| | - Patrick Arveux
- Breast and Gynaecologic Cancer Registry of Côte d’Or, Georges-François Leclerc Comprehensive Cancer Care Centre, 1 rue du Professeur Marion, Dijon, France
- EA 4184, Medical School, University of Burgundy, 7 boulevard Jeanne d’Arc, Dijon, France
- * E-mail:
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Kilpeläinen TP, Talala K, Raitanen J, Taari K, Kujala P, Tammela TLJ, Auvinen A. Prostate Cancer and Socioeconomic Status in the Finnish Randomized Study of Screening for Prostate Cancer. Am J Epidemiol 2016; 184:720-731. [PMID: 27777219 DOI: 10.1093/aje/kww084] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 07/18/2016] [Indexed: 01/09/2023] Open
Abstract
Prostate cancer (PC) screening remains controversial. We investigated whether screening reduces the difference in prostate cancer risk by socioeconomic status (SES). In 1996-2011, a total of 72,139 men from the Finnish Randomized Study of Screening for Prostate Cancer were analyzed. Outcome measures were PC incidence, mortality, and participation in screening. SES indicators were educational level, income, and home ownership status (data obtained from the Statistics Finland registry). The mean duration of follow-up was 12.7 years. Higher SES was associated with a higher incidence of low- to moderate-risk PC but with a lower risk of advanced PC. Higher education was associated with significantly lower PC mortality in both control and screening arms (risk ratio = 0.48-0.69; P < 0.05). Higher income was also associated with lower PC mortality but only in the control arm (risk ratio = 0.45-0.73; P < 0.05). There were no significant differences in SES gradient by arm (Pinteraction = 0.33 and Pinteraction = 0.47 for primary vs. secondary education and primary vs. tertiary education, respectively; Pinteraction = 0.65 and Pinteraction = 0.09 for low vs. intermediate income and low vs. high income, respectively; and Pinteraction = 0.27 among home ownership status strata). Substantial gradients by SES in PC incidence and mortality were observed in the control arm. Higher SES was associated with overdiagnosis of low-risk PC and, conversely, lower risk of incurable PC and lower PC mortality. Special attention should be directed toward recruiting men with low SES to participate in population-based cancer screening.
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Moriceau G, Bourmaud A, Tinquaut F, Oriol M, Jacquin JP, Fournel P, Magné N, Chauvin F. Social inequalities and cancer: can the European deprivation index predict patients' difficulties in health care access? a pilot study. Oncotarget 2016; 7:1055-65. [PMID: 26540571 PMCID: PMC4808051 DOI: 10.18632/oncotarget.6274] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/30/2015] [Indexed: 12/04/2022] Open
Abstract
Context The European Deprivation Index (EDI), is a new ecological estimate for Socio-Economic Status (SES). This study postulates that Time-To-Treatment could be used as a cancer quality-of -care surrogate in order to identify the association between cancer patient's SES and quality of care in a French comprehensive cancer center. Methods retrospective mono-centered cohort study. All consecutive incoming adult patients diagnosed for breast cancer(BC), prostate cancer(PC), colorectal cancer (CRC), lung cancer(LC) or sarcoma(S) were included between January 2013 and December 2013. The association of EDI and Time-To-Diagnosis(TTD), as well as Time-To-Treatment(TTT) was analyzed using a cox regression, and a strata analysis per tumor site was performed. Results 969 patients were included. Primitive tumor site was 505 BC(52%), 169 PC(17%), 145 LC(15%), 116 CRC(12%), and 34 S(4%). Median TTD was 1.41 months (Q1-Q3 0.5 to 3.5 months). Median TTT was 0.9 months (0.4 - 1.4). In a multivariate analysis, we identified the tumor site as a predictive factor to influence TTD, shorter for BC (0.75months, [0.30- 1.9]) than PC (4.69 months [1.6-29.7]), HR 0.27 95%CI= [0.22-0.34], p < 0.001. TTT was also shorter for BC (0.75months [0.4-1.1]) than PC (2.02 [0.9-3.2]), HR 0.32 95%CI= [0.27-0.39], p < 0.001. EDI quintiles were not found associated with either TTT or TTD. Conclusions Deprivation estimated by the EDI does not appear to be related to an extension of the Time-to-Diagnosis or Time-to-Treatment in our real-life population. Further research should be done to identify other frailty-sensitive factors that could be responsible for delays in care.
