Rural–urban inequalities in detection rates of colorectal tumours in the population

Abstract Background Because few data are available on this topic, we investigated the influence of geographical determinants on colorectal adenoma detection and cancer incidence rates. Methods Between 1990 and 1999, 6220 Cote d’Or inhabitants (France) were first-diagnosed with a colorectal adenoma, and 2389 with an invasive adenocarcinoma. The impact of the rural–urban place of residence and of a physician location in municipalities on adenoma and cancer detection rates was studied using Poisson regression. Results World-standardized adenoma detection rate was significantly higher in urban areas (102 [95%CI: 97–107]) than in rural areas (78 [95%CI: 72–84]). The impact of the absence of phys…

Increased erythrocytes n-3 and n-6 polyunsaturated fatty acids is significantly associated with a lower prevalence of steatosis in patients with type 2 diabetes

Summary Background & aims Non-alcoholic fatty liver disease (NAFLD) is commonly associated with obesity, metabolic syndrome and type 2 diabetes. Although dietary fat contributes substantially to the accumulation of liver fat, the role of individual fatty acids in this accumulation is unclear. Objective In this study, we set out to determine whether liver fat content (LFC), was associated with red blood cell fatty acid (RBC-FA) composition in people with type 2 diabetes. Design, settings, and participants One hundred and sixty-two type 2 diabetic patients were included in this study. LFC was measured using 1H-MR Spectroscopy. RBC-FA composition was measured by gas chromatography. Results One…

The lifelong risk of metachronous colorectal cancer justifies long-term colonoscopic follow-up.

The aim of this study was to calculate the risk of metachronous colorectal cancers, to specify their characteristics and potential risk factors in a well-defined French population over a 27-year period.The 10,801 patients who had colorectal cancers totalled 61,879 person-years of follow-up. The actuarial method was used to obtain crude metachronous colorectal cancer rates. Standardised incidence ratios (SIRs) were calculated.The cumulative rate of metachronous colorectal cancer was 1.8% at 5 years, 3.4% at 10 years and 7.2% at 20 years. The incidence of metachronous colorectal cancer following a first colorectal cancer was higher than expected (SIR: 1.5 [1.3-1.7] p0.001). It remained greate…

Dietary components modulate the risk of hepatocellular carcinoma in cirrhotic patients.

Abstract Eighty percent of hepatocellular carcinoma (HCC) cases occur after cirrhosis from various etiologies. The association between diet and cancer is well accepted, but the links with cirrhosis progression and HCC risk have been poorly investigated. However, we hypothesized that diet could be a modifiable preventive factor for HCC. Thus, the aim of our study was to explore the relationships between dietary factors and the risk of HCC in a population of cirrhotic patients. A total of 582 cirrhotic patients were studied: 401 without HCC (controls) and 181 with HCC (cases). These patients were recruited between 2008 and 2012 for the “CiRCE” case-control study conducted in six French univer…

Impact des facteurs nutritionnels pendant et après cancer

Nutritional factors (diet, weight, alcohol, physical activity) are identified as factors having an impact on the onset of several cancer sites. Less abundant scientific data also underline their impact on the tumor progression. A review of the scientific literature was carried out by a group of experts established by the French National Cancer Institute (INCa) to better document the influence of nutritional factors during and after cancer on outcomes such as overall mortality, cancer specific mortality, recurrence, second primary cancers and quality of life. This analysis of the literature completes messages of reduction of alcohol consumption, prevention of undernutrition or excess weight …

A 30-Year, Population-Based Study Shows Improved Management and Prognosis of Hepatocellular Carcinoma

Background & Aims Little is known about the impact of changes in the management of hepatocellular carcinoma (HCC) over time. We assessed trends in the pattern of care and in prognosis at a population level. Methods Data on diagnostic conditions, treatment, and prognosis from 1976–2005 were collected by the population-based digestive cancer registry of Burgundy (France). A nonconditional logistic regression was used to identify factors associated with treatment for cure. A multivariate relative survival analysis was also performed. Results The context of HCC diagnosis has changed; the proportion of asymptomatic patients increased from 5.6% (1976–1985) to 37.2% (1996–2005). The proportion of …

Colonoscopic screening of first-degree relatives of patients with large adenomas: increased risk of colorectal tumors.

