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J Faivre

Publications and source records attributed to J Faivre.

At least 181 records · Page 10Linked to original sources
PubMed1996

Intervention trials on colorectal cancer prevention.

Epidemiological studies have emphasized the major role played by diet in the etiology of large-bowel cancer. Attempts to identify causative or protective factors in epidemiological and experimental studies have led to some discrepancies. The time has come to test the most important hypotheses within the framework of intervention studies. Of 14 studies specifically devoted to colorectal carcinogenesis, nine have been completed and five are ongoing; all the studies evaluate the effect of the intervention on adenoma recurrence and three studies also examine adenoma growth. In addition, five intervention trials considering cardiovascular diseases and various cancer sites will provide data on the effect of the intervention on colorectal cancer incidence. The interventions being evaluated are supplements of vitamins (with or without other antioxidants), fibre or calcium, as well as dietary modifications. Most available data do not support a protective effect of vitamins and antioxidants on colorectal carcinogenesis. There are some arguments in favour of a protective effect of dietary fibre and/or a low-fat diet on adenoma growth. The results of ongoing studies will be available within two to three years. If one of the evaluated interventions proves effective, it will indicate a simple, safe and inexpensive prophylaxis for a very common cancer.

Anticarcinogenic Agents↗
PubMed1996

[Mass screening for colorectal cancer].

Considering the present state of knowledge, only the strategy of screening for intestinal tumours at the asymptomatic stage could reduce such a problem as colorectal cancer. Data from case-control studies provide evidence of the efficacy of screening by rigid proctosigmoidoscopy. But compliance with such a strategy is not known. The effectiveness of screening by sigmoidoscopy has yet to be demonstrated. A European controlled study of flexible sigmoidoscopy in association with the Hemoccult test versus the Hemoccult test alone has been set up. Evaluation by a randomized screening trial with a single flexible sigmoidoscopic examination at age 55 to 60 years has also been suggested. Case-control studies and a randomized study conducted among volunteers demonstrate that it is possible to reduce mortality from colorectal cancer in people who accept screening with faecal occult blood testing, using the Hemocult test. Four population-based studies have been set up in Europe (in England, Denmark, France and Sweden). They are based on a biannual Hemoccult test. Compliance in the test group ranges between 55% and 65% in the first screening campaign and remains high in the following screening campaigns. In France, to achieve this goal, the test must be proposed by GPs and then mailed to those who do not consult GPs. Reliable mortality data will be available within 1 to 3 years. The results of the European trials must be awaited to know if screening biennually is effective in reducing colorectal cancer mortality.

Aged↗
PubMed1996

[Value of cancer registries in the evaluation of colorectal cancer treatment].

Improvement of health care policy requires an assessment of health care practices. In France, morbidity registries might be the best tool of such an assessment. This study shows how the treatment of colorectal cancer can be assessed by French cancer registries. Two studies were conducted. One cross-sectional on data from 7 cancer registries in 1990 and one longitudinal on data from 2 digestive cancer registries (departments of Calvados and Côte-d'Or) between 1978 and 1990. Cancer resection rate significantly increased from 1978 to 1990. In 1990, mean resection rate was 85%, higher for colon (89%) than rectum (79%). Sphincter preservation rate also significantly increased to 40.8% in 1990. No geographical variations were observed for surgical practices. The use of adjuvant radiotherapy had significantly increased between 1978 and 1990, more rapidly in university centres. In more recent years, the use of radiotherapy concerned 50% of resected rectal cancers without differences between the different types of health care centre. However, in 1990, great geographical variations were observed in the use of adjuvant radiotherapy. Similar geographical variations were observed for the use of chemotherapy which did not increased with time. Colorectal cancers were diagnosed more and more earlier from 1978 to 1990 in both departments of Calvados and Côte-d'Or. The French network of French cancer registries (FRANCIM) provides accurate and reliable knowledge on medical practices, geographical variations and trends. Information is also available on prognosis in cancer patients. Potentialities of cancer registries are not actually well known although such information is required to plan health care policy.

Aged↗
PubMed1996

[Mass screening of colorectal cancer: where are we up to?].

