Diet, fibers, and colon cancer.
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Animals↗
Biomedical subjects
J Faivre
Publications and source records attributed to J Faivre.
Chemoprevention of colorectal cancer.
Epidemiological studies have emphasised the major role of diet in the aetiology 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 frame-work of intervention studies. Among studies specifically devoted to colorectal carcinogenesis, eight have been completed and five are ongoing. They evaluate the effect of the intervention on adenoma recurrence and, in three studies, on adenoma growth. Five intervention trials considering cardiovascular diseases and different cancer sites will provide data on the effect of the intervention on colorectal cancer incidence. Vitamins and antioxidants, fibre or calcium supplementation, aspirin therapy and dietary modifications are evaluated. Most of the available data do not support the idea of a protective effect of vitamins and antioxidants against colorectal carcinogenesis. It is too early to draw any conclusions on the effects of fibre, calcium supplementation, aspirin therapy and dietary intervention. The results of ongoing studies will be available within 2 years. If one of the evaluated interventions proves efficient, the benefits of a simple, safe and inexpensive prophylaxis for a very common cancer will be clear.
Anticarcinogenic Agents↗
Faecal occult blood screening and reduction of colorectal cancer mortality: a case-control study.
To estimate the efficacy of screening on colorectal cancer mortality, a population-based case-control study was conducted in well-defined areas of Burgundy (France). Screening by faecal occult blood test prior to diagnosis in cases born between 1914 and 1943 and who died of colorectal cancer diagnosed in 1988-94 was compared with screening in controls matched with the case for age, sex and place of residence. Cases were less likely to have been screened than controls, with an odds ratio (OR) of 0.67 [95% confidence interval (CI) 0.48-0.94]. The negative overall association did not differ by gender or by anatomical location. The odds ratio of death from colorectal cancer was 0.64 (95% CI 0.46-0.91) for those screened within 3 years of case diagnosis compared with those not screened. It was 1.14 (95% CI 0.50-2.63) for those screened more than 3 years before case diagnosis. There was a negative association between the risk of death from colorectal cancer and the number of participations in the screening campaigns. The inverse association between screening for faecal occult blood and fatal colorectal cancer suggests that screening can reduce colorectal cancer mortality. This report further supports recommendations for population-based mass screening with faecal occult blood test.
Aged↗
Influence of stage at diagnosis on survival differences for rectal cancer in three European populations.
Important differences have recently been highlighted between European countries in the survival of colorectal cancer patients. As data on stage at diagnosis were available for rectal cancers in three European population-based registries (Geneva Switzerland; Côte d'Or, France; Mallorca, Spain), we compared relative survival while assessing the effect of stage in a multiple regression model. We analysed 1005 rectal cancer cases diagnosed between 1982 and 1987 and followed up for at least 5 years. In the Mallorca registry, 16% of the patients were diagnosed in the TNM stage I (versus 21% in the Côte d'Or registry and 29% in the Geneva registry, P < 10(-4)) and the 5-year relative survival rate was lower (35%) than in the other two registries (Côte d'Or 47%, Geneva 48%, P = 0.01). In the multivariate analysis, stage was the only independent prognostic factor, whereas the excess death risk did not vary significantly among registries (compared to Geneva, Côte d'Or relative risk was 1.0, Mallorca relative risk 1.11, 95% confidence interval 0.76-1.32 and 0.85-1.44 respectively). Survival differences between the registries were mainly due to stage at diagnosis. Thus, diagnostic conditions appear to be the main determinant of the survival inequalities found in those three European populations.
Adult↗
Interval cancers in a community-based programme of colorectal cancer screening with faecal occult blood test.
Interval cancers represent the major limitation of screening for colorectal cancer with the faecal occult blood test. The aim of this study was to describe the characteristics of interval cancers and the sensitivity of the screening programme in a well-defined French population. During five screening rounds, 398 cancers were diagnosed in those of the population having performed at least one screening test; 57.8% of them were interval cancers. The proportion of interval cancers was higher among cancers of the rectal ampulla (72.2%) than among cancers of other sites (52.9%) (P < 0.001). The proportion of TNM stage I and II were higher among screen-detected cancers (73.8%) than among interval cancers (57.4%). The overall sensitivity of the screening programme was 62.9% within 1 year, and 48.7% within 2 years. An improvement in the sensitivity of the faecal occult blood test for colorectal cancer screening is needed, without an unacceptable loss of specificity.