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Affiliation(s)
- Guillaume Moriceau
- Medical Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.,Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Aurélie Bourmaud
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.,Therapeutic Targeting in Oncology, EMR3738, Claude Bernard University, Lyon, France
| | - Fabien Tinquaut
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Mathieu Oriol
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | | | - Pierre Fournel
- Medical Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Nicolas Magné
- Radiation Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Franck Chauvin
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.,Therapeutic Targeting in Oncology, EMR3738, Claude Bernard University, Lyon, France.,Clinical Investigation Center and Clinical Epidemiology, Jean Monnet University, Saint-Etienne, France
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Walsh EI, Turner EL, Lane JA, Donovan JL, Neal DE, Hamdy FC, Martin RM. Characteristics of men responding to an invitation to undergo testing for prostate cancer as part of a randomised trial. Trials 2016; 17:497. [PMID: 27737692 PMCID: PMC5064919 DOI: 10.1186/s13063-016-1624-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 09/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sociodemographic characteristics are associated with participating in cancer screening and trials. We compared the characteristics of those responding with those not responding to a single invitation for prostate-specific antigen (PSA) testing for prostate cancer as part of the Cluster randomised triAl of PSA testing for Prostate cancer (CAP). METHODS Age, rurality and deprivation among 197,763 men from 271 cluster-randomised primary care centres in the UK were compared between those responding (n = 90,300) and those not responding (n = 100,953) to a prostate cancer testing invitation. RESULTS There was little difference in age between responders and nonresponders. Responders were slightly more likely to come from urban rather than rural areas and were slightly less deprived than those who did not respond. CONCLUSION These data indicate similarities in age and only minor differences in deprivation and urban location between responders and nonresponders. These differences were smaller, but in the same direction as those observed in other screening trials. TRIAL REGISTRATION ISRCTN92187251 . Registered on 29 November 2004.
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Affiliation(s)
- Eleanor I. Walsh
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Emma L. Turner
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - J. Athene Lane
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - Jenny L. Donovan
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - David E. Neal
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Freddie C. Hamdy
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, OX3 9DU UK
| | - Richard M. Martin
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
| | - and the CAP & ProtecT Trial Groups
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS UK
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, Oxford, OX3 9DU UK
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Delaloge S, Bonastre J, Borget I, Garbay JR, Fontenay R, Boinon D, Saghatchian M, Mathieu MC, Mazouni C, Rivera S, Uzan C, André F, Dromain C, Boyer B, Pistilli B, Azoulay S, Rimareix F, Bayou EH, Sarfati B, Caron H, Ghouadni A, Leymarie N, Canale S, Mons M, Arfi-Rouche J, Arnedos M, Suciu V, Vielh P, Balleyguier C. The challenge of rapid diagnosis in oncology: Diagnostic accuracy and cost analysis of a large-scale one-stop breast clinic. Eur J Cancer 2016; 66:131-7. [PMID: 27569041 DOI: 10.1016/j.ejca.2016.06.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 05/30/2016] [Accepted: 06/25/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE Rapid diagnosis is a key issue in modern oncology, for which one-stop breast clinics are a model. We aimed to assess the diagnosis accuracy and procedure costs of a large-scale one-stop breast clinic. PATIENTS AND METHODS A total of 10,602 individuals with suspect breast lesions attended the Gustave Roussy's regional one-stop breast clinic between 2004 and 2012. The multidisciplinary clinic uses multimodal imaging together with ultrasonography-guided fine needle aspiration for masses and ultrasonography-guided and stereotactic biopsies as needed. Diagnostic accuracy was assessed by comparing one-stop diagnosis to the consolidated diagnosis obtained after surgery or biopsy or long-term monitoring. The medical cost per patient of the care pathway was assessed from patient-level data collected prospectively. RESULTS Sixty-nine percent of the patients had masses, while 31% had micro-calcifications or other non-mass lesions. In 75% of the cases (87% of masses), an exact diagnosis could be given on the same day. In the base-case analysis (i.e. considering only benign and malignant lesions at one-stop and at consolidated diagnoses), the sensitivity of the one-stop clinic was 98.4%, specificity 99.8%, positive and negative predictive values 99.7% and 99.0%. In the sensitivity analysis (reclassification of suspect, atypical and undetermined lesions), diagnostic sensitivity varied from 90.3% to 98.5% and specificity varied from 94.3% to 99.8%. The mean medical cost per patient of one-stop diagnostic procedure was €420. CONCLUSIONS One-stop breast clinic can provide timely and cost-efficient delivery of highly accurate diagnoses and serve as models of care for multiple settings, including rapid screening-linked diagnosis.
