Abstract P6-08-07: Decline in compliance to breast cancer screening in France: Results of the 5th EDIFICE survey

Background

The EDIFICE surveys have been conducted since 2005 to provide a better understanding of the participation of the French population in cancer screening programs. The breast cancer (BC) screening program is nowadays widely implemented throughout the target female population: women aged 50-74 years are invited for a mammogram once every two years. We analyzed the behavior of women over time (between 2005 and 2016) regarding BC screening according to age-group, socioprofessional categories (SPC) and social vulnerability.

Methods

The fifth nationwide observational survey, EDIFICE 5, was conducted by phone interviews using the quota method. A representative sample of 1299 subjects aged 50-74 years with no history of cancer was interviewed between November 22 and December 7, 2016. Interviewees (women aged 50-74 yrs; N=657) were asked about their uptake of BC screening, and the date of the last examination to determine the follow-up rate. Demographic data on social characteristics and SPC were also collected to determine the level of social vulnerability (validated EPICES score).

Results

Compliance with BC screening (a mammogram within the past 2 years) decreased significantly from 81% in 2014 to 75% in 2016 (P=0.02). From 2014, a significant impact of age was observed (P=0.02 in 2014 and 2016). In 2016, and for the first time, a significant and disturbing decrease in follow-up rate was recorded among younger women (age 50-54 yrs: 88% in 2014 vs 74% in 2016, P=0.01). SPC had no effect on compliance with screening. However, since 2008, fluctuations have been observed among unemployed individuals (U), with a significant decline in compliance in 2016 (U: 81% in 2014 vs 73% in 2016, P=0.03). In 2016, social vulnerability was seen as a factor that negatively impacts on compliance with BC screening (P≤0.01), but not in 2011 or 2014. We also observed a significant overall decrease in 2016 among both vulnerable (76% in 2014 vs 65% in 2016; P=0.04) and non-vulnerable populations (85% in 2014 vs 79% in 2016, P=0.04), highlighting a general loss of confidence.

Conclusion

For the first time since 2005, compliance with BC screening dropped significantly in France in 2016. A significant overall decline was observed regardless of social vulnerability status. Disturbing significant decreases were observed among the younger age-group (women aged 50-54 yrs) of the target population of the organized program, and among unemployed women. Although organized programs have been shown to ensure equitable access to cancer screening, this achievement remains precarious and requires regular monitoring.

Citation Format: Morère JF, Eisinger F, Blay J-Y, Greillier L, Brignoli-Guibaudet L, Lhomel C, Cortot AB, Couraud S, Viguier J. Decline in compliance to breast cancer screening in France: Results of the 5th EDIFICE survey [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-07.

[Pulmonary metastases from endometrial stromal sarcoma may benefit from hormone therapy]

INTRODUCTION

Low grade endometrial stromal sarcoma (ESS) often expresses oestrogen (ER) and progesterone (PR) receptors, even in metastatic disease. These receptors may also be hormone dependent.

CASE REPORT

Two years after the institution of oestrogen replacement therapy (HRT) a woman of 56 presented with haemoptysis which led to the discovery of multiple pulmonary nodules. Twelve years previously the patient had had a hysterectomy for a low grade endometrial stromal sarcoma, ER and PR positive. Surgical resection of the nodules on the right side confirmed the diagnosis of metastatic endometrial stromal sarcoma. The metastases expressed oestrogen and progesterone receptors. Three months after the withdrawal of HRT and treatment with an aromatase inhibitor (letrozole) the contralateral metastases had disappeared and this complete response was maintained for more than 2 years of follow-up.

CONCLUSION

Care should be taken in the institution of HRT in a woman with a history of low grade ESS. Hormonal treatment with aromatase inhibitors may be considered in cases where ER and PR are expressed by the primary tumour and metastases, with possible benefits even in metastatic disease.

