Impact of tomosynthesis on the evolution of the cancer detection rate in the French National Breast Cancer Screening Program.

OBJECTIVES: This study aims to evaluate the cancer detection rate in French National Breast Cancer Screening Program, especially the cancer detection rate during second reading session (Reading 2) based on digital technologies used in radiology centres. STUDY DESIGN: This was an analytical and descriptive study. METHODS: Cancer detection rate was estimated by the ratio between the number of cancers detected and the number of women screened. The positive predictive value (PPV) was estimated as cancer detection rate among abnormal Reading 2. The relationship between Reading 2's PPV and the predictive factors was evaluated using multilevel mixed-effects logistic regression. RESULTS: A total of 1,380,006 digital mammograms were retained in the analysis between 2010 and 2019. Cancer detection rate represented 7.8‰ at first reading session (Reading 1) and 0.5‰ at Reading 2. Cancer detection rate is significantly associated with the use of tomosynthesis (P < 0.001) at Reading 1, and differences appear within different tomosynthesis brands (P = 0.007). Reading 2's PPV differs significantly according on technologies used by first Reader (P < 0.004). Nevertheless, Reading 2 has 1.9 (1.5-2.4) more likely to predict a cancer with the presence of previous mammogram compared with those without previous images. CONCLUSION: Using tomosynthesis technology improves cancer detection rate at Reading 1, even if differences are noticeable between brands. Using tomosynthesis technology at Reading 1 reduces Reading 2's PPV and cancer detection rate at Reading 2.

Breast cancer incidence by age at discovery of mammographic abnormality in women participating in French organized screening campaigns.

OBJECTIVE: Statistical modeling was already predicted the occurrence/prognosis of breast cancer from previous radiological findings. This study predicts the breast cancer risk by the age at discovery of mammographic abnormality in the French breast cancer screening program. STUDY DESIGN: This was a cohort study. METHODS: The study included 261,083 women who meet the inclusion criteria: aged 50-74 years, living in French departments (Ain, Doubs, Haute-Saône, Jura, Territoire-de-Belfort, and Yonne), with at least two mammograms between January 1999 and December 2017, of which the first was 'normal/benign'. The incidence of each abnormality (microcalcifications, spiculated mass, obscured mass, architectural distortion, and asymmetric density) was first estimated, then the breast cancer risk was predicted secondly according to the age at discovery of each mammographic abnormality, using an actuarial life table and a Cox model. RESULTS: Overall breast cancer (6326 cases) incidence was 3.3 (3.0; 3.1)/1000 person-years. The breast cancer incidence increased proportionally with the discovery age of the speculated mass and microcalcifications. The incidence was twice as high when the spiculated mass age of discovery was ≥70 (12.2 [10.4; 14.4]) compared with age 50-54 years (5.8 [5.1; 6.7]). Depending on the spiculated mass discovery age, the breast cancer risk increased by at least 40% between the age groups 55-59 years (1.4 [1.0; 1.8]) and ≥70 years (2.4 [1.9; 3.3]). Whatever the abnormality, the incidence of breast cancer was higher when it was present in only one breast. CONCLUSION: The study highlights a stable incidence of breast cancer between successive mammograms, an increased risk of breast cancer with the finding age of spiculated mass and microcalcifications. The reduced delay between the abnormality discovery date and the breast cancer diagnosis date would justify a specific follow-up protocol after the finding of these two abnormalities.

[Colorectal cancer screening program : Test completion rate and follow-up results after selective mailing of the test kit, based on likelihood of participation]. / Dépistage organisé du cancer colorectal : taux de réalisation du test et résultats du suivi après un envoi postal sélectif du kit de test, basé sur la probabilité de participation.

