Les cinq départements et régions d’outre-mer (DROM) sont la Guadeloupe, la Guyane, La Réunion, la Martiniqueet Mayotte. Dans les DROM, on observe dans certains territoires des sur-incidences significatives de certains cancers, notamment pour les cancers gynécologiques ; avec des survies nettes standardisées à cinq ans globalement inférieures à celles observées en France hexagonale. Nous présentons ici un état des lieux de la prise en charge des cancers gynécologiques dans chaque DROM.

The five overseas departments and regions (DROMs) are Guadeloupe, French Guiana, Reunion, Martinique and Mayotte. In the DROMs, certain areas show significantly higher incidence rates for certain cancers, particularly gynaecological cancers; overall, the 5-year net standardised survival rates are lower than those observed in mainland France. Here, we present an overview of the management of gynaecological cancers in each DROM.

Introduction: The incidence of cervical cancer in French Guiana is among the highest worldwide. It ranks 5th among all cancers and is the 2nd most common cancer in women after breast cancer. The primary objective of this study was to establish the proportion of high-grade cytological lesions of the cervix in women under 25 years of age who underwent a cervico-uterine smear (CUS) in French Guiana over a 10-year period. Material and methods: This cross-sectional, retrospective, and descriptive study included all female patients under 25 years of age who underwent CUS between January 1, 2010, and December 31, 2019, in French Guiana, regardless of the reason for consultation. Results: A total of 17,275 CUS were selected for analysis of the results and study of squamous abnormalities, of which 15,421 (89.3%) showed no abnormality, and 1,854 (10.7%) showed a squamous abnormality. Only 3.9% of patients presented with atypical squamous cell evocating high grade lesions and 4.4% with high-grade squamous intraepithelial lesions. The prevalence and severity of the abnormalities increased with age; no cases of cancers were detected. Conclusion: In view of the results and the benefit/risk balance, systematic generalized early screening for those aged 25 and over does not appear to be warranted. Instead, screening should be targeted based on clinical history.

Introduction L’exposition au mercure est un sujet de santé mis en évidence en Guyane en 1994 suite à des études menées par le réseau de santé publique sur les niveaux d’imprégnation en population générale, chez les femmes en âge de procréer et les jeunes enfants vivant le long des fleuves guyanais (jusqu’à 10,6 µg/g > au seuil toléré par l’OMS) dans les cheveux. L’objectif de ce travail est de décrire les connaissances et modalités de diffusion des recommandations de consommation de poissons, par les professionnels de santé (PDS) auprès des populations vulnérables et d’identifier des leviers d’amélioration en Guyane en 2024. Méthodes Il s’agit d’une enquête transversale (exploratoire) menée de janvier à mai 2024 auprès des PDS du champ de la périnatalité de l’Ouest Guyanais (CHOG, CDPS, PMI, et professions libérale) à travers un questionnaire en ligne afin de produire un état des lieux des connaissances et pratiques des recommandations. Résultats À l’issue des premiers entretiens réalisés (résultats préliminaires) auprès des PDS (n = 150-200), une tendance se dégage sur leur profil sociodémographique nous confiant ne pas informer leurs patients sur l’exposition au mercure, estiment être en difficultés et ne pas avoir de solution alternative à proposer. Les indicateurs sur le profil des PDS ont beaucoup changé ces 5 dernières années, le turn-over, les déserts médicaux et l’éloignement géographique restent des freins à la transmission des messages aux populations vulnérables. Discussions et conclusions Notre étude d’ici avril 2024 (résultats définitifs), nous permettra d’apporter des pistes de réflexion sur l’urgence de mettre à jour et de diffuser de manière standardisée les recommandations via les spots télé, radio dans les Centres Délocalisés de Prévention et de Soins, les hôpitaux de proximité et les trois hôpitaux de Guyane.