Considering the present state of knowledge on the question, only the strategy of screening for intestinal tumours at the asymptomatic stage would seem capable of reducing such a problem as colorectal cancer. Detection of occult blood in stool is currently being evaluated through a mass screening test. Methods used to obtain a high participation rate are now well-defined. In France, to achieve this goal, the test must be proposed by GPs and then mailed to those who do not consult GPs. Four case-control studies and one randomized study conducted among volunteers suggest the efficacy of screening with faecal occult blood testing to reduce mortality from colorectal cancer but they do not indicate effectiveness within a population. Four population-based studies have been set up in Europe (Denmark, England, Sweden and France). Results will be available within one to three years. They should lead to a national screening strategy.

Aged↗
PubMed1996

[Contribution of cancer registries to the evaluation of cancer treatment: on the example of rectal cancer].

Improvement of health care policy requires an assessment of health care practices. In France, morbidity registries might be the best tool for such an assessment. This study shows how the treatment of rectal cancer can be assessed by French cancer registries. Two studies were conducted: a cross-sectional study on data from 7 cancer registries in 1990 and a longitudinal study on data from 2 digestive cancer registries (departments of Calvados and Côte d'Or) between 1978 and 1990. Finally, we conducted a regional audit concerning quality control in rectal resection for cancer in Lower Normandy between 1988 and 1993. In 1990 the mean resection rate was 77.8%. The sphincter preservation rate was also significantly increased to 53.9% in 1990. The use of adjuvant radiotherapy significantly increased between 1978 and 1990, more rapidly in university centres. In more recent years, the use of radiotherapy concerned 50% of resected rectal cancers with no differences between the various types of health care centres. However, in 1990, major geographical variations were observed for the use of adjuvant radiotherapy. Similar geographical variations were observed for the use of chemotherapy which did not increase with time. Rectal cancers were not diagnosed earlier from 1978 to 1990 in the two departments of Calvados and Côte d'Or. The use of reproducible quality criteria (length of distal excision, number of nodes examined and histological status of lateral margins) showed a global deficiency and marked variations between the various types of health care centres and levels of surgical training. The french network of French cancer registries (FRANCIM) provides accurate and reliable knowledge on medical practices, geographical variations, trends and quality control. The potential of cancer registries has not been clearly determined, although such information is required to plan health care policy.

Cross-Sectional Studies↗
PubMed1995

Tobacco, alcohol, and colorectal tumors: a multistep process.

A case-control study in the Côte d'Or area of France used the multistep concept of colorectal carcinogenesis to compare lifetime tobacco consumption and present alcohol consumption in patients with small adenomas (less than 1 cm, n = 154) or large adenomas (n = 208) and in polyp-free controls (n = 427). Cancer patients (n = 171) were compared with population controls (n = 309). In men, smoking was associated with the risk of adenomas (odds ratio = 3.6 over 20 pack-years vs. nonsmokers, p < 0.001). Alcohol was a risk factor for large adenomas only, with relative risks of 4.2 (p < 0.01), 3.0 (p < 0.05), and 4.4 (p < 0.01) for consumptions of 20-39, 40-59, and 60 g/day compared with less than 10 g/day. When patients with large adenomas were compared with polyp-free controls, both alcohol and tobacco were independently related to the risk of tumor. There was no association between tobacco or alcohol intakes and cancer risk. In women, consumption was much lower in all groups, and no significant association with either risk factor was observed. These data suggest for the first time that there is an independent effect of alcohol and tobacco in men at different early steps of the adenoma-carcinoma sequence. They demonstrate the usefulness of such a model for etiologic studies on cancer.

Adenoma↗
PubMed1995

Prospective study of prognostic factors in patients with unresected hepatic metastases from colorectal cancer. Fondation Française de Cancérologie Digestive.