BACKGROUND: Even though theinterest of a Colorectal-Cancer Screening Program has been amply demonstrated, in French departments the participation rate (PR) seldom reaches 45%. In the absence of mass mailing, a strategy (S-1) consisting in mailing a test kit to people having made a request was implemented in 2015. In 2017, another mailing strategy (S-2), which consisted in sending the test kit only to people likely to take the test, was programmed. This study assesses the respective impact of these two strategies as compared to the standard approach (S-0). METHODS: The study included 254,113 (S-0), 4,130 (S-1) and 10,887 (S-2) people aged 50-74, targeted during the 2016-2017 campaign in Seine-Saint-Denis (France). S-0 persons received a 2nd reminder without a test-kit, while S-1 persons received, at their request, a mailed test kit. Without having made a request, S-2 persons the mailed test kit according to probability of participation (Proba) which was estimated a priori by the ratio between the sum total of index values (frequency of previous participation, date of most recent participation, age) and a theoretical maximum. Completion rates (test/colonoscopy) were compared 18 months after the last S-2 kit was sent. RESULTS: PR was highest in S-1 (S-0: 5.8%, S-1: 74.9%, S-2: 31.3%; p < 0.0001). In S-2, PR rose as Proba increased (Proba: ]0-30%], ]30-50%], ]50-75%], ]75-100%]; PR: 21.1%, 23.3%, 36.2%, 52.8% respectively; p < 0.05). Compared to the ≥70 years age-group, the 50-54 years age-group presented a lower PR in S-1 (65.9% vs. 85.1%; p < 0.05) whereas it presented a higher PR in S-0 (4.3% vs. 7.1%; p < 0.05) and in S-2 (23.2% vs. 54.5%; p < 0.05). All in all, colonoscopy completion rates were highest in S-1 (S-0: 62.2%, S-1: 80.0%, S-2: 65.0%; p < 0.001). CONCLUSION: Test-kit mailing without spontaneous request does not lead to an optimal level of participation, thereby highlighting a need to give thought to new and improved mobilization methods. The relatively pronounced participation of younger persons, who are not favored by present-day testing specifications, underscores the interest of a specific approach addressed to active people, who are less inclined than elderly individuals to regularly consult their attending physicians.

Feasibility of encouraging participation in colorectal cancer screening campaigns by motivating people through the social network, Facebook.

AIM: To describe the results of a feasibility phase and the expected results of a new approach to increase the participation rate in a Colorectal Cancer Organized Screening Program (CRCSP) through Facebook awareness messages. METHOD: This approach targets people aged 50-74 years, who reside in an urban deprived area and regularly connect to Facebook. The feasibility phase ran over 2 months (December 2018 and January 2019) in six municipalities (Seine-Saint-Denis, France). The full provisional campaign will run over a year. The approach consists of sending electronic awareness messages on the importance of screening for colorectal cancer using a specific Facebook module. Subjects who consent to screening complete a test-kit application form. The eligibility of each subject to participate in screening is determined by a doctor before the kit is sent out. RESULTS: A total of 39 900 people were reached by the feasibility phase campaign, and 9200 were able to watch at least one Facebook message/video. Of those, 4450 people logged to learn more about the CRCSP, 298 applied for a test kit, 160 test kit applicants were eligible to participate and the test completion rate was 41.9%. According to these feasibility results, 366 120 targeted people would connect regularly in the tested area, 141 541 of whom would be interested in a specific promotional message posted on Facebook. Requests could be made for 9770 kits, with 5246 people being eligible to participate in screening. The expected test-completion rate is estimated at 42%-89%. This would represent 5%-11% of the tests carried out in the area during the same period by 'classical' CRCSP. CONCLUSION: Implementation of the Facebook strategy would significantly improve the rate of participation in the CRCSP by mobilizing people with no previous participation, including younger subjects.

Impact of stopping sending colorectal cancer screening test kits by regular mail.

OBJECTIVE: From 2009 to 2013, the French colorectal cancer screening program (CRCSP) provided for a medical phase and a phase of systematic mailing of the test kit (SMTK) to people who could not participate in the medical phase. After 2013, the SMTK was abandoned in most districts. This study aims to analyze the impact of this termination. STUDY DESIGN: This was a descriptive and cohort study. METHODS: The study concerned a cohort of 143,989 people (aged 50-74 years) living in Seine-Saint-Denis (France), invited to participate in the 2013 campaign (with SMTK) and in the 2015 campaign (without SMTK). The impact of SMTK termination was analyzed in terms of the difference between the participation rates and between the delay (expected vs observed) in performing the screening test in 2015. These differences were described based on previous solicitation in the CRCSP. Expected rates and expected delay were estimated in a Monte Carlo simulation. RESULTS: The participation rate observed (20.0%) was higher than expected (16.1% [15.9-16.3]). People who have never had a SMTK between 2007 and 2013 (80.0% [79.3-80.7] vs 69.6%) and those who participated in all campaigns before 2015 (97.0% [96.7-97.3] vs 82.6%) had an observed rate lower than expected. The delay observed (4.2 months) was longer than expected (2.5 months). CONCLUSION: The sudden termination certainly contributed to the extension of the delay. However, it did not have a major impact on the participation rate, partly due to information campaigns on the new screening test. In this cohort, the low participation would be explained better by the behavior in the previous campaigns than by the lack of SMTK.

