Incidence, mortality and receptor status of breast cancer in African Caribbean women: Data from the cancer registry of Guadeloupe.

BACKGROUND: Geographical disparities in breast cancer incidence and outcomes are reported worldwide. Women of African descent show lower incidence, higher mortality rates and earlier age of onset. We analyzed data from the cancer registry of Guadeloupe for the period 2008-2013. METHODS: We describe breast cancer characteristics by molecular subtype, as well as estimated observed and net survival. We used Cox proportional hazard models to determine associations between cancer subtypes and death rate, adjusted for variables of interest. RESULTS: Overall, 1275 cases were recorded with a mean age at diagnosis of 57(±14) years. World standardized incidence and mortality were respectively 71.9/100,000 and 14.1/100,000 person-years. Age-specific incidence rates were comparable to European and US populations below the age of 45, and higher in Guadeloupean women aged between 45 and 55 years. Overall, 65.1% of patients were hormone receptor (HR)+ and 20.1% were HR-. Triple negative breast cancers (TNBC) accounted for 14% of all cases, and were more frequent in patients under 40 (21.6% vs. 13.4%, p=0.02). Five-year net survival was 84.9% [81.4-88.6]. It was higher for HR+/Her2+ and HR+/Her2- subtypes, and lower for HR-/Her2+ and TNBC patients. CONCLUSION: We found high age-specific incidence rates of breast cancer in women aged 45 to 55 years, which warrants further investigation in our population. However, this population of mainly African descent had good overall survival rates, and data according to subtypes are consistent with those reported internationally. These results may suggest that poorer survival in other African descent populations may not be an inherent feature of the disease but may be amenable to improvement.

[A case study regarding the use of antibiotic therapies for the treatment of preterm premature rupture of fetal membranes, and emergence of antibiotic resistant bacteria]. / Comparaison des protocoles d'antibiothérapie en cas de rupture prématurée des membranes avant terme entre deux maternités de niveau III en termes de sélection de bacilles Gram négatifs résistants.

OBJECTIVE: The objective of this retrospective study is to compare two types of antimicrobial management used to treat premature rupture of membranes in pregnancy. This study evaluates both duration and the type of antibiotic therapy used for treatment. PATIENTS AND METHODS: The antimicrobials used to treat premature rupture of membranes include a first generation cephalosporin in one group and amoxicillin in the other group. Cephalosporin was used over a 7-day period to treat 38 cases, whereas amoxicillin was used through delivery in 52 cases. Emergence of multidrug-resistant Gram negative bacteria (GNB) on maternal of neonatal sampling was the primary outcome. RESULTS: Emergence of antibiotic resistant GNB can be seen under both antibiotic regimens and appears to be linked to the duration of latency, and to duration of antibiotic treatment. Other outcomes (duration of latency period, gestational age at delivery, maternal and neonatal complications) were similar in both groups. CONCLUSION: Antibiotic treatment in PPROM favors a selection of GNB. This emergence is positively linked with the duration of latency between rupture of membranes and delivery and with the length of antibiotic administration. The extension of antibiotherapy does not alter other maternal or neonatal parameters.

[Assessment of imminence of unplanned out-of-hospital deliveries in Guadeloupe: experience of the mobile emergency and resuscitation service of Pointe-à-Pitre]. / Évaluation de l'imminence de l'accouchement inopiné extra-hospitalier en Guadeloupe : expérience du service médical d'urgence et de réanimation de Pointe-à-Pitre.

OBJECTIVES: Medical tools to determine the imminence of unplanned out-of-hospital birth have not been validated. The main goal of this study was to analyze assessments of the imminence of these deliveries, by methods such as the Manilas score and the need to push. PATIENTS AND METHODS: All calls made to the Emergency Medical Aid Service in Guadeloupe concerning risks of unplanned delivery between January 1st and June 30th 2011 were reviewed retrospectively, and 69 of the 85 cases cared for by the hospital mobile emergency unit were included. RESULTS: Risks of unplanned out-of-hospital deliveries represented 1.9% of the calls during the study period. The Malinas score was used for dispatching in only 13% and was not used for intervention in any case. It was estimated that the need-to-push feeling was used for 58% (dispatching) and 54.5% (intervention) of patients. Its sensitivity, specificity and predictive values were higher than those of the Malinas score in dispatching and substantially higher in intervention. CONCLUSION: These results argue for the development of tools for estimating the imminence of unplanned delivery. Such tools should be applicable in extra-hospital emergency situations to ensure their use in practice.