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Affiliation(s)
- Suzette Delaloge
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France.
| | - Julia Bonastre
- Gustave Roussy, Université Paris-Saclay, Department of Biostatistics, Epidemiology and Health Economics, Villejuif, F-94805, France; INSERM U1018, CESP Centre for Research in Epidemiology and Population Health, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Isabelle Borget
- Gustave Roussy, Université Paris-Saclay, Department of Biostatistics, Epidemiology and Health Economics, Villejuif, F-94805, France; INSERM U1018, CESP Centre for Research in Epidemiology and Population Health, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Jean-Rémi Garbay
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Rachel Fontenay
- Gustave Roussy, Université Paris-Saclay, Department of Biostatistics, Epidemiology and Health Economics, Villejuif, F-94805, France; INSERM U1018, CESP Centre for Research in Epidemiology and Population Health, Université Paris-Sud, Université Paris-Saclay, Villejuif, France
| | - Diane Boinon
- Gustave Roussy, Université Paris-Saclay, Department of Supportive Care, Villejuif, F-94805, France
| | - Mahasti Saghatchian
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Marie-Christine Mathieu
- Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France
| | - Chafika Mazouni
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Sofia Rivera
- Gustave Roussy, Université Paris-Saclay, Department of Radiation Therapy, Villejuif, F-94805, France
| | - Catherine Uzan
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Fabrice André
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Clarisse Dromain
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Bruno Boyer
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Barbara Pistilli
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Sandy Azoulay
- Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France
| | - Françoise Rimareix
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - El-Hadi Bayou
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Benjamin Sarfati
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Hélène Caron
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Amal Ghouadni
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Nicolas Leymarie
- Gustave Roussy, Université Paris-Saclay, Department of Surgery, Villejuif, F-94805, France
| | - Sandra Canale
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Muriel Mons
- Gustave Roussy, Université Paris-Saclay, Department of Medical Information, Villejuif, F-94805, France
| | - Julia Arfi-Rouche
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
| | - Monica Arnedos
- Gustave Roussy, Université Paris-Saclay, Department of Medical Oncology, Villejuif, F-94805, France
| | - Voichita Suciu
- Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France
| | - Philippe Vielh
- Gustave Roussy, Université Paris-Saclay, Department of Pathology, Villejuif, F-94805, France
| | - Corinne Balleyguier
- Gustave Roussy, Université Paris-Saclay, Department of Radiology, Villejuif, F-94805, France
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Delaloge S, Bachelot T, Bidard FC, Espie M, Brain E, Bonnefoi H, Gligorov J, Dalenc F, Hardy-Bessard AC, Azria D, Jacquin JP, Lemonnier J, Jacot W, Goncalves A, Coutant C, Ganem G, Petit T, Penault-Llorca F, Debled M, Campone M, Levy C, Coudert B, Lortholary A, Venat-Bouvet L, Grenier J, Bourgeois H, Asselain B, Arvis J, Castro M, Tardivon A, Cox DG, Arveux P, Balleyguier C, André F, Rouzier R. [Breast cancer screening: On our way to the future]. Bull Cancer 2016; 103:753-63. [PMID: 27473920 DOI: 10.1016/j.bulcan.2016.06.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 06/02/2016] [Accepted: 06/19/2016] [Indexed: 01/24/2023]
Abstract