Vaccination coverage among children and adolescents below 18 years of age in French Guiana: inventory and determinant factors.

OBJECTIVE: The purpose of this study was to estimate the vaccination coverage (VC) rate in persons aged from 9 months to 18 years and to describe it according to the predictive factors of good vaccination status. STUDY DESIGN: Descriptive and etiological study. METHODS: The study involved 1332 persons aged below 18 years and members of 521 representative households in French Guiana. VC was estimated by the proportion of people with complete immunization for 13 vaccines (four mandatory, seven recommended, and two specific). This vaccination status was described in terms of sociodemographic characteristics. The relationship between vaccination status and predictive factors was analyzed in a hierarchical mixed, polytomic, and ordered regression model. RESULTS: For compulsory vaccination, VC was 81.2% for yellow fever, 63.4% for diphtheria, 61.7% for tetanus, and 61.6% for poliomyelitis. The proportion of people with complete immunization for recommended vaccines remains well below 50% (11.7% for pneumococcus and 6.2% for meningitis). Regardless of the vaccine, respondents aged 3-7 years were 2.5 times more likely to have an up-to-date vaccination compared to respondents younger than 3 years of age (P < 0.001). CONCLUSION: The VC observed in this study is still below the departmental objectives. The link between age and vaccination status could be explained by the efforts of the national education authorities to systematically check health cards for preschool and school enrollment.

[Profile of cranio-cerebral trauma and spinal cord trauma related road accidents in Guinea]. / Profil des traumatismes crânio-encéphalique et vertébro-médullaire liés aux accidents de la voie publique en Guinée.

OBJECTIVE: To describe the profile of the patient injured in traffic accidents and having a cranio-cerebral trauma (CCT) or spinal cord trauma (SCT). METHOD: Cross-sectional and retrospective survey of records management in 2829 road accident victims with CCT and/or a SCT and admitted to a hospital in Guinea between 1st January and 31st December, 2009. The profile was described by: the sociodemographic data, the circumstances of the accident and the clinical, therapeutic and follow-up data. RESULTS: For an average age of 27.1±12.7 years, the location of the trauma was cranio-cerebral in 82.0% of cases, spinal in 8.9% of cases and mixed in 9.1%. A large proportion of CCT (66.3%) and mixed trauma (63.1%) comes from to two-wheeled vehicles, while the large proportion of SCT (54.2%) is attributable to vehicles with four wheels. The Glasgow Coma average was 13.2±2.6 at admission, 21.7% of the victims are taken in charge beyond the first 12hours after the accident. Only 19.2% of patients underwent a surgical treatment with a hospital mortality ranging from 3.3 % (TVM) to 7.7% (mixed). CONCLUSION: CCT and SCT are characterized by an age under 30 years and male predominance. The support care suffers greatly from the unbalanced distribution of qualified personnel on the national territory and the lack of material means.

[Envenomations of the Kindia prefecture treated in the Institut Pasteur of Guinea for one year (2003-2004)]. / Les envenimations de la préfecture de Kindia traitées à l'Institut Pasteur de Guinée durant un an (2003-2004).

After a broadcast information on the availability of antivenom serum in Guinea Pasteur Institute (GPI), 76 snakebites victims have been admitted to the health centre of GPI within 11 months (October 2003-September 2004), 48 of whom were in a serious condition. In addition, 13 deaths occurred during the transport of the victims, i.e. a total incidence of 89 cases. Among these cases, 84% of the bites occurred during farming works (clearing, weeding, harvesting). Among the 76 victims who came alive at GPI, 9 of them did not present any envenomation. The 67 other victims have systematically received antivenom serum with a 100% recovery rate.