Carboxymethyl benzylamide dextran and tamoxifen combination inhibits tumor growth and angiogenesis

We showed previously that a carboxymethyl dextran benzylamide (CMDB7) blocks angiogenesis of MDA-MB-435 carcinoma and its lung metastases in nude mice. In this study, we examined the combination effects of CMDB7 and tamoxifen (TAM) on cell proliferation, tumor growth, and angiogenesis on the MCF-7RAS cells. We showed that CMDB7 and TAM acted in a synergistic manner to inhibit the growth of MCF-7RAS cells, blocking them in G(0)/G(1) phase of the cell cycle. For 7 weeks, the CMDB7- (300 mg/kg/week) and TAM- (20 mg/kg/week) treated groups showed tumor growth inhibition of about 66% and 76%, respectively. Combined treatments with CMDB7 and TAM block the tumor development by 94% and induce a complete regression of 4 of 8 mice. Histological analysis showed markedly less neovascularization (88%) in the tumors treated with a combination of CMDB7 and TAM. This antiangiogenic activity was further demonstrated by direct inhibition of endothelial cell proliferation. Overall, this study points to the potential use of a combination of CMDB7 and TAM to inhibit tumor angiogenesis that can prevent tumor progression.

Dose-finding study of paclitaxel and carboplatin in patients with advanced non-small cell lung cancer

This dose-finding study was designed to determine the maximum tolerated dose (MTD), efficacy and toxicity of combined paclitaxel and carboplatin in 35 previously untreated patients with advanced non-small cell lung cancer (NSCLC). Paclitaxel was given as a 3-h infusion at escalating dose levels (100-250 mg/m2) immediately followed by carboplatin as a 30-min infusion (325 or 350 mg/m2) every 3 weeks. The dose-limiting toxicity, paresthesia, occurred at the highest dose level, therefore the recommended dose was established one level below (paclitaxel 225 mg/m2 with carboplatin 325 mg/m2). Neutropenia was the most common hematotoxicity; dose dependency was not apparent. Two patients, at different dose levels, had febrile neutropenia. Thrombocytopenia was rare. Non-hematological toxicities grade 3 or higher included infection, anorexia, alopecia and paresthesia. One patient had a hypersensitivity reaction (transient hypotension). The overall response rate was 23% and median survival time was 7.5 months. Promising activity and acceptable toxicity supports the development of this combination as a useful chemotherapeutic option in advanced NSCLC.

The suppression of fibroblast growth factor 2/fibroblast growth factor 4-dependent tumour angiogenesis and growth by the anti-growth factor activity of dextran derivative (CMDB7)

Our previous studies showed that carboxymethyl benzylamide dextran (CMDB7) blocks basic fibroblast growth factor (FGF-2)-dependent cell proliferation of a human breast epithelial line (HBL100), suggesting its potential role as a potent antiangiogenic substance. The derived cell line (HH9), which was transformed with the hst/FGF4 gene, has been shown to be highly proliferative in vitro and to induce angiogenic tumours in nude mice. We show here that CMDB7 inhibits the mitogenic activities of the conditioned media from HBL 100 and HH9 cells in a dose-dependent manner. When HH9 cells were injected s.c. into nude mice, CMDB7 treatment (300 mg kg(-1) week(-1)) suppressed the tumour take and the tumour growth by about 50% and 80% respectively. Immunohistochemical analysis showed a highly significant decrease, by more than threefold, in the endothelial density of viable tumour regions, together with a significant increase in the necrosis area. This antiangiogenic activity of CMDB7 was further demonstrated by direct inhibition of calf pulmonary artery (CPAE) and human umbilical vein (HUVEC) endothelial cell proliferation and migration in vitro. In addition, we showed that CMDB7 inhibits specifically the mitogenic effects of the growth factors that bind to heparin such as FGF-2, FGF-4, platelet-derived growth factor (PDGF-BB) and transforming growth factor (TGF-beta1), but not those of epidermal growth factor (EGF) and insulin-like growth factor (IGF-1). These results demonstrate that CMDB7 inhibits FGF-2/FGF-4-dependent tumour growth and angiogenesis, most likely by disrupting the autocrine and paracrine effects of growth factors released from the tumour cells.