Breast cancer remains a potentially lethal disease, which requires aggressive treatments and is associated with long-term consequences. Its prognosis is linked to both tumor biology and burden at diagnosis. Although treatments have allowed important improvements in prognosis over the past 20 years, breast cancer screening remains necessary. Mammographic screening allows earlier stage diagnoses and a decrease of breast cancer specific mortality. However, breast cancer screening modalities should be revised with the objective to address demonstrated limitations of mammographic screening (limited benefit, imperfect sensitivity and specificity, overdiagnoses, radiation-induced morbidity). Furthermore, both objective and perceived performances of screening procedures should be improved. Numerous large international efforts are ongoing, leading to scientific progresses that should have rapid clinical implications in this area. Among them is improvement of imaging techniques performance, development of real time diagnosis, and development of new non radiological screening techniques such as the search for circulating tumor DNA, development of biomarkers able to allow precise risk evaluation and stratified screening. As well, overtreatment is currently addressed by biomarker-based de-escalation clinical trials. These advances need to be associated with strong societal support, as well as major paradigm changes regarding the way health and cancer prevention is perceived by individuals.
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Affiliation(s)
- Suzette Delaloge
- Université Paris Saclay, institut Gustave-Roussy, département de médecine oncologique, Inserm U981, 114, rue Edouard-Vaillant, 94800 Villejuif, France.
| | - Thomas Bachelot
- Centre Léon-Bérard, département de cancérologie médicale, 28, rue Laënnec, 69008 Lyon cedex 08, France
| | - François-Clément Bidard
- Université de recherche Paris, sciences et lettres, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - Marc Espie
- Hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - Etienne Brain
- Institut Curie, Saint-Cloud, 35, rue Dailly, 92210 Saint-Cloud, France; Université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France
| | - Hervé Bonnefoi
- Université de Bordeaux, institut Bergonie, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Joseph Gligorov
- Hôpital Tenon, université Paris-Sorbonne, Inserm U938, 4, rue de la Chine, 75020 Paris, France
| | - Florence Dalenc
- Institut universitaire du cancer-Toulouse oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | | | - David Azria
- Université de Montpellier, institut du cancer, IRCM U1194, 34298 Montpellier, France
| | - Jean-Philippe Jacquin
- Institut de cancérologie de la Loire, 108 B, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France
| | | | - William Jacot
- Université de Montpellier, institut du cancer, IRCM U1194, 34298 Montpellier, France
| | - Anthony Goncalves
- Université Aix-Marseille, institut Paoli-Calmettes, Inserm U1068, 232, boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Charles Coutant
- Université de Bourgogne, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21000 Dijon, France
| | - Gérard Ganem
- Centre Jean-Bernard, 9, rue Beauverger, 72000 Le Mans, France
| | - Thierry Petit
- Université de Strasbourg, centre Paul-Strauss, 3, rue de la Porte-de-l'Hôpital, 67000 Strasbourg, France
| | | | - Marc Debled
- Université de Bordeaux, institut Bergonie, 229, cours de l'Argonne, 33000 Bordeaux, France
| | - Mario Campone
- Institut d'oncologie de l'Ouest, Inserm U892, IRT-UN, 8, quai Moncousu, 44007 Nantes cedex, France
| | - Christelle Levy
- Centre François-Baclesse, 3, avenue du Général-Harris, 14000 Caen, France
| | - Bruno Coudert
- Université de Bourgogne, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21000 Dijon, France
| | - Alain Lortholary
- Centre Catherine-de-Sienne, 2, rue Éric-Tabarly, 44202 Nantes, France
| | - Laurence Venat-Bouvet
