Colorectal cancer (CRC) screening using sigmoidoscopy followed by colonoscopy: a feasibility and efficacy study on a cancer institute based population.

BACKGROUND: Advanced distal neoplasia found at sigmoidoscopy could be the marker for more proximal lesions. PATIENTS AND METHODS: In the setting of a screening clinic, subjects underwent flexible sigmoidoscopy. If no significant lesion was found, sigmoidoscopy was planned after 5 years. If an advanced neoplasia was found, colonoscopy was performed just after the first sigmoidoscopy and at 1, 3 and 5 years. If a non-advanced neoplasia was found, sigmoidoscopy was performed at 1, 3 and 5 years and followed by colonoscopy if advanced lesion was found. RESULTS: At first screening 1704/1912 (88%) subjects had a negative sigmoidoscopy, 104 (5.4%) had an advanced neoplasia, 96 (6%) had a non-advanced neoplasia and eight (0.4%) had invasive colorectal cancer (CRC). At follow-up examinations at 1, 3 and 5 years, among 170 subjects with advanced and non-advanced neoplasia, one developed invasive CRC and 47 (31.6%), advanced neoplasia. At 5 years, among 718 first negative sigmoidoscopies, 572 (80%) were confirmed negative and 97 (14%) had advanced neoplasia. Colorectal cancer status at 5 years could be checked for interval cancers in 97% of subjects and no CRC was diagnosed in subjects who did not attend sigmoidoscopy at 5 years. Comparison of the incidence of invasive CRC to the data of registries of the Netherlands and Luxembourg suggested that the incidence of CRC was decreased by 36%-46%. Seven of the nine CRCs were Duke's A and the two others were Duke's B and C. CONCLUSIONS: Screening with sigmoidoscopy followed by colonoscopy in case of positive sigmoidoscopy leads to substantial decreases in the incidence of CRC. Most CRCs found are at an early, curable stage of their development.

[Breast cancer: apropos of "in situ"]. / Le cancer du sein: à propos des "In Situ".

Since the introduction of screening mammography, the proportion of ductal carcinoma in situ (DCIS) has significantly increased. Their early detection result in the majority of the cases in an exclusive radiologic expression and a histopathologic measure inferior to 20 mm. Newly formulated proposals of histologic classifications may permit in the future to identify subtypes of DCIS with a different clinical behaviour and prognosis. In analogy to the treatment's evolution for invasive mammary cancers, the concept of conservative breast surgery is evaluated in prospective randomized trials, together with the impact of adjuvant radiotherapy. Preliminary results report high survival rates, despite a considerable number of local recurrences. Radiotherapy seems not to reduce proportionally the risk for non-invasive and invasive recurrences.

[Value of serum immunoglobulin assays in early myocardial infarction]. / Intérêt du dosage des immunoglobulines sériques lors de l'installation d'un infarctus du myocarde.

Serum immunoglobulin (Ig) levels were assayed in 672 patients admitted for acute myocardial infarction with onset within 24 hours of hospitalization. Supranormal Ig levels (A > or = 300, G > or = 1,200) or subnormal Ig levels (M < 40 mg/100 ml) were seen in patients with one or several risk factors (diabetes mellitus, alcohol abuse) or a history of previous myocardial infarction. Patients with one or more Ig anomalies were more likely to exhibit unfavorable outcomes, including early death, suggesting that increased viscosity due to aggregation of Ig molecules may occur.