Inhibition of MCF-7ras tumor growth by carboxymethyl benzylamide dextran: blockage of the paracrine effect and receptor binding of transforming growth factor beta1 and platelet-derived growth factor-BB

The highly tumorigenic human breast cancer MCF-7ras line (Ha-ras-transfected MCF-7 cell line) loses estrogen dependence and secretes diffusible growth factors that support its own tumor growth in vivo. Our previous studies showed that carboxymethyl benzylamide dextran (CMDB7) inhibits the growth of breast MCF-7 and MCF-7ras cell lines. In this study, we have shown that conditioned medium (CM) from MCF-7 and MCF-7ras cells stimulated the DNA synthesis of BALB/c3T3 fibroblasts and that CMDB7 strongly inhibited these mitogenic effects in a dose-dependent manner. Neutralizing antibodies against platelet-derived growth factor (PDGF) partially inhibited the mitogenic effect of MCF-7ras CM. The flow cytometry analysis of the cell cycle showed that the CM of tumor cells increased the percentage of fibroblasts in S phase and that CMDB7 blocked them in G0/G1 phase. CMDB7 inhibited the mitogenic effect of PDGF-BB and transforming growth factor (TGF) beta1 but not those of epidermal growth factors and insulin-like growth factor on BALB/c3T3 fibroblasts. CMDB7 increased the electrophoretic mobility of radiolabeled PDGF-BB and TGF-beta1, apparently by forming a stable complex with these factors. On intact BALB/c3T3 fibroblasts, binding of iodinated growth factors (125I-TGF-beta1 and 125I-PDGF) to their receptors was completely displaced by CMDB7. In vivo studies demonstrated that s.c. injection of CMDB7 inhibited by 66% the tumor growth of MCF-7ras xenografts in nude mice. These results showed that CMDB7 inhibits the mitogenic effect of growth factors released from MCF-7 and MCF-7ras cells and suppresses tumor growth in the MCF-7ras model.

Inhibition of human breast epithelial HBL100 cell proliferation by a dextran derivative (CMDB7): interference with the FGF2 autocrine loop [corrected]

Fibroblast growth factor 2 (FGF2) has been shown to be an autocrine growth factor in human breast epithelial cells HBL100. Here we studied the effects of one dextran derivative (CMDB7) on this autocrine loop. CMDB7 caused a dose-dependent decrease of HBL100 growth in serum-free medium. [3H]thymidine uptake in HBL100 cells and Balbc/3T3 cells by exogenous FGF2 was inhibited by CMDB7. Receptor binding assays with radio-iodinated FGF2, IGF1, EGF showed that CMDB7 only displaced the binding of 125I-FGF2 in a dose dependent manner. Scatchard analysis revealed that the presence of CMDB7 reduced 78% and 82 % FGF2 binding capacity to its high and low affinity receptors respectively without altering the affinites of binding sites. These results suggest that CMDB7 exert its antiproliferative action on HBL100 cells by interfering with FGF2 autocrine loop.

[Induction chemotherapy followed by concomitant combined radiotherapy and chemotherapy in stage III non-small cell bronchial carcinoma]

PURPOSE

To determine the efficacy and safety of induction chemotherapy followed by concomitant chemoradiotherapy in the treatment of stage III non-small cell lung cancer and whether the response to induction chemotherapy can predict the response to subsequent chemoradiotherapy and survival.

MATERIALS AND METHODS

Between December 1987 and June 1993, 46 patients with previously untreated stage III non-small cell lung cancer received every 21 days induction chemotherapy (ICT) including three cycles of 5-fluorouracil (600 mg/m2/d in short infusion from d1 to d5), cisplatin (15 mg/m2/d from d1 to d5), etoposide (50 mg/m2/d from d1 to d5) and hydroxyurea (1,500 mg/d from d1 to d5). The first 21 patients also received bleomycin (3 mg/m2/d from d1 to d5). All patients received concomitant chemotherapy and had chest radiotherapy (CCRT). Patients received irradiation (65 Gy/33-6 fractions/7 weeks) on d25 after the third cycle of chemotherapy. Concomitant chemotherapy was composed of cisplatin (20 mg/m2) and 5-fluorouracil (500 mg/m2) that were administered each Monday and Thursday during radiotherapy. Maintenance chemotherapy consisted of thiotepa (10 mg/m2) and methotrexate (10 mg/m2) that were administered every 2 weeks for 6 months.

