Background: Colorectal cancer prevalence is an important determinant of the health demand that completes information provided by cancer incidence. Current estimations established from data for the years 1985 and 1995 can be used to establish a precise description of changing healthcare needs for colorectal cancer.Method: Prevalence estimates method were based on incidence data computed on the regional scale by the FRANCIM network and mortality data provided by INSERM. We used the relationship that exists between the net risk of cancer, the net risk of dying of the given cancer and the age-specific prevalence of cancer.Results: In 1995, the prevalence of patients who had a diagnosis of colorectal cancer amounted to 200 000 persons. The estimated number of prevalent cases was never lower than 3500 in any region and in 7 regions this number was higher than 10 000. From 1985 to 1995, there has been an increase of 35% in the prevalence rates.Conclusion: The evaluation of the number of persons who have had a diagnosis of colorectal cancer provides knowledge for health care planning. Such information on the regional scale is very useful for the health organisation (SROS). This geographical level induces difficulties not encountered at the national level.

After an increase in the 1980s, incidence and mortality for prostate cancer in North America or England and Wales started to decrease in the early 1990s. The reasons for this evolution are widely debated, notably the importance of early detection. This study describes trends of prostate cancer incidence and mortality in 5 areas in France, where practices of early detection for this cancer are widely used. The 5 French administrative areas, covered by a population‐based registry, have a total population of approximately 1,700,000 men. Incidence data from these registries were studied for the period 1982–1995, and mortality data were provided by the Institut National de la Santé et de la Recherche Médicale ( INSERM ) for the period 1982–1996. Age‐Period‐Cohort models by Poisson regression were created to characterize these trends. Between 1982 and 1995, 14,699 cases of prostate cancer were registered by the 5 registries under consideration. After a little intensification of the increase in 1987, undoubtedly due to early detection (notably using Prostate‐Specific Antigen), the trend of the incidence seems to reverse from 1993. Mortality increased monotonically from 1982–1990 by an average of 1.8% per year, before decreasing annually by an average of 3.3% until 1996. Poisson regressions indicated a period effect on both incidence and mortality data; a small, but significant, cohort effect exists for incidence evolution, showing that elements such as etiologic factors may have an influence. Until results of randomized studies on mass screening are available, the question of individual screening remains; improved knowledge of risk factors could be interesting. © 2001 Wiley‐Liss, Inc.

With 10,882 estimated new cases in 1995 in France, lip, oral cavity and pharynx tumours rank 4th, representing 8.1% of all cancers in men. They are less frequent in women, with a sex ratio of 7. Based on the French cancer registries data which cover 13% of the metropolitan territory in 2000, both incidence and mortality increased until early 1980s to decrease thereafter. The main hypothesis proposed to explain the French leadership world-wide for these tumours deals with alcohol and tobacco consumption. Important differences observed between several areas within Europe, for some subsites, in connection with age or sex, are pointing toward the need of new studies about environment and/or genetics. Until now, comparisons between countries were made at the level of lip, oral cavity and pharynx category as a whole or by large subgroups. In this work we attempt to establish more accurate statistics, in order to comply with the situation of this cancer in France. Present results should encourage the scientific community to conduct site specific epidemiological studies.

OBJECTIVE:A description of radical prostatectomy (PR) practice in the general population in France has never been reported. The objective of this study was to analyse RP practice in France, and its determinants and geographical variations based on the CCAFU-Francim survey on prostate cancer (PC) diagnosed in 1995.MATERIAL AND METHOD:175 PR were performed on the sample of 798 patients selected at random from the cases of PC identified in 1995 by four cancer registries (Bas-Rhin, Calvados, Isère and Tarn). Analysis was based on tumour characteristics, diagnostic methods and histopathological results. Multivariate analysis by logistic regression taking into account age, PSA and clinical stage studied variations between departments and types of urology practice (private or public).RESULTS:The mean age of the patients at the time of the diagnosis was 65.3 years (46-76). The median PSA was 18.3 ng/ml (1-184). The diagnosis was made by biopsies (91%) which were systematized in 74% of cases or by transurethral resection (7%). The clinical stage was T1 (22.3%), T2 (64%), T3 (8.6%), N+ (0.611) and unknown (4.5%). The pathological stage was pT2N0 (46.3%), pT3N0 (40%), pT4N0 (1.7%), pTxN0 (8.6%) and unknown (3.4%). Adjuvant treatment (radiotherapy: 13.7%, endocrine therapy: 13.7% or both: 31%) was performed in 54 patients (31%). Multivariate analysis showed that the adjusted probability to be treated by RP was 3 times higher in one department compared to others and 2.6 times higher in the private sector.CONCLUSION:This study of RP practice in the general population shows a concordance with the 1995 recommendations, but it also shows practice variations according to the region and the type of practice, reflecting different schools of thought and medical education within the same country.