BackgroundInfant mortality in French Guiana, a French overseas territory, is 2.7 times greater than in mainland France. Given the importance of better understanding infant mortality we aimed to describe the early & late neonatal, and postneonatal mortality in French Guiana between 2007 and 2022.MethodsWe used data from the Institut National de la Statistique et des Etudes Economiques to describe trends and performed survival analysis.ResultsOverall, there were 1 073 deaths before one year of age, of which 297 (27.7 %) occurred on the first day of life. The overall proportion of early neonatal deaths was 47.1 %, late neonatal deaths was 17.3 %, and post-neonatal deaths was 35.6 %. The overall incidences were 4.6 per 1,000 for early neonatal mortality, 1.4 per 1,000 for late neonatal mortality, and 3.1 per 1,000 for post neonatal mortality. The incidence for infant mortality for French Guiana residents was thus 9.1 per 1,000.ConclusionsWe show that post neonatal deaths in French Guiana are proportionally greater than in mainland France and they do not seem to decline, as they did in France. The relative proportions of post-neonatal mortality can thus help to identify important areas for action to correct excess infant mortality. Although poor pregnancy follow-up remains a problem we show that follow-up of infants is also a pressing problem that warrants increased efforts.

BACKGROUND:French Guiana is a French overseas territory which combines a well-funded universal health system and a population where half are under the poverty line. In this context, we aimed to measure and describe the causes of infant mortality and, because French Guiana is a French territory, to compare them with mainland France. METHODS:National death certificate data between 2001 and 2017 was used. RESULTS:Overall, 6.9 % of deaths before 65 years concerned infants <1 year (in mainland France 2.6%). The infant mortality rate over the 2001-2017 period was 2.6 times that of mainland France (1159.5 vs 446.2 per 100,000 infants <1 year) with excess incidence in perinatal causes, malformations and chromosomal anomalies, accidents, infectious causes, and in poorly defined conditions. Over time, there seemed to be a reduction of infant mortality for all the main causes, except for congenital malformations and chromosomal anomalies, which, on the contrary, seemed to increase. The data sources did not allow to study the weight of social factors or place of residence. CONCLUSIONS:All causes of infant mortality seemed to decline over time except malformations and chromosomal anomalies, which increased. Although exposure to heavy metals, infectious diseases are potential explanations we cannot pinpoint the cause of this increase with the available data. The present results suggest infant mortality and malformations should benefit from more detailed data sources in order to better assess and alleviate the burden of infant mortality in French Guiana.

Context: There is a general health decline among farmers and the leading cause of death in this population remains cardiovascular (CV) diseases. The situation is similar in the Guianese general population, with a preoccupying increase in CV diseases. However, there are no data on farmers’ health. Methods: A cross-sectional study analyzed data from the “Novembre Vert” action conducted in 2018 in French Guiana. Beneficiaries and farmers affiliated to the Mutualité Sociale Agricole who completed the survey were included. The objective was to assess their CV risk. Results: 603 farmers were included. The sex-ratio was 1.6 and the median age was 52. Over 70% of the participants had a Body Mass Index ≥ 25, with a greater risk of obesity in the female population. High blood pressure (HBP) affected 53.1% of farmers and 80.1% were diagnosed during screening. About 13.5% had diabetes. Overall, 27% of participants were at high or very high CV risk. CV risk was 3 times greater in men. Conclusion: HBP (53.1%), obesity (30.3%) and diabetes (13.5%) prevalence are particularly worrying and underline the importance of policies to reduce cardiovascular morbimortality among farmers.