Aged↗
Foods as risk factors for colorectal cancer: a case-control study in Burgundy (France).
Although the high meat-low vegetable diet is considered the reference high-risk diet for colorectal cancer, particularly in USA communities, other at-risk dietary patterns, such as high intakes of processed meat and refined carbohydrates are emerging. Little is known about risk factors for colorectal cancer in France, a country at high risk of rectal cancer and moderately high risk of colon cancer. We compared diet of colorectal cancer cases (n = 171) and general population controls (n = 309) in Burgundy (France). Categories of intake were established by sex and based on the distributions of food intakes in controls. Odds ratios for the fourth vs first quartile of intake (OR4) were 2.0 (1.1-3.6) for refined cereal products (rice, pasta and pastry), 2.4 (1.3-4.5) for delicatessen, 2.3 (1.2-4.2) for patés, 1.7 (1.1-2.8) for offal and 2.1 (1.1-4.0) for butter, lard and cream. There was no association with consumption of fresh meat (OR4 = 1.2), fish (OR4 = 1.5), egg (OR4 = 1.1) or dairy products (OR4 = 1.0). A protective effect of vegetables was only observed for left colon cancer (OR3 = 0.3; 0.1-0.6). In men, the most significant risk factors were refined cereal products, seasoning animal fats, chocolate and coffee, whereas risk factors were delicatessen, fat meat, pasta, rice, and chocolate in women. The strong association with refined cereal products is consistent with the hypothesis of a role of hyperinsulinism in colorectal carcinogenesis. The association with processed but not fresh meat suggests the importance of exogenous carcinogenesis in that area.
Adult↗
Pattern of epithelial cell proliferation in colorectal mucosa of patients with large bowel adenoma or cancer: an ECP case-control study. European cancer prevention.
Proliferative abnormalities of the normal colorectal mucosa have been proposed as a possible marker of enhanced susceptibility to colorectal cancer. A case-control study was conducted to compare the cell kinetics of normal colon mucosa through the different steps of the adenoma-carcinoma sequence. The number and position of labelled epithelial nuclei after in vitro incubation of tritiated thymidine were compared in patients with large bowel cancer (n = 39), large adenoma >1 cm (n = 47), small adenoma (n = 30) and in controls (n = 135). The distribution of tertiles between cases and controls was analysed using odds ratio (OR), comparing the second tertile (OR2) and the third tertile (OR3) to the first one. There was no significant difference in the overall cell proliferation rate when comparing cancer, large adenoma and small adenoma groups to the control group. The ratio number of labelled cells in the upper 40% of the crypt/total number of labelled cells (4h index) was found to be significantly higher only when the cancer group was compared to the control group: OR2 = 5.87 (1.33-25.90), OR3 = 9.48 (2.07-43.38), P for trend = 0.002. The upward shift of the proliferative compartment in the normal mucosa of patients with large bowel cancer suggests that this abnormality is related to cancer risk.
Adenoma↗
Faecal neutral sterols and bile acids in patients with adenomas and large bowel cancer: an ECP case-control study. European cancer prevention.
It is unclear whether neutral steroids and bile acids are involved in large bowel carcinogenesis. This study was conducted to compare the concentration of these faecal constituents at the different stages of the adenoma-carcinoma sequence. Neutral sterols and free bile acid concentrations were determined from stool samples collected form patients with large bowel cancer (n = 47), large adenoma > or = 1 cm (n = 42), small adenoma (n = 24), and controls (n = 104). The distribution of tertiles between cases and controls was analysed using odds ratio (OR), with 95% confidence interval (CI), comparing (two-sided tests) the second tertile (OR2) and the third tertile (OR3) to the first one. Persistence of primary bile acids appeared as a protective factor against cancer: (OR = 0.09, 95% CI 0.02-0.54). High values of cholesterol were associated with cancer risk (OR2 = 5.8, 95% CI 1.3-26.6; OR3 6.4, 95% CI 1.3-31.4). High values of cholesterol were more frequently observed in patients with large adenomas than in controls (OR2 = 8.5, 95% CI 1.9-37.5; OR3 = 4.3, 95% CI 0.9-20.9). Neutral sterols, cholesterol especially, may play a role in adenoma growth and adenoma transformation into carcinoma. Persistence of primary bile acids may afford protection.