- CHU de Limoges, service d'oncologie médicale, 22, avenue Martin-Luther-King, 87000 Limoges, France
| | - Julien Grenier
- Institut Sainte-Catherine, 250, chemin de Baignes-Pieds, 84918 Avignon cedex 9, France
| | | | | | - Johanna Arvis
- Ligue nationale contre le cancer, comité du Lot, 28, boulevard Gambetta, 46000 Cahors, France
| | - Martine Castro
- Europadonna France, 14, rue Corvisart, 75013 Paris, France
| | - Anne Tardivon
- Université de recherche Paris, sciences et lettres, institut Curie, 26, rue d'Ulm, 75005 Paris, France
| | - David G Cox
- Université de Lyon, 69000 Lyon, France; Université Lyon 1, 69100 Villeurbanne, France; Centre de recherche en cancérologie de Lyon, Inserm U1052, CNRS UMR5286, 69000 Lyon, France; Centre Léon-Bérard, 69008 Lyon, France
| | - Patrick Arveux
- Registre de Côte d'Or, centre Georges-François-Leclerc, 1, rue du Pr-Marion, 21000 Dijon, France
| | - Corinne Balleyguier
- Institut Gustave-Roussy, département d'imagerie médicale, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Fabrice André
- Université Paris Saclay, institut Gustave-Roussy, département de médecine oncologique, Inserm U981, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Roman Rouzier
- Université de recherche Paris, sciences et lettres, institut Curie, 26, rue d'Ulm, 75005 Paris, France; Institut Curie, Saint-Cloud, 35, rue Dailly, 92210 Saint-Cloud, France; Université Versailles-Saint-Quentin, 78180 Montigny-le-Bretonneux, France
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Rasmussen M, Poulsen EK, Rytter AS, Kristiansen TM, Bak CK. Experiences with Recruitment of Marginalized Groups in a Danish Health Promotion Program: A Document Evaluation Study. PLoS One 2016; 11:e0158079. [PMID: 27336787 PMCID: PMC4919014 DOI: 10.1371/journal.pone.0158079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/09/2016] [Indexed: 11/18/2022] Open
Abstract
Background Studies have found that marginalized groups living in deprived neighborhoods are less likely to participate in health programs compared to the majority of society. This study evaluates recruitment approaches conducted during a national government-funded project in 12 deprived neighborhoods across Denmark between 2010 and 2014. The aim of this study was to understand how recruitment approaches could promote participation in health programs within deprived neighborhoods to reach marginalized groups. Method Documents from all 12 of the included municipalities were collected to conduct a document evaluation. The collected documents consisted of 1,500 pages of written material with 12 project descriptions, three midterm and 10 final evaluations. The collected data were analyzed through a qualitative content analysis. Results The results are based on the fact that only 10 municipalities have developed evaluations related to recruitment, and only three evaluations provided a description of which marginalized groups were recruited. Challenges related to recruitment consist of difficulties involving the target group, including general distrust, language barriers and a lack of ability to cope with new situations and strangers. Additional geographical challenges emerged, especially in rural areas. Positive experiences with recruitment approaches were mainly related to relationship building and trust building, especially through face-to-face contact and the project employees’ presence in the neighborhood. Additionally, adjusting some of the interventions and the recruitment strategy increased participation. Conclusion This study found that relation and trust between the residents and the project employees is an important factor in the recruitment of marginalized groups in deprived neighborhoods as well as adjusting the health interventions or recruitment strategy to the target groups. In future research, it is necessary to examine which recruitment approaches are effective under which circumstances to increase participation among marginalized groups.