Prognostic factors of unresected liver metastases in patients with colorectal cancer are not well established. A total of 544 patients with unresected liver metastases from colorectal cancer were registered in a national survey over a 1-year period and followed until death. Twenty factors were studied in a univariate analysis (log rank test) and 16 influenced survival (P < 0.01). These 16 factors were entered in a multivariate analysis (Cox model) and eight, ranging from the most significant (relative risk of death 1.9) to the less significant (relative risk of death 1.2), independently influenced survival: performance status, alkaline phosphatase level, number of involved liver segments, administration of chemotherapy, presence of extrahepatic metastases, site of the primary tumour, prothrombin time and resection of the primary lesion. Two simple classifications are proposed, taking into account the performance status and the alkaline phosphatase level, or the performance status and the number of involved liver segments.

Aged↗
PubMed1995

Family history of colorectal tumours and implications for the adenoma-carcinoma sequence: a case control study.

Family history of colorectal cancer is a risk factor for sporadic colorectal cancer, but it is not known which step of the adenoma-carcinoma pathway it influences. This case control study investigated the relation between family history of cancer and colorectal adenomas and cancers. Family history of colorectal cancer (FHCRC) was as frequent in small (< 10 mm) adenoma patients (11.7%, n = 154) as in polyp free patients (10.6%, n = 426), whereas it was more frequent in patients with large adenoma(s) (18.8%, n = 208; p < 0.01). Odds ratios for FHCRC were 1.2 (p > 0.10) for small adenomas and 2.1 (p < 0.01) for large adenomas. Family history of other (non-colorectal) cancers (FHOC) was similar in the three groups. Patients with a colorectal cancer (n = 171) had more frequently a family history of cancer, both colorectal (15.8%; p < 0.01) and other cancers (35.7%; p < 0.001) than general population controls (n = 309; FHCRC: 8.1%; FHOC: 21.7%). In a logistic model, both factors were independently related to colorectal cancers (odds ratios: 1.9 (p < 0.05) for FHCRC and 2.1 (p < 0.001) for FHOC). These data suggest that family history of colorectal cancer influences only the growth of adenomas or their malignant transformation. The finding of a further predisposition to any type of cancer needs to be confirmed.

Adenoma↗
PubMed1995

[Primary prevention of colorectal cancer].

Results from case-control studies and prospective studies suggest that diet is involved in the causation of large bowel cancer either as initiator, promoter or inhibitor of carcinogenesis. Available data are not sufficient to serve as a basis for firm specific dietary advice. In the present situation it is attractive to investigate available hypotheses within the frame work of intervention trials. The adenoma appears to be one of the most appropriate end point of intervention studies. Several arguments indicate that the adenoma-carcinoma sequence is a multistep process. Colorectal cancer could possibly be prevented by intervening in the development of a small adenoma or in the growth into a large adenoma. Four intervention trials have been published so far. One of them suggest a protective effect of antioxidants vitamins on adenoma recurrence and three of them conclude to the absence of effect of these vitamins. A protective effect of lactulose on adenoma recurrence has also been suggested. Three studies are currently evaluating the effect of calcium supplementation on adenoma recurrence or growth of calcium supplementation, three studies the effect of fibre supplements, two studies the effect of antioxidants (one of them with calcium) and two studies the effect of diet intervention. The results of these studies will be available within three years.

Adenoma↗
PubMed1995

[Treatment of cancer of the rectum. Practical survey based on 7 French departments in 1990].

OBJECTIVES AND METHODS: Therapeutic modalities in rectal cancer were analyzed in a French population based study. This work reviewed all the new cases of rectal adenocarcinoma diagnosed in a one-year period from January 1st to December 31st 1990 among the population of 7 provinces. Thus, 427 new cases of rectal cancer were included in a data base (EUROCARE). The main goal of this study was to provide an up-to-date, unbiased evaluation of the different treatments of rectal cancer according to its stage when diagnosed. The aim was also to point out differences in therapeutic management between these different geographic areas. A three-stage clinico-pathological staging was used to minimize stage migration bias. RESULTS: 77.8% of the patients underwent a rectal excision; among them, 53.9% had a sphincter saving procedure. Adjuvant radiotherapy was associated to rectal resection in 46.2% of the patients and was pre-operative in 45.9%. Only 13.7% of patients had chemotherapy. CONCLUSIONS: We demonstrated a significative difference of therapeutic modalities between these different french geographic areas concerning adjuvant radiotherapy and chemotherapy. This work supports the need and the value of population-based study for clinical management, prognostic evaluation and evaluation of public health issues.