PurposeThe Maroni basin -delineating the border between Suriname and French Guiana- presents sociocultural, geographical and economic circumstances that have been conducive to the circulation of sexually transmitted infections and to delays in diagnosis and care. Given the scarcity of published data, we aimed to describe different sexually transmitted infections along the Maroni and to gain a broader understanding of the epidemiologic situation. MethodsWe conducted a scoping review of the efforts to approach the problem of sexually transmitted infections in this complex border area. Temporal trends were plotted and crude numbers were divided by local population numbers. ResultsFor HIV, despite increasing testing efforts, most patients still present at the advanced HIV stage (median CD4 count at diagnosis is < 20 per mm(3)), and 25% of patients in Saint Laurent du Maroni were lost to follow-up within 6 years. However, progress on both sides has led to a decline in AIDS cases and mortality. Despite a rapid increase in the 1990's along the Maroni, the current HIV prevalence seemed lower (0.52%) in the rural villages than in coastal urban centers (> 1%). High risk HPV infection prevalence among women reaches 23.3%. The incidence of gonorrhea was 4.2 per 1,000 population aged 15-59. For chlamydiasis it was 3.4 per 1,000 population aged 15-59. For syphilis, the incidence was 2.5 per 1,000 population aged 15-59. Gonorrhea, chlamydiasis, hepatitis B detection increased over time with greater testing efforts and new diagnostic tests. Since the COVID-19 epidemic, congenital syphilis has dramatically increased in Saint Laurent du Maroni reaching 808 per 100,000 live births. ConclusionSexually transmitted infections seemed more prevalent in Saint Laurent du Maroni -the sole urban center-than in the remote villages along the Maroni. The syndromic approach and the heterogeneity of diagnostic platforms presumably overlook most infections in the region. Therefore, a concerted approach and a shared diagnostic upgrade with molecular diagnosis and rapid diagnostic tests seem necessary to reduce the burden of sexually transmitted infections on both sides of the Maroni. Congenital syphilis resulting from COVID-19 disruption of health services requires urgent attention.

Objectives: Cervical cancer is the second most frequent cancer among women in French Guiana. The objective was to review a decade of cervical cancer data, and to study spatial and temporal trends.Study design: The design was retrospective and descriptive. Methods: The cancer registry of French Guiana compiled exhaustive data on cervical cancer throughout French Guiana between 2005 and 2015. Age-standardized incidence and mortality were computed and mapped to identify priority areas.Results: With 232 new cases recorded in French Guiana between 2005 and 2014 (23 annual cases), cervical cancer ranked 5th among all incident cancers (11%) and was the 2nd most frequent cancer in women (12% of cancers among women). The standardized incidence rate over the period 2005-2014 was 23.8 cases of cervical cancer per 100 000 woman-years. Between 2005-2009 and 2010-2014 the incidence of cervical cancer decreased from 26.26 cases per 100 000 to 22.66 cases per 100 000 and the mortality rate from cervical cancer decreased from 6 deaths per 100 000 to 3.2 deaths per 100 000. Within French Guiana, the standardized incidence rates were very heterogenous with the highest rates in remote areas. The standardized death rate from cervical cancer over the 2005-2014 decade was 4.4 cases per 100 000 woman-years.Conclusions: The present results suggest there has been progress in French Guiana, but there are still areas where screening is challenging and should be expanded. The recent authorization of HPV testing is an opportunity that could help health professionals achieve this goal. HPV vaccination -with a nonavalent vaccine-is also an important public health endeavor that could alleviate the burden of cervical cancer among the cohorts of women benefitting from it.

Amerindian and Maroon populations of French Guiana have been living in isolation for generations and sexual networks remained mostly endogamous. The present study aimed to describe the phylogeny of E6 and E7 sequences of the most common high-risk HPV genotypes in these regions, to ascertain the diversity of intra-type variants and describe evolutionary relationships. There were 106 women with at least one of HPV16, 18, 31, 52, 58, and 68 genotypes. The most clear-cut phylogenetic pattern was obtained for HPV18 and HPV58 for which the major branches were crisply divided between Amerindian villages on the Oyapock and Maroon villages on the Maroni. Such clustering was less clear for HPV31 and 52. For HPV16, there was also some evidence of clustering on the Oyapock with type A European viruses and on the Maroni with type B and C African viruses among Maroon women. HPV68 showed the largest sequence heterogeneity of the six genotypes at both nucleotide and amino acid levels and was restricted to Maroon women. The present results show that there were significant geographically based differences of E6 and E7 oncogenes. These differences were compatible with different ancestral virus populations and local virus evolution in a context of prolonged population isolation.

Cervical cancer prevention using cervical cytology is insufficiently sensitive, a significant proportion of HPV-infected women having normal cytology.

