Facteurs comportementaux, radiologiques et histopronostiques des cancers du sein de plus de 20 mm détectés dans le programme français de dépistage organisé.

With the collaboration of all coordinating physicians responsible for breast cancer screening in France, the authors studied factors related to personal history, mammographic characteristics prior to the diagnosis and the tumours of women with breast cancers larger than 20 mm. This retrospective study concerned 7,407 cancers larger than 20 mm diagnosed in the context of screening.Although criteria of tumour aggressiveness were more marked and technological factors were more commonly encountered, compliance with screening appears to be a major determinant in the discovery of these large tumours.It is essential for the population to take up these screening programmes in order to have an impact on the prognosis of breast cancer..

Mammographic density and urbanization: a population-based screening study.

OBJECTIVES: The high incidence of female breast cancer that has been consistently reported in urban areas could be mediated by breast density, which is considered to reflect the cumulative exposure of breast tissues to hormones. The aim of this study was to assess how mammographic density varies by the degree of urbanization. SETTING: The population consisted of 55,597 cancer-free women, aged 50-59 years, who participated in a French breast cancer screening programme (Franche-Comté region) between 2005 and 2009. METHODS: Ordered logistic regression was run with mammographic density as the outcome, and degree of urbanization as the independent variable, while adjusting for some known confounding factors. Multiple imputation was used to deal with missing data. RESULTS: A significant positive linear trend with urbanization was found in a univariate approach (P trend <10(-3)), and after adjusting for risk factors (P trend = 10(-3)). A negative and highly significant association with mammographic density was highlighted both for age at the time of mammography (odds ratio (OR) 0.41, 95% confidence interval (CI) 0.39-0.43, per 10 years), and for low socioeconomic status (OR 0.71, 95% CI 0.67-0.75). The OR for hormone replacement therapy use was 1.51 (95% CI 1.43-1.58). CONCLUSIONS: Knowledge of this urbanization gradient in density (whatever its mechanism) may help to identify women who may require full-field digital mammography for the early detection of breast cancer, and could assist primary care providers in recommending the best screening strategy in a risk factor-based approach.

Trends in invasive breast cancer incidence among French women not exposed to organized mammography screening: an age-period-cohort analysis.

BACKGROUND: The long tenure of the Doubs cancer registry (France) and the late implementation of a mass screening program provide a unique opportunity to assess the relative contributions of age, period and cohort effects to the increase in female invasive breast cancer incidence, while avoiding the influence of an organized screening program. METHODS: Population and incidence data were provided for the Doubs region during the 1978-2003 period. Breast cancer counts and person-years were tabulated into 1-year classes by age and time period. Age-period-cohort models with parametric smooth functions were fitted to the data, assuming a Poisson distribution for the number of observed cases. RESULTS: A total of 5688 incident cases of invasive breast cancer in women were diagnosed in women aged 30-84 years in the Doubs region between 1978 and 2003. The annual percentage increase in incidence is 2.09%. Age effects rise dramatically until age 50, and at a slower pace afterwards. Large cohort curvature effects (p<10(-6)), show departure from linear trends, with a significant peak for women born around 1940. Period curvature effects are lower in magnitude (p=0.01). CONCLUSION: Both cohort and period effects are involved in the marked increase in breast cancer incidence over a 25-year period in the Doubs region. Although the future trend for breast cancer incidence is difficult to predict, the introduction of an organized screening program, and the sharp decline in hormone replacement therapy use will likely contribute to period effects in future analyses.

Usefulness of weekly methicillin-resistant Staphylococcus aureus screening.

We evaluated the usefulness of adding weekly methicillin-resistant Staphylococcus aureus (MRSA) screening to our established admission screening and clinical sampling in 4 acute care units of a university hospital. Our results suggest that weekly MRSA screening allows the detection of 56.1% of all cases of hospital-acquired MRSA carriage. These cases would have remained undetected had admission screening and clinical sampling been the only types of surveillance in place.