Adenocarcinoma↗
Evidence of improving survival of patients with rectal cancer in france: a population based study.
BACKGROUND: Over the past 20 years there have been many changes in the management of rectal cancer. Their impact on the overall population is not well known. AIMS: To determine trends in management and prognosis of rectal cancer in two French regions. SUBJECTS: 1978 patients with a rectal carcinoma diagnosed between 1978 and 1993. METHODS: Time trends in treatment, stage at diagnosis, operative mortality, and survival were studied on a four year basis. A non-conditional logistic regression was performed to obtain an odds ratio for each period adjusted for the other variables. To estimate the independent effect of the period a multivariate relative survival analysis was performed. RESULTS: Over the 16 year period resection rates increased from 66.0% to 80.1%; the increase was particularly noticeable for sphincter saving procedures (+30.6% per four years, p=0.03). The percentage of patients receiving adjuvant radiotherapy increased from 24.0% to 40.0% (p=0.02). The proportion of patients with Dukes' type A cancer increased from 17. 7% to 30.6% with a corresponding decrease in those with more advanced disease. Operative mortality decreased by 31.1% per four years (p=0.03). All these improvements have resulted in a dramatic increase in relative survival (from 35.4% for the 1978-1981 period to 57.0% for the 1985-1989 period). CONCLUSIONS: Substantial advances in the management of rectal cancer have been achieved, but there is evidence that further improvements can be made in order to increase survival.
Adolescent↗
Cancer registry data based estimation of regional cancer incidence: application to breast and colorectal cancer in French administrative regions.
STUDY OBJECTIVE: In many countries, cancer registries cover only a small part of the national population. Cancer incidence for the rest of the country has therefore to be estimated. This can be done from mortality data using the relation between incidence and mortality observed in the cancer registry areas. Such an approach was used to study geographical variation and trend of colorectal and breast cancer incidence in France where 10% of the national population is covered by cancer registries. DESIGN: This study applies the incidence/mortality ratios of cancer registry areas to regional mortality data to obtain an estimation of cancer incidence at a given point in time. Age and period effects are included in the statistical models. MAIN RESULTS: The incidence estimations are given for 21 administrative regions and three time points (1985, 1990, 1995). The European standardised incidence rates for breast cancer ranged from 86.8 to 128.8. For colorectal cancer, these rates ranged from 48.2 to 79.6 for men, and from 32.5 to 48.8 for women. Breast cancer incidence has increased considerably between 1985 and 1995 with a higher increase in the north than in the south of France. The incidence of colorectal cancer has also increased, albeit to a lesser extent. CONCLUSION: The incidence estimation method proposed leads to regional incidence rates that are useful for planning health care services on a regional basis and may also be used to study regional differences in incidence. This method is useful when only partial incidence data are available.
Adult↗
Incidence trends of ischemic stroke and transient ischemic attacks in a well-defined French population from 1985 through 1994.
BACKGROUND AND PURPOSE: The changing incidence of ischemic stroke is of major concern in view of its public health impact, to define the population concerned, to identify risk factors, and to set up health-care systems. The aim of this study was to evaluate the time trends associated with the incidence of all the subtypes of ischemic stroke and transient ischemic attacks in a well-defined population for 10 years. METHODS: Since 1985, a population registry has recorded each patient living in Dijon (France) who suffered from a cerebrovascular disease (CVD) regardless of the type of management. This study involved all patients suffering from their first ischemic stroke and their first transient ischemic attacks (TIAs) during 1 calendar year between January 1, 1985 and December 31, 1994. The incidence changes according to age, sex, and type of cerebral ischemic event (cortico-subcortical infarct, lacunar infarct, and TIA) were studied on the basis of their annual variations. RESULTS: During the 10-year study period, 834 cortico-subcortical infarcts (52.1%), 296 lacunar infarcts (18.5%), 369 TIAs (23.1%), and 101 undetermined ischemic strokes (6.3%) were collected. The incidence of all ischemic events was relatively stable in both sexes over the 10-year period. However, the incidence rates differed according to age and type of ischemia. An increased incidence of cerebral cortico-subcortical infarct was observed in patients older than 75 years of age (+5.45% annual change [AC] in men, P<0.05; +5. 09% AC in women, NS). In parallel, a higher proportion of emboligenic cardiac arrhythmias was observed in these patients (P<0. 001). The incidence of lacunar infarcts tended to decrease, regardless of age but mainly in men under younger than 75 years of age (-12.74% AC in men, NS; +0.31% AC in women, NS). The incidence of TIAs was relatively stable in both sexes. Because our population consisted of a large number of elderly subjects, the increase in cardioembolic causes could partially explain the increased incidence of cerebral cortico-subcortical infarcts in patients older than 75 years of age. CONCLUSIONS: These preliminary data emphasize the importance of stroke surveillance in considering the variations of the different mechanisms of ischemic cerebrovascular disease. Although the incidence of TIA is stable and the incidence of lacunes tends to decrease in men, mainly before 75 years of age, we emphasize the rise of the crude incidence of cortico-subcortical infarcts in men older than 75 years of age, induced by an increase in cardioembolic causes.