OBJECTIVE The management, diagnosis and treatment of prostate cancer (PC) in the general population are poorly defined in France. The objective of this survey was to analyse the diagnostic and therapeutic modalities of prostate cancer in 1995, on the basis of a population derived from 4 French cancer registries. MATERIAL AND METHOD A sample of 803 PCs diagnosed in 1995 were selected at random from the cases listed in the 4 registries (Bas-Rhin, Calvados, Isère and Tarn). Analysis by questionnaire concerned the modalities of diagnosis, clinical tumour stage and the treatment performed. Clinical stage (TNM 1992) was submitted to centralized coding. Logistic regression was used to quantify the various practices, taking into account the patient's age, PSA level and clinical stage. The probability of receiving each treatment modality was studied by using the same clinical determinants. RESULTS The mean age of the patients was 71.6 years (range: 46-94). The clinical stage was T1 or T2 in 60% of cases, T3 or T4 in 14% of cases and N+ or M+ in 17% of cases. PSA (median: 18.2 ng/ml) was assayed in 92.4% of cases. The diagnosis was established by biopsy in 63% of cases and by endoscopic resection (TURP) in 32% (5% unknown). The main treatments were: radical prostatectomy (RP): 21.9%, radiotherapy: 19.4%, endocrine therapy: 33%, isolated TURP: 16.3%, conservative management: 6% and unspecified treatment: 5.6% of cases. 31% of cases received combinations of various treatment modalities. RP was performed more frequently in patients over the age of 60 years, for T2 tumours (OR: 3.3) and for 4 < PSA < 20 ng/ml. Radiotherapy tended to be reserved for older patients with T3-T4 tumours and 20 < PSA < 50 ng/ml. The frequency of endocrine therapy increased with age and PSA (> 50 ng/ml). The frequency of TURP and surveillance also increased with age, decreased with high PSA and essentially concerned T1 tumours. CONCLUSION PC was diagnosed relatively early in France in 1995 with clinically localized tumours in 60% of cases. In this survey, 94% of patients received treatment during the year following diagnosis, with 40% of curative treatments and 31% of combined treatments.

There has as yet been no descriptive study of the practice of radical prostatectomy in the general population in France. The objective of this work was to investigate the use of radical prostatectomy (RP) in France and its determinants and geographic variations. A total of 175 radical prostatectomies was identified in a random sample of 798 cases of prostate cancer recorded in 1995 by four cancer registries, in the departments of Bas-Rhin, Calvados, Isère and Tarn. Tumour characteristics, diagnostic procedures and histopathological results were analysed. Multivariate analysis by logistic regression was used to take into account age, prostate specific antigen (PSA) levels and clinical stage in order to study variations between geographical departments and sectors of activity (private or public). The mean age of the patients at the time of diagnosis was 65.3 y (range 46–76). Median PSA level was 18.2 ng/ml (range 1–184). Diagnosis was made by randomised biopsies in 73.8% of cases or by transurethral resection (6.9%). Clinical stage was classified T 1 (22.3%), T 2 (64%), T 3 (8.6%), N + (0.6%) and unknown (4.5%). The histopathological result was pT 2 N0 in 46.3% of cases, pT 3 N0 in 40%, pT 4 N0 in 1.7%, pT x N + in 8.6% and unknown in 3.4%. Adjuvant therapy (radiotherapy 13.7%, hormonal treatment 13.7% or both 3%) was administered in 54 patients (31%). Logistic regression showed that the probability of undergoing RP was three times higher in one department than in the other departments, and was 2.6 times as high in the private sector. This study on the practice of RP is the first performed in the general population in France. It shows that practice differs according to geographical region and sector of activity, indicating that schools of thought and medical culture vary within the same country.