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Affiliation(s)
- Marianne Rasmussen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- * E-mail:
| | - Eva Kanstrup Poulsen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Guillaume E, Pornet C, Dejardin O, Launay L, Lillini R, Vercelli M, Marí-Dell'Olmo M, Fernández Fontelo A, Borrell C, Ribeiro AI, de Pina MF, Mayer A, Delpierre C, Rachet B, Launoy G. Development of a cross-cultural deprivation index in five European countries. J Epidemiol Community Health 2016; 70:493-9. [PMID: 26659762 PMCID: PMC4853548 DOI: 10.1136/jech-2015-205729] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 10/25/2015] [Accepted: 11/13/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite a concerted policy effort in Europe, social inequalities in health are a persistent problem. Developing a standardised measure of socioeconomic level across Europe will improve the understanding of the underlying mechanisms and causes of inequalities. This will facilitate developing, implementing and assessing new and more effective policies, and will improve the comparability and reproducibility of health inequality studies among countries. This paper presents the extension of the European Deprivation Index (EDI), a standardised measure first developed in France, to four other European countries-Italy, Portugal, Spain and England, using available 2001 and 1999 national census data. METHODS AND RESULTS The method previously tested and validated to construct the French EDI was used: first, an individual indicator for relative deprivation was constructed, defined by the minimal number of unmet fundamental needs associated with both objective (income) poverty and subjective poverty. Second, variables available at both individual (European survey) and aggregate (census) levels were identified. Third, an ecological deprivation index was constructed by selecting the set of weighted variables from the second step that best correlated with the individual deprivation indicator. CONCLUSIONS For each country, the EDI is a weighted combination of aggregated variables from the national census that are most highly correlated with a country-specific individual deprivation indicator. This tool will improve both the historical and international comparability of studies, our understanding of the mechanisms underlying social inequalities in health and implementation of intervention to tackle social inequalities in health.
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Affiliation(s)
- Elodie Guillaume
- French Institute of Health and Medical Research—Caen University, U1086 “Cancers & Préventions”, Caen, France
| | - Carole Pornet
- French Institute of Health and Medical Research—Caen University, U1086 “Cancers & Préventions”, Caen, France
- Pôle Recherche, University Hospital of Caen, Caen, France
| | - Olivier Dejardin
- French Institute of Health and Medical Research—Caen University, U1086 “Cancers & Préventions”, Caen, France
- Pôle Recherche, University Hospital of Caen, Caen, France
| | - Ludivine Launay
- French Institute of Health and Medical Research—Caen University, U1086 “Cancers & Préventions”, Caen, France
- Centre François Baclesse, Avenue du Général Harris—BP5026, Caen, France
| | - Roberto Lillini
- Department of Sociology, PhD School in Applied Sociology and Methodology of Research, University of Milan-Bicocca, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Marina Vercelli
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Marc Marí-Dell'Olmo
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | | | - Carme Borrell
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Ana Isabel Ribeiro
- Instituto de Engenharia Biomédica—INEB, Universidade do Porto—Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública, Faculdade de Medicina do Porto, Universidade do Porto—Instituto de Saúde Pública da Universidade do Porto—ISPUP, Porto, Portugal
| | - Maria Fatima de Pina
- Instituto de Engenharia Biomédica—INEB, Universidade do Porto—Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública, Faculdade de Medicina do Porto, Universidade do Porto—Instituto de Saúde Pública da Universidade do Porto—ISPUP, Porto, Portugal
| | | | - Cyrille Delpierre
- INSERM, U1027, Toulouse F-31300, Toulouse, France
- Université Toulouse III Paul-Sabatier, UMR1027, Toulouse F-31300, Toulouse, France
| | - Bernard Rachet
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Guy Launoy
- French Institute of Health and Medical Research—Caen University, U1086 “Cancers & Préventions”, Caen, France
- Pôle Recherche, University Hospital of Caen, Caen, France
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Orsini M, Trétarre B, Daurès JP, Bessaoud F. Individual socioeconomic status and breast cancer diagnostic stages: a French case–control study. Eur J Public Health 2016; 26:445-50. [DOI: 10.1093/eurpub/ckv233] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Lagerlund M, Merlo J, Vicente RP, Zackrisson S. Does the Neighborhood Area of Residence Influence Non-Attendance in an Urban Mammography Screening Program? A Multilevel Study in a Swedish City. PLoS One 2015; 10:e0140244. [PMID: 26460609 PMCID: PMC4604149 DOI: 10.1371/journal.pone.0140244] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 09/23/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND AIM The public health impact of population-based mammography screening programs depends on high participation rates. Thus, monitoring participation