[Sociodemographic and medical features of abortion among underage people in Guadeloupe (French West Indies)]. / Caractéristiques sociodémographiques et médicales des interruptions volontaires de grossesse des mineures en Guadeloupe.

OBJECTIVE: In France, contraception is available for everybody; however, the number of abortion does not decrease, especially among young people. The aim of our study is to analyze, in the Guadeloupian context, the characteristics of underage people who ask for an abortion. METHODS: This retrospective study, analyses sociodemographic and medical characteristics of 129 teenagers, who had an abortion in 2010 in our abortion center. For 67 of them results of interviews with the psychologist were also reported. RESULTS: Preferentially from large single parent families, these underage people had a mean age of 15.9 years (± 1.12), 96.1% were born in France, 10.9% had had a previous pregnancy, 67.2% had an over 18 partner, 64.4% used contraception before the abortion. Main motivations for abortion were continuing studies and young age. Abortion occurs after 9 weeks of amenorrhea in 55.1% and 43.3% of underage people reported psychological problems linked to the abortion. CONCLUSION: From this profile, our study suggests some reflection which could help the fight against unwanted pregnancies in this particular population of underage people.

[Transgenerational evolution of age of the main stages of reproductive life in Guadeloupe]. / Évolution transgénérationnelle de l'âge des principales étapes de la vie reproductive en Guadeloupe.

OBJECTIVE: The aim of this study was to assess changes in the ages at which the main stages of reproductive life, including first sexual intercourse in particular, occur in Guadeloupe (French West Indies). PATIENTS AND METHODS: We conducted a transverse study of three generations of men and women over the age of 20 years. We recorded age at first intercourse and at first child for all subjects, plus age at menarche, at first pregnancy and at menopause for the women. RESULTS: We collected information for 803 women and 169 men. For women, median age at menarche and at first intercourse had decreased significantly, reaching 12 and 17 years, respectively. The risk of first intercourse occurring before the median age was linked to the earliness of menarche. Age at first pregnancy, at menopause for women and at first intercourse for men remained roughly stable. A non-significant trend towards increasing age at the birth of the first child was observed in both sexes. DISCUSSION AND CONCLUSION: Age indicators for the main stages of reproductive life in Guadeloupe follow the trends reported in most Western countries, including mainland France. However, most of the ages recorded for particular stages are below those in mainland France. The link between age at menarche and sexual precocity may justify targeted awareness programs.

[Pregnancies among underage girls in Guadeloupe: a new inventory]. / Grossesses évolutives chez les mineures en Guadeloupe : nouvel état des lieux.

OBJECTIVES: In Guadeloupe (French West Indies), fecondity rate of teenagers is higher than in mainland France. The aim of our study was to analyze sociodemographic characteristics and perinatal indicators among underage girls and to compare them to those of a previous study also conducted in our maternity unit in 1993 and 1994. MATERIALS AND METHODS: The sociodemographic, medical, obstetrical and neonatal data of 163 underage pregnant girls delivered from 2009 to 2010 at the University hospital of Pointe-à-Pitre/Abymes were collected retrospectively and compared with the previous study. RESULTS: In 16 years, in contrast to perinatal indicators, which did not significantly evolve, the sociodemographic characteristics of this population have changed. In addition, the increase of neonatal morbidity seems to be related to late initiation of obstetrical care, which also still remains insufficient. CONCLUSION: Our results are close to those described in the other French regions and have hardly evolved since our previous study. The differences found for the obstetric and perinatal risks seem to be related to sociodemographic factors surrounding these underage pregnancies. Those factors should be taken into consideration in any approach aiming to reduce incidence and prevent complications of pregnancies among teenagers.

Medical and sociodemographic risk factors for preterm birth in a French Caribbean population of African descent.

There appears to be an incompressible high rate of preterm births among populations of African origin irrespective of their geographic location. The objective of this study was to assess the risk factors for preterm birth in a French Caribbean population of African descent, offered medical care comparable to that on the French mainland, but presenting a higher rate of preterm birth. The study was based on a birth cohort at maternity hospitals in Guadeloupe (French West Indies) including 911 singleton pregnancies enrolled during their third trimester check-up visits. Associations between risk factors and the risk of preterm delivery (spontaneous and induced) were assessed using a multivariate Cox model. In addition, prevalences of sociodemographic and medical factors in Guadeloupe were compared with those on the French mainland. 144 women (15.8 %) delivered preterm, medically induced in 52 %. Women delivering preterm were more often over 35 years old (37 %), single (54 %), and had higher prevalence of prior preterm birth (20 %), prior miscarriage (37 %), lupus (3 %), asthma (14 %), gestational hypertension (26 %), gestational diabetes (13 %) and urinary tract infection (24 %) than women with term births. In the whole cohort, these risk factors were also more frequent than in mainland France. Our results suggest highly prevalent medical risk factors for preterm births in Guadeloupe. This observation combined with specific social risk factors (older maternal age, single living) less frequent on the French mainland probably explains a large part of a higher prevalence of preterm births in this population despite similar medical provision.