In France, as in other European countries, management of prostate cancer in the population is rather variable. The objective was to analyse diagnosis and treatment modalities of prostate cancer in patients from French cancer registries. A sample of 803 patients with prostate cancer diagnosed in 1995 was drawn at random from cases recorded in four cancer registries in the geographical regions of Bas-Rhin, Calvados, Isère and Tarn. Diagnosis, clinical staging and treatment were analysed by questionnaire. Multivariate analysis by logistic regression was used to describe medical determinants (age, PSA, clinical staging) of the various treatment choices. The mean age of the patients was 71.6 y (range 46–94 y). Clinical staging showed 60% T1–2 tumours, 15% T3–4 and 17% N+or metastases. PSA rate (median 18.2 ng/ml) was assessed in 92.4% of patients. Prostate cancer was diagnosed by prostate biopsy in 63% and by transurethral resection of the prostate (TURP) in 32% of patients. The main treatments were radical prostatectomy 22%, radiotherapy 19.4%, hormonal therapy 33%, TURP alone 17.7% and expectant management 6%. The method of treatment was unknown in 5.7% of cases. Adjuvant radiotherapy or hormonal therapy had been used in 31% of cases. Logistic regression analysis showed that radical prostatectomy was most often performed in patients aged <60 y, three times more frequently for T2 tumour and for PSA between 4 and 20 ng/ml. Radiotherapy was the most frequently applied treatment for patients aged between 65 and 75 y, especially in T3 tumours. Approximately 75% of the patients in the study underwent a specific treatment for prostate cancer with a curative intention in 40%. This study provides a baseline to clinicians and public health authorities on the management of prostate cancer in France with recent data. This survey will be useful to compare future descriptive analysis and to provide data regarding changing clinical practice. .

The cervical cancer screening campaign has been settled in 1990 in the french department of Bas-Rhin and has effectively started in 1994. The 1901 law association EVE, gathering the partners concerned by illness and screening, has been designed as responsible for organisation. In relation with the field actors, the main guidelines were to try and increase the women's participation in the screening, to insure the quality of the cytological interpretation and the follow-up of pathological smears. After a four and a health years campaign, 80.3% of 25 to 65 years old women had the benefit one smear at least. The quality of the cytological interpretation is quite good and the follow-up of pathological smears is acceptable. This experience indicates the screening by the existing medical structures is possible. Many laboratories of cytology have accepted to participate in the campaign and to respect the modalities, notably for the transfer of data and the process insurance-quality. The majority of the practioners (gynecologists and general practioners) takes part in collecting the information about the follow-up. However, there's no regulation from official texts about the screening modalities and that makes to come to an arrangement with the health professionals in order to obtain and maintain their participation.

Objectives - The objective of this work was to study the reporting of resected colonic carcinomas and to compare them with Consensus Guidelines published in January 1998.Methods - The study included 535 colonic carcinomas collected in 8 French registries in 1995, and chosen by drawing lots. For each report, the presence of the information requested by the Guidelines was looked for. Three synthetic variables were built: 2 scores and one qualitative at 2 classes. The influence of patients, tumour and health care system's characteristics was analyzed on the 3 dependent variables.Results - Some important variations were observed for information's percents in reporting. In monovariate analysis, scores were significantly influenced by cancer's sub-location, aera of patient's residence, surgical center, type of laboratories and pathologist case volume. In multivariate analysis, significant heterogeneity in practices remained between geographical aeras. Type of laboratories and pathologist case volume affected differently dependent variables.Conclusion - This study shows the necessity to assess the practices before consensus because of the impact of pathological forms in therapeutic decisions and variations observed.

OBJECTIVES:Information about the incidence of cancer in the national territory is a necessity for decision makers in public health. The aim of this study was to estimate for the first time the incidence of digestive tract cancers in each region of France in 1992 as well as trends in incidence between 1985 and 1995.METHODS:The incidence/mortality ratio established by sex, by age group and by localization in the departments covered by a cancer registry was applied to the mortality of each region studied. The mortality data were fit by applying a log linear model.RESULTS:The highest incidence rates of esophageal cancer were found in the North, in Brittany, Normandy and Picardy. The lowest rates were found in the regions of Midi-Pyrénées, Languedoc-Roussillon, Provence-Alpes-Côte d'Azur, Aquitaine and Poitou-Charentes. The incidence of this cancer decreased slightly between 1985 and 1995. Brittany and Normandy were also high risk regions for gastric cancer, while Provence-Alpes-Côte d'Azur, Midi-Pyrénées and Poitou-Charente were low risk regions. The incidence of gastric cancer also decreased more markedly than that of esophageal cancer. Colorectal cancer was more frequent in Alsace, Lorraine and in the North, it was less common in Provence-Alpes-Côte d'Azur, Midi-Pyrénées and Franche-Comté. The incidence of this cancer increased little over the 10 years of the study.CONCLUSION:There are regional disparities in the incidence and trends of digestive cancer incidence. These are more marked for esophageal cancer and gastric cancer than for colorectal cancer. The data supplied are of use both in the planning of health care and in the study of the causes or the prevention of digestive cancers.