International audience; Background & Aims: The risk of developing colorectal neoplasia is not well established among family members of individuals with large adenomas and screening strategies remain under debate in this population. This study aimed at quantifying the risk of colorectal adenomas and cancers using colonoscopic screening in first-degree relatives of patients with large adenomas. Methods: This case-control study was performed in 18 endoscopic units of French non-University Hospitals. A colonoscopy was offered to first-degree relatives of 306 index cases with adenomas ≥ 10 mm, if they were alive, aged 40-75 and could be contacted by the index case. Among 674 relatives meeting th…

Circulating Apelin is increased in patients with type 1 or type 2 diabetes and is associated with better glycaemic control

SummaryContext Apelin is an adipokine expressed in several tissues and it appears to be involved in energy metabolism. Objective The aim of this study was to determine serum apelin levels in a large cohort of patients with type 1 and type 2 diabetes and control subjects and to correlate the results with glycaemic control. Design and Participants One hundred and thirty patients with type 1 diabetes, 98 patients with type 2 diabetes and 162 controls were enrolled in the study. Apelin levels were measured by enzyme-linked immunosorbent assay. Results Serum apelin levels were significantly higher in type 1 and type 2 diabetic patients than in controls (P < 0·0001). Serum apelin levels were high…

Potentiel inflammatoire de l’alimentation et risque de carcinome hépatocellulaire chez des patients atteints de cirrhose

Introduction et but de l’etude La repetition d’episodes inflammatoires de plusieurs origines (virales, alcooliques, metaboliques) conduisant a la cirrhose sont sans doute des causes majeures de carcinogenese hepatique. La relation entre alimentation et carcinome hepatocellulaire (CHC) sur cirrhose a encore ete peu exploree. Notre objectif etait d’examiner l’association entre le potentiel inflammatoire de l’alimentation (evalue par Dietary Inflammatory Index, DII) et le risque de CHC chez des patients cirrhotiques. Materiel et methodes Dans l’etude multicentrique CiRCE (Cirrhose et Risque de Carcinome hepatocellulaire dans le grand Est), 181 patients cirrhotiques avec CHC (cas) et 401 patien…

Pratiques du jeûne et de régimes restrictifs pour perdre du poids parmi 2700 survivants du cancer : résultats de la cohorte NutriNet-Santé

Introduction et but de l’etude La nutrition est souvent utilisee par les survivants du cancer comme un levier leur permettant d’etre acteurs de leur propre sante. Cependant, certains comportements alimentaires ne sont actuellement pas recommandes pour les patients sans surveillance medicale. Cette etude avait pour objectif d’evaluer les regimes restrictifs pour perdre du poids et les pratiques de jeune chez les survivants du cancer de la cohorte NutriNet-Sante, ainsi que les facteurs sociodemographiques et de mode de vie associes. Materiel et methodes En octobre 2016, 2733 survivants du cancer avaient complete un questionnaire specifique sur leurs pratiques alimentaires. Resultats et analys…

Prevalence of patients with colorectal cancer requiring follow-up or active treatment

Abstract Introduction The objective of this study was to estimate prevalence of colorectal cancers requiring care or follow-up. Materials and methods Prevalence was observed in 2005 on the population-based digestive cancer registry of Burgundy (France). Total and 5-year partial prevalences were calculated. The prevalence of patients requiring follow-up was estimated using non-mixture cure models. The prevalence of patients with recurrence was estimated using annual recurrence rates. Results Total prevalence was 262,244 cases in France. The mean variation in 5-year partial prevalence between successive 5-year periods was +8.0%. Time to cure was estimated to be 9.3 years, suggesting that foll…