Aged↗
PubMed1994

[Epidemiology of colorectal cancer. Prospects of prevention].

Colorectal carcinoma is very common in western countries. It is in the front line of malignant pathology in France. The estimated number of new cases is almost 26,000 per year. The role played by diet in the onset of colorectal carcinomas is well established. The majority of studies indicate the protective role played by green vegetables. The role of other factors remains controversial: protective role of fibres, calcium and vitamins and favourising role of fats, proteins, red meat, alcohol and caloric intake. A number of intervention studies are underway. They should enable the proposal of a primary prevention strategy. The early detection of carcinomas and the secondary prevention of colorectal carcinoma are areas of great interest. Detection of occult blood in stools as a mass screening test is currently being evaluated. It will be necessary to wait for 1 to 4 years before being able to determine the effect on mortality and an even longer period to evaluate the effect on the incidence of colorectal carcinoma.

Colorectal Neoplasms↗
PubMed1994

Changing pattern of oesophageal cancer incidence in France.

BACKGROUND: Data from several Western countries suggest a rapid increase in the incidence of adenocarcinoma of the oesophagus, as well as variations in the sex ratio and the subsite distribution of oesophageal cancer. Although France has a high incidence rate of oesophageal cancer in males, no information was available on trends in its occurrence. The purpose of this study was to report changes in the pattern of oesophageal cancer incidence in three regions of France. METHODS: Data from the three population-based cancer registries of Calvados, Côte d'Or and Haute-Garonne were used to study time trends of oesophageal cancer by sex, age, subsite and histological type between 1978 and 1987. Annual incidence rates have been standardized by the direct method using the world standard population. To test the trend in cancer incidence, either an exponential curve of the form y = aekt was fitted to the annual incidence rates by means of a regression technique, or incidence rates were compared between two 5-year periods after age standardization by Mantel-Haenszel test. RESULTS: The mean annual variation of oesophageal cancer in males was -2.9% in Calvados (P < 0.05), + 0.5% in Côte d'Or (NS) and + 12.4% in Haute-Garonne (P < 0.05). The corresponding figures in females were + 7.9% (NS), + 19.6% (P < 0.05) and + 50.7% (NS). The significant variations in males (decrease in Calvados and increase in Haute-Garonne) were confined to the oldest age group (> or = 65 years). With regard to subsite, incidence in males increased in Haute-Garonne for the upper and the middle third, while there was a significant decrease in Calvados only for the middle third. For histological type, no increase in adenocarcinoma was noticed in males while there was a slight increase in incidence in females (statistically significant in Calvados). CONCLUSIONS: In France, the incidence of oesophageal cancer has decreased in the high-risk region (Calvados) in males, while there was a slight increase in the three studied regions in females. The important rise in incidence of oesophageal adenocarcinomas observed in some Western countries has yet to be seen in France.

Adenocarcinoma↗
PubMed1994

[Prognostic factors in colorectal adenocarcinoma of Dukes stage B. Study of a series of population].

A study of prognostic factors in Dukes B colorectal adenocarcinoma was performed on a population basis in order to determine subgroups with poor prognosis which could benefit from adjuvant therapy after surgery. The study considered the 746 cases of Dukes B colorectal carcinoma diagnosed during the 1976-1988 period among Côte-d'Or residents (Burgundy, France). The overall 5-year crude survival rate was 55.7%, the corresponding relative survival rate being 73%. In the final Cox model, age, tumour extension to adjacent organs, number of examined lymph nodes and tumour size were significant prognostic factors. The corresponding multivariate relative survival model considered only tumour extension and number of examined lymph nodes as having a prognostic value. The relative risk of death was 2.3 (range: 1.5-3.3) in case of a tumor extension and 2.5 (range: 1.5-4.4) when no lymph node was found compared to surgical samples with at least 6 lymph nodes. These data should be taken into account when conceiving or analyzing future therapeutic trials.

Adenocarcinoma↗