Background In French Guiana, cervical cancer is the second most frequent cancer in females. The objective of the present study was to describe the prevalence of HPV infections in women with normal cervical cytology living in the remote villages of French Guiana. Methods Before the study, the study team communicated in the remote villages on the importance of screening. All women from the target population were offered to participate. They signed informed consent during inclusion and then had a concomitant HPV-test and cervical smear. Only women with normal cytology and a good quality smear were analyzed. The detection of HPV-DNA was performed using the GREINER-BIO-ONE kit. Results Overall, 27.2% of women with normal cervical cytology had a positive HPV-test. There was a U-shaped evolution of prevalence with women over 50 years having the highest HPV prevalence, followed by the 20 to 29 years group. The most prevalent HPV genotypes were HPV 53(3.52%), 68(3.33%), 52(2.59%), 31(2.22%) and 16 (1.85%). The proportion of HPV 16 among HPV-infected women was 6.8%. Conclusions HPV prevalence in cytologically normal women was very high. The most prevalent genotypes were very different from what is usually described in the world, and notably in South America.

International Journal of Gynecology & ObstetricsVolume 125, Issue 2 p. 166-167 Brief communications Survival of patients with invasive cervical cancer in French Guiana, 2003–2008 Maylis Douine, Corresponding Author Maylis Douine [email protected] Centre D'investigation Clinique, Epidemiologie Clinique Antilles Guyane (Inserm/DGOS CIE802), Centre Hospitalier Andrée Rosemon, Cayenne, FranceCorresponding author at: CIC-EC Antilles Guyane, Centre Hospitalier Andrée Rosemon, 3, avenue des Flamboyants, BP 6006, 97306 Cayenne, Guyane. Tel.: + 594 694 40 29 66; fax: + 594 594 39 48 72.Search for more papers by this authorTristan Roue, Tristan Roue Registre des Cancers de Guyane, Cayenne, FranceSearch for more papers by this authorAngela Fior, Angela Fior Registre des Cancers de Guyane, Cayenne, France Laboratoire d'anatomopathologie, Centre Hospitalier Andrée Rosemon, Cayenne, FranceSearch for more papers by this authorAntoine Adenis, Antoine Adenis Centre D'investigation Clinique, Epidemiologie Clinique Antilles Guyane (Inserm/DGOS CIE802), Centre Hospitalier Andrée Rosemon, Cayenne, FranceSearch for more papers by this authorNadia Thomas, Nadia Thomas Association Guyanaise de dépistage organisé des cancers, Cayenne, FranceSearch for more papers by this authorMathieu Nacher, Mathieu Nacher Centre D'investigation Clinique, Epidemiologie Clinique Antilles Guyane (Inserm/DGOS CIE802), Centre Hospitalier Andrée Rosemon, Cayenne, France Equipe d'accueil EPAT, EA 3593, Université Antilles Guyane, Cayenne, FranceSearch for more papers by this author Maylis Douine, Corresponding Author Maylis Douine [email protected] Centre D'investigation Clinique, Epidemiologie Clinique Antilles Guyane (Inserm/DGOS CIE802), Centre Hospitalier Andrée Rosemon, Cayenne, FranceCorresponding author at: CIC-EC Antilles Guyane, Centre Hospitalier Andrée Rosemon, 3, avenue des Flamboyants, BP 6006, 97306 Cayenne, Guyane. Tel.: + 594 694 40 29 66; fax: + 594 594 39 48 72.Search for more papers by this authorTristan Roue, Tristan Roue Registre des Cancers de Guyane, Cayenne, FranceSearch for more papers by this authorAngela Fior, Angela Fior Registre des Cancers de Guyane, Cayenne, France Laboratoire d'anatomopathologie, Centre Hospitalier Andrée Rosemon, Cayenne, FranceSearch for more papers by this authorAntoine Adenis, Antoine Adenis Centre D'investigation Clinique, Epidemiologie Clinique Antilles Guyane (Inserm/DGOS CIE802), Centre Hospitalier Andrée Rosemon, Cayenne, FranceSearch for more papers by this authorNadia Thomas, Nadia Thomas Association Guyanaise de dépistage organisé des cancers, Cayenne, FranceSearch for more papers by this authorMathieu Nacher, Mathieu Nacher Centre D'investigation Clinique, Epidemiologie Clinique Antilles Guyane (Inserm/DGOS CIE802), Centre Hospitalier Andrée Rosemon, Cayenne, France Equipe d'accueil EPAT, EA 3593, Université Antilles Guyane, Cayenne, FranceSearch for more papers by this author First published: 07 February 2014 https://doi.org/10.1016/j.ijgo.2013.10.031Citations: 11Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References [1]Roue T., Nacher M., Fior A., Plenet J., Belliardo S., Gandolfo N. et al. Cervical cancer incidence in French Guiana: South American. Int J Gynecol Cancer. 22 (5): 2012; 850– 853 [2]Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynecol Obstet. 105 (2): 2009; 103– 104 [3]Duport N. Epidemiological data of cervical cancer. http://www.sante.gouv.fr/IMG/pdf/cancer_col_uterus__connaissances.pdf, Published January 2007 [4]Carmo C.C., Luiz R.R. Survival of a cohort of women with cervical cancer diagnosed in a Brazilian cancer center. Rev Saude Publica. 45 (4): 2011; 661– 667 [5]Galic V., Herzog T.J., Lewin S.N., Neugut A.I., Burke W.M., Lu Y.S. et al. Prognostic significance of adenocarcinoma histology in women with cervical cancer. Gynecol Oncol. 125 (2): 2012; 287– 291 Citing Literature Volume125, Issue2May 2014Pages 166-167 ReferencesRelatedInformation