Age Factors↗
[Incidence of treatment modalities for cancer of the small intestine in Burgundy (France)].
AIMS: To determine the epidemiological characteristics and management of cancers of the small bowel, on a population-based survey. METHODS: The registry of digestive tumors of Burgundy recorded all new cases of cancers of the small intestine in the departments of Côte d'Or and Saône et Loire (1,052,000 inhabitants). RESULTS: Two hundred and ten new cases of malignant tumors of the small intestine were recorded between 1976 and 1995 including 4 main histological types: adenocarcinomas (39.5%), carcinoids (26.2%), lymphomas (18.6%) and sarcomas (10.5%). Age-standardized incidence rates for males and females were respectively 8.8 and 5.6 per 1,000,000 inhabitants. There was evidence of lymph node invasion in 29.5% and visceral metastasis in 31.4%. Treatment was primarily surgical (90.5%), with a post-operative death rate of 17.1%. The rate of curative surgery remained constant over time, averaging 58.6%, 20% of the patients underwent chemotherapy, with a high proportion of lymphomas, often in association with surgery. The relative survival rates at 1, 3 and 5 years were 51.2, 38.3 and 32.7%, respectively. The multivariate analysis showed that survival was linked to age, and strongly to histological type and stage of diagnosis. CONCLUSION: Cancers of the small intestine are an heterogeneous group of rare tumors, often diagnosed at advanced stage. No significant improvement has been achieved in their management over the past 20 years.
Adolescent↗
Residential magnetic field measurements in France: comparison of indoor and outdoor measurements.
Residential magnetic field (MF) measurements were performed for the first time in a representative sample of French dwellings. Exposure levels were assessed by two methods: indoor and outdoor measurements. Linear and logistic regression models were used to determine factors associated with the time-weighted average (TWA) home MF. TWA magnetic field magnitudes were approximately log-normally distributed with geometric means under 0.010 microT for both indoor and outdoor measurements. Only 5% of the dwellings presented indoor MF levels greater than 0.120 microT (1.2 mG). Both indoor and outdoor MF variations were explained by three factors: wiring configuration, the dwelling's location (i.e., urban or rural), and housing characteristics (individual houses or apartment building). The reliability of outdoor spot measurements with 30-min bedroom recordings was assessed by an intraclass correlation coefficient. The measurements were accurate in rural areas and small towns. In urban centers, local MF variations spoil the outdoor measurement's reliability. If indoor measurements are taken as the reference method, the use of outdoor instead of indoor measurement leads to an important decrease in statistical power. Further assessment of MF near high power transmission lines is necessary to evaluate the usefulness of outdoor spot recordings near such lines. The urban MF environment also has to be explored to identify extraneous sources.
Case-Control Studies↗
[What can be done for digestive cancer in 1999? Recommendations of the French Foundation of Digestive Cancer (1st Part)].
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Digestive System Neoplasms↗
[Performance of the Hemoccult test in the screening of colorectal cancer and adenoma. Results of 5 screening campaigns in Saône-et-Loire].