rates, as well as understanding and considering the factors influencing attendance, is important. With the goal to acquire information on the appropriate level of intervention for increasing screening participation our study aimed to (1) examine whether, over and above individual factors, the neighborhood of residence influences a woman's mammography non-attendance, and (2) evaluate, whether knowing a woman's neighborhood of residence would be sufficient to predict non-attendance. METHODS We analyze all women invited to mammography screening in 2005-09, residing in the city of Malmö, Sweden. Information regarding mammography screening attendance was linked to data on area of residence, demographic and socioeconomic characteristics available from Statistics Sweden. The influence of individual and neighborhood factors was assessed by multilevel logistic regression analysis with 29,901 women nested within 212 neighborhoods. RESULTS The prevalence of non-attendance among women was 18.3%. After adjusting for individual characteristics, the prevalence in the 212 neighborhoods was 3.6%. Neighborhood of residence had little influence on non-attendance. The multilevel analysis indicates that 8.4% of the total individual differences in the propensity of non-attendance were at the neighborhood level. However, when adjusting for specific individual characteristics this general contextual effect decreased to 1.8%. This minor effect was explained by the sociodemographic characteristic of the neighborhoods. The discriminatory accuracy of classifying women according to their non-attendance was 0.747 when considering only individual level variables, and 0.760 after including neighborhood level as a random effect. CONCLUSION Our results suggest that neighborhoods of residence in Malmö, Sweden (as defined by small-area market statistics (SAMS) areas) do not condition women's participation in population based mammography screening. Thus, interventions should be directed to the whole city and target women with a higher risk of non-attendance.
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Affiliation(s)
- Magdalena Lagerlund
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Skåne University Hospital, Malmö, Sweden
- * E-mail:
| | - Juan Merlo
- Unit for Social Epidemiology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Raquel Pérez Vicente
- Unit for Social Epidemiology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Sophia Zackrisson
- Department of Translational Medicine, Diagnostic Radiology, Lund University, Skåne University Hospital, Malmö, Sweden
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Obertová Z, Hodgson F, Scott-Jones J, Brown C, Lawrenson R. Rural-Urban Differences in Prostate-Specific Antigen (PSA) Screening and Its Outcomes in New Zealand. J Rural Health 2015; 32:56-62. [DOI: 10.1111/jrh.12127] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Zuzana Obertová
- Waikato Clinical School; University of Auckland; Hamilton New Zealand
| | - Fraser Hodgson
- Waikato Clinical School; University of Auckland; Hamilton New Zealand
| | - Joseph Scott-Jones
- Department of General Practice and Primary Care; University of Auckland; Auckland New Zealand
| | - Charis Brown
- Waikato Clinical School; University of Auckland; Hamilton New Zealand
| | - Ross Lawrenson
- Waikato Clinical School; University of Auckland; Hamilton New Zealand
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Dialla PO, Arveux P, Ouedraogo S, Pornet C, Bertaut A, Roignot P, Janoray P, Poillot ML, Quipourt V, Dabakuyo-Yonli TS. Age-related socio-economic and geographic disparities in breast cancer stage at diagnosis: a population-based study. Eur J Public Health 2015; 25:966-72. [PMID: 25829506 DOI: 10.1093/eurpub/ckv049] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study aimed to determine the impact of socio-economic and geographic disparities on disease stage at diagnosis according to age in breast cancer (BC) patients. Secondary purpose was to describe survival METHODS All women with primary invasive BC, diagnosed from 1998 to 2009 in the department of Côte d'Or were retrospectively selected using data from the Côte d'Or BC registry. European transnational ecological deprivation index (French European Deprivation Index) was used to measure the socio-economic environment. Relationships between socio-geographic deprivation and disease stage at diagnosis according to age were assessed by a multilevel ordered logistic regression model. Relative survival rates (RSRs) were given at 5 years according to tumour and patients characteristics. RESULTS In total, 4364 women were included. In multivariable analysis, socio-economic deprivation was associated with disease stage at diagnosis. Women aged between 50 and 74 years and living in deprived areas were more often diagnosed with advanced tumour stages (stages II/III vs. I or stages IV vs. II/III) with odds ratio = 1.27 (1.01-1.60). RSRs were lowest in women living in the most deprived area compared with those living in most affluent area with RSR = 88.4% (85.9-90.4) and 92.6% (90.5-94.2), respectively. CONCLUSIONS Socio-economic factors affected tumour stage at diagnosis and survival. Living in a deprived area was linked to advanced-stage BC at diagnosis only in women aged 50-74 years. This is probably due to the socio-economic disparities in participation in organized BC screening programmes. Furthermore, living in deprived area was associated with a poor survival rate.
