ABSTRACT
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.
Subject(s)
Colorectal Neoplasms/mortality , Mass Screening , Occult Blood , Aged , Case-Control Studies , Colorectal Neoplasms/diagnosis , Female , France/epidemiology , Humans , Male , Middle Aged , Odds RatioABSTRACT
PURPOSE: The aim of this study was to describe the implication of the different health care structures in the treatment of breast cancer. METHODS: In Côte-d'Or, from 1982 to 1992, there were 2432 cases of breast cancer. Surgery came first as treatment for 93% of the patients, radiotherapy came second (77%). The department is subdivided in several geographic areas (ZPIU):--Dijon, equipped with university hospital (UH) and with private hospitals (PH),--cities with general hospitals (GH)--and areas without hospitals. Demographic, geographic and clinical variables were studied in order to explain the patient distribution between the various hospitals. RESULTS: 52% of the cases were operated in PH, 37% in UH and 11% in GH. The main users of the GH were women who lived nearby. Age over 75 was associated with a treatment in GH. Women with clinical signs of severity were twice as often operated in UH rather than PH. Post-operative radiotherapy was done in 95% of the cases in the same structure where surgery was done. CONCLUSION: No matter how popular university and private hospitals were in our regional capital, general hospitals played a proximity role.
Subject(s)
Breast Neoplasms/therapy , Practice Patterns, Physicians' , Adult , Age Distribution , Aged , Female , France , Humans , Middle Aged , Neoadjuvant TherapyABSTRACT
Time trends in therapeutic approaches and in the prognosis of colon cancer for patients aged 75 years and above have been investigated in comparison with corresponding trends for younger patients using a population-based series of 2089 colon cancer patients diagnosed between 1976 and 1990 in the Côte-d'Or area (478,000 inhabitants), Burgundy, France. Significant progress has been achieved in the management of patients with colon cancer in both age groups, but trends have been more noticeable in patients aged 75 years and above. In the elderly, the proportion of cancers limited to the digestive tract wall showed a 3-year average increase of 2.8% (P = 0.02) and the frequency of curative surgery an average increase of 8.6% (P < 0.001), so that it was performed in 80% of cases in the last 3-year period. Operative mortality decreased by 2.5% between 3-year periods (P < 0.004). Crude 5-year survival rates in elderly patients increased from 15% in the 1976-78 period to 29% in the 1985-87 period (P < 0.001), the corresponding figures being 36% and 44% (P > 0.10) in younger patients.