[Illegal abortion with misoprostol in Guadeloupe]. / Avortements illégaux par le misoprostol en Guadeloupe.

OBJECTIVES: The aim of this study was to describe the typical profile, and to assess the motivations of women who underwent illegal abortion with misoprostol in Guadeloupe (French West Indies). MATERIALS AND METHODS: We conducted a 1-year prospective study on women who consulted after failure or complication of an illegal abortion with misoprostol. RESULTS: Fifty-two cases of illegal abortion with misoprostol were recorded. The most common profile was an unemployed woman, who was unmarried, foreign-born, had no medical insurance, and a low level of education; the median age was 28 (range 17 to 40). The justifications given were that the legal procedure was considered to be too slow, the young age of the woman, the ease of the self-medication procedure, a history of illegal abortion by misoprostol in the woman's country of origin, ignorance of the legal process, and financial and/or administrative problems. CONCLUSION: The problem of illegal abortion is probably underestimated in Guadeloupe and possibly France. This description of the profile of the population concerned and the justifications for choosing illegal abortion by misoprostol provides elements allowing better focus of education concerning abortion, contraception and family planning. Access to legal abortion centers should also be improved.

[Identification of barriers to routine HIV testing prescription by midwifes and doctors in Guadeloupe]. / Identification des freins à la prescription du test de dépistage de l'infection au VIH par les sages-femmes et médecins en Guadeloupe.

OBJECTIVES: Guadeloupe is the second highest French area for diagnosis and prevalence of HIV infection and AIDS. In October 2009, the French High Health Authority has published guidelines for a more systematic HIV screening. The goal of this study is to identify the limitations in HIV testing prescription by the Guadeloupian prescribers according to these new recommendations. MATERIALS AND METHODS: Data were collected with a questionnaire submitted to physicians and midwives after random selection. RESULTS: Among 285 randomly selected prescribers, 67 midwives and 40 physicians participated from August to December 2010. The main limitations to HIV testing prescription were: a consultation for another purpose, patient or his life style were known, and lack of HIV infection symptoms. Some characteristics of more easily screened patient did not match with those who had been newly diagnosed in Guadeloupe. Finally, both quantitative and qualitative knowledge of these new recommendations was insufficient. CONCLUSION: Implementation of these new testing recommendations should give emphasis to the systematic and annual nature of HIV testing for whole population. It should also insist on distinction between HIV testing and diagnosis of a symptomatic patient.

Cervical intraepithelial neoplasia and invasive cancer risks in women infected with HIV in the French West Indies.

OBJECTIVE: The aim of the study was to assess whether HIV infection is associated with a higher risk of invasive cervical cancer (ICC). METHODS: We conducted a region-wide, population-based observational cohort study of 1232 HIV-infected women over the age of 15 years in Guadeloupe, a French Caribbean archipelago, during the period 1999-2006. The observed numbers of incident cases of cervical intraepithelial neoplasia (CIN) and ICC were compared with the expected numbers of cases based on the incidence rates for the general population, and the standardized incidence ratios (SIRs) and 95% confidence intervals (CIs) were calculated. RESULTS: The incidence rate of CIN was higher in the HIV-infected women than in the general population for all grades (SIR 10.1, 95% CI 6.8-14.6 for CIN grade 1; SIR 9.9, 95% CI 6.1-15.3 for CIN grade 2; and SIR 5.2, 95% CI 3.4-7.7 for CIN grade 3). However, no increase in the risk of ICC was observed (SIR 1.7, 95% CI 0.3-4.9). CONCLUSIONS: Despite an increase in the occurrence of cervical cancer precursors, no increase in the risk of cervical cancer was found in a population of HIV-infected women who receive treatment for their infection and have access to ICC prevention services.

[Pregnancy in a rudimentary uterine horn]. / Grossesse dans une corne utérine rudimentaire.

The authors report a case of pregnancy in a rudimentary horn diagnosed by laparotomy. The location could not be suspected by any clinical sign. This pregnancy stopped at 19 weeks of amenorrhoea. Any attempts of induction of labour failed. Laparotomy was necessary to assess the diagnosis and to allow the resection of the uterine horn. The authors present a review of literature.