RESULTS

Pulmonary toxicity was observed in four out of 21 patients who had received bleomycin and subsequently developed pulmonary fibrosis, leading to death for two of them. ICT alone produced five complete responses (11%) and 13 partial responses (28%). The combination of chemotherapy and radiotherapy led to 19 complete responses (41%) and 14 partial responses (30%). Eighteen of the 18 responders (100%) to ICT responded to subsequent CCRT, of whom 13 (72%) became complete responders. Fifteen of the 28 non-responders to ICT (53%) responded to CCRT, six of them being complete responders (21%) (P < 0.001). The median overall survival rate was 17 months when considering all patients, 25 months in patients responding to ICT and 13 months in non-responders. The 2-year survival rates were 28, 55 and 11%, respectively (P < 0.05). ICT did not influence the rate of subsequent metastatic events. However, locoregional reprogression was lower in responders to ICT. The number of metastatic events was not significantly related to response to ICT. By contrast, the rate of local failure was higher when there was resistance to ICT (75% versus 39%). Out of the 19 complete responders to CCRT (13 responders to ICT and six non-responders to ICT), four developed secondary locoregional reprogression (21%) and six developed metastatic disease (31%). In complete responders to CCRT, the rate of locoregional failure was 15% in responders to ICT (2/13) and 33% (2/6) in non-responders to ICT. Four out of the 13 responders to CCRT after response to ICT (31%) and two out of the six complete responders to CCRT developed metastatic disease after non-response to ICT.

CONCLUSION

There is a statistically significant relationship not only between the response to ICT and the response to CCRT, but also between the response to ICT and the local outcome and survival.

[Infectious complications during treatments with interleukin-2]

Between January 1989 and May 1991, 97 patients were treated with interleukin 2 in the Oncology Department of the Avicenne Hospital (Bobigny, France). IL 2 was given over 5 days by continuous infusion through an implantable port. Ten patients (4 males, 6 females), mean age 46 years (36-67) with various cancers (breast 3, kidney 1, melanoma 1, colorectal 5), developed infection: 4 local infections around the port, 1 phlebitis, 4 septicemias, 1 bacteremia were observed. In 9 cases blood cultures were positive: Staphylococcus aureus 5, Staphylococcus epidermidis 3, Streptococcus G 1. In 5 cases the same pathogen was isolated from the port and from the blood. The mean leucocyte count was 10,627/mm3 at the time of infection. The delay between the beginning of interleukin 2 treatment and the infection was 3 months. The mean dose of IL 2 administered before infection was 456 million IU. In all cases infection was controlled without lethal complication by antibiotics and catheter removal. This high incidence (8 percent) of staphylococcal infection is partly due to the skin toxicity of IL 2 and to depressed neutrophil chemotactic response. Prophylactic antibiotics are warranted during IL 2 intravenous therapy.

Treatment of advanced epithelial ovarian cancer with a cis-dichloro-diammine platinum, cyclophosphamide, and bleomycin combination

Twenty-five consecutive patients with previously untreated stage III (18) and IV (7) epithelial ovarian carcinoma underwent maximum surgical tumor reduction followed by cyclophosphamide, cisplatinum, and bleomycin chemotherapy, given 5 days every 3 weeks for a total of 6-8 courses. Patients were then submitted to second-look surgery, and complete responders to a 1-year additional chemotherapy with L phenylalanine mustard and hexamethylmelamine. The median survival is 23 months for the whole group, and 31+ months for 13 patients found in microscopically assessed complete remission (CR) at the time of second-look surgery. The possible significance of these results and of the addition of bleomycin to a well-known combination are discussed, together with the limitations of a phase II study.

[Induction of objective responses by an anticancer chemotherapy based on the prolonged combination of bleomycin and cisplatin. 1062 cases]

A cis-platin + bleomycin combination, sometimes associated with a third cytostatic drug, was administered for prolonged periods to 1062 cancer patients previously subjected to a wide variety of treatments. The objective response rate was about 70% in localized squamous cell and anaplastic bronchial carcinoma and 40% in bronchial adenocarcinoma and metastatic squamous cell carcinoma. Cancers of the head and neck responded in 70% of the cases before irradiation and in 30% after irradiation. Other epidermoid tumours responded objectively in the proportion of 45%, as did 58% of metastatic and refractory breast cancers. These results were not clearly improved by any of the other cytostatic drugs used concomitantly, and the combination alone was less toxic. The high response rate obtained is attributed to a synergistic effect of cis-platin and bleomycin administered for prolonged periods.

[Granulomas of the liver : a clinical and pathological study of fifty-five cases (author's transl)]

After a clinical and pathological study of 55 cases of granulomatous hepatitis, the authors are trying to understand the data so that they can predict the etiology of the granulomas. The authors must insist on the necessity of homogeneity in clinical data, histological findings and ethnic origins.