Jeûne, régimes restrictifs et cancer : revue de la littérature et recommandations issues du rapport du réseau NACRe

National audience

Epidemiology and prognosis of synchronous colorectal cancers

Abstract Background The aim of this population-based study was to report on the incidence, treatment and prognosis of synchronous colorectal carcinomas. Methods Data were obtained from the population-based cancer registry of Burgundy. Results Between 1976 and 2004, 15 562 colorectal cancers were diagnosed. Some 3·8 per cent of patients had synchronous colorectal cancers. The risk of having synchronous cancers was higher in men (odds ratio (OR) 1·41 (95 per cent confidence interval (c.i.) 1·19 to 1·68)), when associated adenomas were present (OR 2·02 (95 per cent c.i. 1·69 to 2·41)), when there were adenomatous remnants on pathological examination (OR 2·10 (95 per cent c.i. 1·73 to 2·55)) an…

Mitochondrial D310 mutations in colorectal adenomas: an early but not causative genetic event during colorectal carcinogenesis.

Somatic mutations of the D310 sequence of the mitochondrial DNA are reported in human cancers, including colorectal cancers (CRC). The presence of these mutations at early or late steps of colorectal carcinogenesis is unknown. Their prevalence increased significantly with the number of cytosines in the D310 sequence of the matched normal tissue (D310 polymorphism), suggesting that this polymorphism could be a risk factor for CRC. The aim of this study was (i) to investigate the prevalence of D310 mutations in 64 colorectal adenomas and 36 liver metastases from 15 CRC patients, (ii) to assess the relation between D310 polymorphism and the risk of colorectal adenoma in a case-control study in…

Colonoscopic screening of first-degree relatives of patients with large adenomas: increased risk of colorectal tumors.

International audience; Background & Aims: The risk of developing colorectal neoplasia is not well established among family members of individuals with large adenomas and screening strategies remain under debate in this population. This study aimed at quantifying the risk of colorectal adenomas and cancers using colonoscopic screening in first-degree relatives of patients with large adenomas. Methods: This case-control study was performed in 18 endoscopic units of French non-University Hospitals. A colonoscopy was offered to first-degree relatives of 306 index cases with adenomas ≥ 10 mm, if they were alive, aged 40-75 and could be contacted by the index case. Among 674 relatives meeting th…

Alcoholic beverages, obesity, physical activity and other nutritional factors, and cancer risk: A review of the evidence

International audience; Purpose: Prevention is a priority in the fight against cancers, especially nutritional prevention. To update the levels of evidence of relationships between 10 nutritional factors and cancer risk, the scientific literature published from 2006 to 2014 was reviewed by an expert group.Methods: Data from 133 meta-analyses, pooled analyses or intervention trials were examined. Nearly 150 relationships between nutritional factors and cancer at various sites were evaluated.Results: According to the evidence graded as convincing or probable, these factors were divided in two groups. Factors which increase the risk of cancer are alcoholic beverages, overweight and obesity, re…

Dietary patterns and the risk of colorectal adenoma recurrence in a European intervention trial

The relations between individual foods and nutrients to colorectal tumours are conflicting. Few studies have taken into account the interdependence between individual components of diet and their possible interactions. The aim of the study was to examine the associations between dietary patterns and the risk of colorectal adenoma recurrence in the European fibre-calcium intervention trial. Among the 640 patients with confirmed adenomas at the index colonoscopy, 592 had an initial dietary assessment using a diet history questionnaire. The present analysis was restricted to 277 men and 165 women without history of adenoma prior to the index colonoscopy and who completed the study. The main en…

Comorbidities Alone Do Not Explain the Undertreatment of Colorectal Cancer in Older Adults: A French Population-Based Study