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Affiliation(s)
- Pegdwende O Dialla
- 1 Breast and Gynaecologic Cancer Registry of Côte d'Or, Department of Medical Information Centre Georges François Leclerc comprehensive cancer centre, Dijon, France 2 EA 4184, Medical School University of Burgundy, Dijon, France
| | - Patrick Arveux
- 1 Breast and Gynaecologic Cancer Registry of Côte d'Or, Department of Medical Information Centre Georges François Leclerc comprehensive cancer centre, Dijon, France 2 EA 4184, Medical School University of Burgundy, Dijon, France
| | - Samiratou Ouedraogo
- 1 Breast and Gynaecologic Cancer Registry of Côte d'Or, Department of Medical Information Centre Georges François Leclerc comprehensive cancer centre, Dijon, France 2 EA 4184, Medical School University of Burgundy, Dijon, France
| | - Carole Pornet
- 3 Department of Epidemiological Research and Evaluation, CHU de Caen, France 4 EA3936, Medical School, Université de Caen Basse-Normandie, Caen, France 5 U1086 Inserm, Cancers and Preventions, Medical School, Université de Caen Basse-Normandie, Avenue de la Côte de Nacre, Caen, France
| | - Aurélie Bertaut
- 1 Breast and Gynaecologic Cancer Registry of Côte d'Or, Department of Medical Information Centre Georges François Leclerc comprehensive cancer centre, Dijon, France 2 EA 4184, Medical School University of Burgundy, Dijon, France
| | | | | | - Marie-Laure Poillot
- 1 Breast and Gynaecologic Cancer Registry of Côte d'Or, Department of Medical Information Centre Georges François Leclerc comprehensive cancer centre, Dijon, France 2 EA 4184, Medical School University of Burgundy, Dijon, France
| | - Valérie Quipourt
- 8 Coordination Unit in Geriatric oncology in Burgundy, Hôpital de jour Gériatrique, Hôpital de Champmaillot, Dijon, France
| | - Tienhan S Dabakuyo-Yonli
- 2 EA 4184, Medical School University of Burgundy, Dijon, France 9 Biostatistics and Quality of Life Unit, Department of Medical Information Centre Georges François Leclerc comprehensive cancer centre, Dijon, France
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Jones M, Ross B, Cloth A, Heller L. Interventions to reach underscreened populations: a narrative review for planning cancer screening initiatives. Int J Public Health 2015; 60:437-47. [PMID: 25712244 DOI: 10.1007/s00038-015-0666-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 02/10/2015] [Accepted: 02/13/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES This review was conducted to support knowledge translation (KT) and implementation of interventions to increase participation in organized cancer screening programs in the province of Ontario, Canada. METHODS A rigorously designed literature search yielded over 900 references which were then subjected to exclusion criteria. The remainder was organized according to type of intervention, based on the categories applied in two authoritative systematic reviews and an analysis of the level of evidence. Emerging themes in the literature were then identified to provide a bridge between high-level evidence and on-the-ground practice. RESULTS We identify three promising types of KT interventions: community-based health education; lay or peer health education; and targeted or tailored interventions. Each is summarized with illustrative examples and a summary of key themes and considerations. CONCLUSIONS The authors conclude with a summary the types and a decision tool designed to help KT and implementation teams select interventions which could be adapted to their own context.
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Kalecinski J, Régnier-Denois V, Ouédraogo S, Dabakuyo-Yonli TS, Dumas A, Arveux P, Chauvin F. Dépistage organisé ou individuel du cancer du sein ? Attitudes et représentations des femmes. SANTE PUBLIQUE 2015. [DOI: 10.3917/spub.152.0213] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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