For the first time, the incidence of cervical cancer was estimated in French Guiana, an overseas French Territory of South America. A certified cancer registry collected exhaustive data on cervical cancer between 2003 and 2005. The age-standardized rate of invasive cervical cancer was 30.3 per 100,000 women. Women from rural areas had lesions with a significantly greater extension than women from urban areas. Compared to South American figures, the standardized incidence of cervical cancer seemed relatively high when viewed in comparison with the gross domestic product per capita. The curative orientation of the health system should move from opportunistic screening for cervical cancer to organized screening, with an emphasis on the rural parts of French Guiana.

Contexte – Le cancer du col de l’uterus est le deuxieme cancer feminin le plus frequent en Guyane francaise. Des etudes ont montre que les populations residant dans les communes isolees de l’interieur du departement debutent leur vie sexuelle de facon precoce et que le multipartenariat sexuel y est frequent. Dans ce contexte, l’objectif principal de cette etude etait de determiner la prevalence de l’infection a papillomavirus humains (HPV) dans ces zones. Methodes – Cette etude transversale multicentrique a ete conduite aupres des femmes âgees de 20 a 65 ans residant dans les communes isolees des fleuves Maroni et Oyapock. Les femmes etaient incluses sur la base du volontariat apres avoir ete informees du passage de l’equipe de l’etude via la radio locale et par les leaders d’opinion. La recherche d’infection a HPV et les analyses cytologiques ont ete realisees sur chaque prelevement. L’infection a HPV etait definie par la detection d’ADN viral par le kit de depistage Greiner Bio One®. Les analyses cytologiques ont ete decrites selon la classification de Bethesda 2001. Resultats – Au total, 643 femmes ont ete incluses. La prevalence de l’infection a HPV, standardisee sur l’âge, etait de 35%. La courbe de prevalence par classe d’âge presentait une forme en U : les femmes de plus de 50 ans avaient le plus haut risque d’etre infectees par HPV, suivies par les femmes âgees de 20 a 29 ans. Par ailleurs, 26,1% des femmes ayant un frottis normal etaient infectees par le HPV. Les genotypes les plus frequents etaient HPV52, HPV58 et HPV16. Sur les frottis interpretables, 1,16% des femmes avaient des lesions de haut grade (type HSIL). Conclusions – Le taux standardise de prevalence de l’infection par le HPV en Guyane est parmi les plus eleves au monde. Les lesions cytologiques de type HSIL etaient pres de 4 fois plus frequentes qu’en Ile-de-France. Etant donne l’importance de l’incidence du cancer du col de l’uterus en Guyane, ces resultats montrent qu’il est peut etre preferable d’utiliser le test HPV plutot que la cytologie. La vaccination anti-HPV, de preference avec le nouveau vaccin nonavalent, semble etre une mesure de prevention appropriee. Pour autant, cela reste un challenge de mettre en oeuvre ces interventions dans cette region ou une part importante de la population n’a pas d’assurance maladie.