OBJECTIVES: To investigate the influence of comorbidities on treatment modalities of colorectal cancer according to the age of patients and French recommendations. DESIGN: Population-based study SETTING: French Digestive Cancer Registry, Burgundy. PARTICIPANTS: Two thousand nine hundred twenty-one incident colorectal cancers diagnosed between 2004 and 2007. MEASUREMENTS: The independent influence of comorbidities (recorded according to the Charlson index) on treatment was analyzed using multivariate logistic regressions controlling for age, sex, and their interaction. RESULTS: The association between comorbidities and resection for cure was significant only in patients younger than 75 (P in…

UP TO WHAT AGE PROPOSE MASS SCREENING FOR COLORECTAL CANCER BY FAECAL OCCULT BLOOD TEST? ANALYSIS OF A COHORT IN A WELL-DEFINED POPULATION

Potential role of oxidative DNA damage in the impact of PNPLA3 variant (rs 738409 CG) in hepatocellular carcinoma risk.

International audience

Long-term effect of faecal occult blood screening on incidence and mortality from colorectal cancer

Abstract Background Several randomized trials have shown a reduction of colorectal cancer mortality by screening using guaiac-based faecal occult blood tests. However, little is known on the long-term effect of screening at the population level in everyday practice. Methods Small-sized geographic areas including a total of 91,199 individuals were allocated to either biennal screening using the Hemoccult-II test or no screening. The expected mortality and incidence in the cohort invited to screening was determined using mortality and incidence in the non-screened population. Results Colorectal cancer mortality was significantly lower in the population invited to screening than in the non-scr…

Disparités du taux de détection des adénomes colorectaux en fonction du lieu de domicile et de la distance aux médecins en Côte-d’Or, entre 1990 et 1999

Trends in colorectal cancer incidence: a period and birth-cohort analysis in a well-defined French population.

Abstract Background France stands among high-risk areas for colorectal cancer. Different trends in CRC incidence are reported around the world. The aim of this study was to provide temporal trends in CRC incidence over a 30-year period in a French well-defined population. Methods Between 1976 and 2005, 17,028 new cases were registered by the Burgundy digestive cancer registry. The mean variations in age-standardized incidence rates were estimated using a Poisson regression adjusted for age for each gender and location. The cumulative risk by birth cohort of developing a cancer over the age range 0-74 years was estimated using an age-cohort model. Results Incidence rates for right and left c…

Impact pronostique de la concentration de 3-hydroxymyristate sur la survie des patients atteints de cirrhose alcoolique ou virale

Etat de la question Le role de l’endotoxemie liee a la translocation bacterienne sur l’aggravation de la cirrhose fait l’objet de nombreuses etudes, mais son impact sur la mortalite au cours de la cirrhose est mal connu. Le but de ce travail etait d’etudier l’impact de la concentration sanguine de 3-hydroxymyristate (3-HM) total (composant specifique des lipopolysaccharides, endotoxine), sur le risque de deces et de complications des malades cirrhotiques. Materiel et methodes Au total, 593 patients atteints de cirrhose alcoolique ou virale, sans carcinome hepatocellulaire ont ete inclus entre 2008 et 2012 dans six centres hospitalo-universitaires francais. Le dosage de 3-HM total, libre et …

Fasting and weight-loss restrictive diet practices among 2,700 cancer survivors: results from the NutriNet-Santé cohort

Nutrition is often used by cancer survivors as a lever to take charge of their own health. However, some dietary behaviors are not currently recommended for patients without medical supervision. Our study aimed at evaluating weight-loss restrictive diets and fasting practices among cancer survivors of the NutriNet-Sante cohort, as well as related socio-demographic and lifestyle factors. In October 2016, 2,741 cancer survivors had completed a specific questionnaire about their practices. Fasting and non-fasting patients (respectively dieting and non-dieting) were compared using logistic regression models. Analyses were weighted according to the age, gender, and cancer location distribution o…

Facteurs nutritionnels et risque de carcinome hépatocellulaire chez des personnes atteintes de cirrhose