OBJECTIVES: The aim of this population-based study was to specify the positivity rate, the positive predictive value of Hemoccult test as well as the characteristics of the cancers and adenomas screened during the successive colorectal cancer screening campaigns. METHODS: This study focused on five colorectal cancer mass screening campaigns by Hemoccult test carried out between 1988 and 1996. The test was offered every two years to a cohort of subjects born between 1914 and 1943 and living in some districts of the Saône-et-Loire administrative area. RESULTS: The positivity rate of the test was higher in the first campaign (2.1%) than in the subsequent ones (mean 1.3%). It was also higher in males than in females and it increased with age. After a positive test, 85.4% of the subjects had a colonic exploration. The exploration rate was higher when the test was offered by general practitioners (88.0%) than when it was mailed (77.8%) (P < 0.01). Through this test, cancer was detected in 168 patients, and one adenoma or more in 414 patients. The positive predictive value was 11.4% for cancer, 17.1% for adenoma > or = 1 cm and 11.1 for adenoma < 1 cm. It was higher in males than in females and it increased with age. Depending on the campaigns, 35.9% to 47.3% of the subjects explored after a positive test had a cancer or an adenoma. The screened cancers or adenomas were more often localized in the sigmoid or the rectum. Three quarters of screened cancers were stage I or II (TNM classification). All together, 82.7% of cancers were treated with surgical resection for cure and 10.1% with endoscopic resection. CONCLUSIONS: This work confirms the feasibility of carrying out regular colorectal cancer screening campaigns, through which a few subjects can be selected for undergoing colonic explorations. These latter can detect a cancer or adenoma in 40% of cases.
Adenoma↗
[What can be done for patients with digestive cancer in 1999? Guidelines of the French Foundation of Digestive Cancerology (2nd part)].
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Antineoplastic Agents↗
[Estimation of the incidence of digestive tract cancers by region].
OBJECTIVES: Information about the incidence of cancer in the national territory is a necessity for decision makers in public health. The aim of this study was to estimate for the first time the incidence of digestive tract cancers in each region of France in 1992 as well as trends in incidence between 1985 and 1995. METHODS: The incidence/mortality ratio established by sex, by age group and by localization in the departments covered by a cancer registry was applied to the mortality of each region studied. The mortality data were fit by applying a log linear model. RESULTS: The highest incidence rates of esophageal cancer were found in the North, in Brittany, Normandy and Picardy. The lowest rates were found in the regions of Midi-Pyrénées, Languedoc-Roussillon, Provence-Alpes-Côte d'Azur, Aquitaine and Poitou-Charentes. The incidence of this cancer decreased slightly between 1985 and 1995. Brittany and Normandy were also high risk regions for gastric cancer, while Provence-Alpes-Côte d'Azur, Midi-Pyrénées and Poitou-Charente were low risk regions. The incidence of gastric cancer also decreased more markedly than that of esophageal cancer. Colorectal cancer was more frequent in Alsace, Lorraine and in the North, it was less common in Provence-Alpes-Côte d'Azur, Midi-Pyrénées and Franche-Comté. The incidence of this cancer increased little over the 10 years of the study. CONCLUSION: There are regional disparities in the incidence and trends of digestive cancer incidence. These are more marked for esophageal cancer and gastric cancer than for colorectal cancer. The data supplied are of use both in the planning of health care and in the study of the causes or the prevention of digestive cancers.
Adolescent↗
[Reporting of resected colonic carcinomas. Assessment of practices in 8 French counties in 1995].
OBJECTIVES: The objective of this work was to study the reporting of resected colonic carcinomas and to compare them with Consensus Guidelines published in January 1998. METHODS: The study included 535 colonic carcinomas collected in 8 French registries in 1995, and chosen by drawing lots. For each report, the presence of the information requested by the Guidelines was looked for. Three synthetic variables were built: 2 scores and one qualitative at 2 classes. The influence of patients, tumour and health care system's characteristics was analysed on the 3 dependent variables. RESULTS: Some important variations were observed for information's percents in reporting. In monovariate analysis, scores were significantly influenced by cancer's sub-location, area of patient's residence, surgical center, type of laboratories and pathologist case volume. In multivariate analysis, significant heterogeneity in practices remained between geographical areas. Types of laboratories and pathologist case volume affected differently dependent variables. CONCLUSION: This study shows the necessity to assess the practices before consensus because of the impact of pathological forms in therapeutic decisions and variations observed.
Aged↗