STUDY OBJECTIVE: In many countries, cancer registries cover only a small part of the national population. Cancer incidence for the rest of the country has therefore to be estimated. This can be done from mortality data using the relation between incidence and mortality observed in the cancer registry areas. Such an approach was used to study geographical variation and trend of colorectal and breast cancer incidence in France where 10% of the national population is covered by cancer registries. DESIGN: This study applies the incidence/mortality ratios of cancer registry areas to regional mortality data to obtain an estimation of cancer incidence at a given point in time. Age and period effects are included in the statistical models. MAIN RESULTS: The incidence estimations are given for 21 administrative regions and three time points (1985, 1990, 1995). The European standardised incidence rates for breast cancer ranged from 86.8 to 128.8. For colorectal cancer, these rates ranged from 48.2 to 79.6 for men, and from 32.5 to 48.8 for women. Breast cancer incidence has increased considerably between 1985 and 1995 with a higher increase in the north than in the south of France. The incidence of colorectal cancer has also increased, albeit to a lesser extent. CONCLUSION: The incidence estimation method proposed leads to regional incidence rates that are useful for planning health care services on a regional basis and may also be used to study regional differences in incidence. This method is useful when only partial incidence data are available.

EVE is a pilot project for cervical cancer screening whose aim is to test the feasibility of organized screening in the French liberal health system with a consensus of medical participants. After three and a half years, 74.8% of women aged 25 to 64 had had at least one smear. Coverage varies with age, from 89% between 25 and 29 to 56% between 55 and 60. Only 8% of smears are taken by General Practitioners. There is a tendency to space out smears because only 14% of women had had a second smear within one year and 41.1% within 2 years. On the other hand more then 20% percent of women do not return after 3 years. Pathological smears represent 1.94% of all smears. For these, a questionnaire is sent to the physician in order to get information on follow-up. This enables cytologic/histologic correlation. The histologic exam reveals a pathological lesion in 95% of cytologies consistent with invasive cancer, 91% of those consistent with high grade lesions and 70% of those consistent with low grade lesions.

The aims of the European Network of Cancer Registries (ENCR) are to improve the quality, comparability and availability of cancer registry data in Europe. This paper on cancer incidence and mortality in France presents the most recent available data, with short-term projections to 1995, and a commentary based, where possible, on epidemiological research carried out in France. Cancer incidence in men in France increased throughout the study period 1975 to 1995, from 92,000 new cases in 1975 to about 135,000 in 1995. This increase was partly due to the ageing of the French population, but incidence rates have also increased, particularly from 1975 to 1985. The trend appears to be levelling off in the 1990s, with an incidence rate in 1995 of about 482 per 100,000 (this and subsequent rates quoted are standardized to the European Standard Population). Among women, the all-cancer incidence rates also increased during the 1970s and 1980s. Although the rate of increase was less pronounced than in men, the trend is continuing in the 1990s. The estimated age standardized rate in 1995 was 309 per 100,000, representing 104,000 new cases. The main components of these changes in the last decade were, for men, increases in large bowel and prostate cancer, which have been partly compensated for by decreases in oral cavity, larynx and stomach cancer. For women the trend was dominated by the continuing increase in breast cancer with increases also in large bowel and lung cancers. Of the numerically important cancers in women, only stomach cancer has shown a clear decline. The situation in 1995 was that breast cancer remained the predominant cancer affecting women in France, accounting for almost one third of all new cases of cancer diagnosed and one fifth of cancer deaths. The next most frequent cancers in women were those of the large bowel. Regrettably, incidence rates of both breast and bowel cancer are increasing in women. For men in France the most frequent cancers in 1995 were those of the prostate, large bowel and lung, all of which increased in incidence since 1975. Although it is estimated that there will be more newly diagnosed cases of prostate cancer than lung cancer in 1995, the latter will cause many more deaths, particularly of young men.