Introduction et but de l’etude Le carcinome hepatocellulaire (CHC) se developpe dans 80 % des cas sur un foie cirrhotique. En France, l’incidence augmente et les traitements restent peu efficaces. L’alimentation peut etre un moyen de prevention interessant mais les resultats d’etudes dans ce domaine restent rares et divergents. Notre objectif etait donc d’etudier les liens entre differents facteurs alimentaires et le risque de CHC dans une population francaise atteinte de cirrhose. Materiel et methodes Pour l’etude multicentrique Cirrhose et risque de carcinome hepatocellulaire dans le grand est (CiRCE), des patients cirrhotiques avec CHC histologiquement confirme (cas) et des patients cirr…

Trends in the incidence and management of biliary tract cancer: a French population-based study.

The trends in incidence and management of biliary tract cancer (BTC) were investigated in a well-defined French population over a 30-year period (1976-2005).Data were obtained from the Burgundy digestive cancer registry. Age-standardised incidence rates and trends in incidence were determined. Treatment and stage at diagnosis were also investigated. Five-year survival rates were calculated.Six hundred and fifteen cases of BTC were recorded. There was no significant change in BTC incidence over the 30-year period. For extrahepatic BTC age-standardised incidence rates were 1.1/100,000 for 1976-80 and 2001-2005. These rates were respectively 0.3 and 0.2/100,000 for intrahepatic BTC. The propor…

Nutrition and physical activity: French intergroup clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, ACHBT, AFC, SFP-APA, SFNCM, AFSOS)

International audience; This document is a summary of the French intergroup guidelines regarding the nutrition and physical activity (PA) management in digestive oncology. This collaborative work was produced under the auspices of all French medical and surgical societies involved in digestive oncology, nutrition and supportive care. It is based on published guidelines, recent literature review and expert opinions. Recommendations are graded according to the level of evidence. Malnutrition affects more than half of patients with digestive cancers and is often underdiagnosed. It has multiple negative consequences on survival, quality of life and risk of treatment complications. Consequently,…

Incidence and patterns of late recurrences in colon cancer patients

Long-term recurrences of colon cancer raised questions about the possible benefit of prolonging the recommended active 5-year surveillance. The aim of this study was to determine, for the first time, the incidence and patterns of late 10-year recurrence following curative resection of colon cancer. Data were obtained from two French digestive cancer registries. A total of 3,622 patients under 85 years resected for cure for colon cancer diagnosed between 1985 and 2000 were included. Information regarding recurrences was actively collected. Cumulative failure rates at 10 years were estimated using Kaplan-Meier estimates corrected by cause-specific hazards, and multivariable analysis was perfo…

Prognostic Impact of 3-HM Concentration in Patients with Alcoholic or Viral Cirrhosis

The role of endotoxemia related to intestinal bacterial translocation in worsening liver disease is the subject of many studies, but its impact on cirrhosis mortality has not been well evaluated. In this study, 3-hydroxymyristate (3-HM) (specific lipid of lipopolysaccharides) was directly quantified by an innovative patented assay with the aim of assessing the impact on cirrhosis mortality. The 3-HM concentration was measured in 593 patients with alcoholic or viral cirrhosis in stable clinical condition. A Cox hazards regression model was used to evaluate association between 3-HM and its fractions bound or nor bound to lipoprotein and the mortality. The 3-HM concentration was increased in p…

Rural–urban differences in the long-term risk of colorectal cancer after adenoma removal: A population-based study

Abstract Background We investigated the impact of municipality of residence on colonoscopic surveillance and colorectal cancer risk after adenoma resection in a French well-defined administrative area. Methods This registry-based study included all patients residing in Cote d’Or (n = 5769) first diagnosed with colorectal adenomas between January 1, 1990, and December 31, 1999. Information about colonoscopic surveillance and colorectal cancer incidence was collected until December 31, 2003. Results A rural place of residence reduced the probability of colonoscopic surveillance in men [HR = 0.89 (95%CI: 0.79–0.99), p = 0.041] and in patients without family history of colorectal cancer [HR = 0…