Olivier Ganry

Spatial health inequalities have often been analyzed in terms of socioeconomic and environmental factors. The present study aimed to evaluate spatial relationships between spatial data collected at different spatial scales. The approach was illustrated using health outcomes (mortality attributable to cancer) initially aggregated to the county level, district socioeconomic covariates, and exposure data modeled on a regular grid. Geographically weighted regression (GWR) was used to quantify spatial relationships. The strongest associations were found when low deprivation was associated with lower lip, oral cavity and pharynx cancer mortality and when low environmental pollution was associated with low pleural cancer mortality. However, applying this approach to other areas or to other causes of death or with other indicators requires continuous exploratory analysis to assess the role of the modifiable areal unit problem (MAUP) and downscaling the health data on the study of the relationship, which will allow decision-makers to develop interventions where they are most needed.

Although cancer survivors are known to be at greater risk of developing second primary cancer (SPC), SPC incidence estimates in France are thus far lacking. We used a multivariate approach to compute these estimates and analyzed the effect of patient characteristics (gender, age at diagnosis, first cancer site, year of diagnosis and follow-up) on SPC risk.

General practitioners (GPs) play a central role in disseminating information and most health policies are tending to develop this pivotal role of GPs in dissemination of health-related information to the public. The objective of this study was to evaluate use of the waiting room by GPs as a vector for health promotion.

Objectives To test the hypothesis that high bone mass density (BMD), a potential marker for cumulative exposure to endogenous estrogen, calcium and vitamin D intake, is associated with a lower risk of colon cancer, and that women with a lower BMD are likely to develop a more aggressive form of colon cancer, as defined by mortality. Study design and setting BMD was measured in three different sites (Ward’s triangle, trochanter, femoral neck) in 1,471 women 60 years of age. All incident cases of colon cancers were identified through record-linkage of cancer registry. The women were followed for a mean of 9.5 years. Results Overall 31 cases of colon cancer were observed among 28.6 expected (standardized incidence ratio (SIR) = 1.09, 95% confidence interval: 0.79–1.25). The SIR decreased with increasing BMD showing a significantly decreasing risk of 20% for women who were at the higher BMD comparatively to women who were at the lower BMD in all the skeletal sites. The 10-year survival rates showed that survival was increasing with increased BMD, but not significantly. Conclusion The findings suggest that postmenopausal women with lower BMD have an increased risk of colon cancer. The biological mechanisms linking bone mass to colon cancer risk are not clear.

In France, cancers are the leading causes of death in men and in women aged to 35 to 65, and the cancer incidence in Picardy area is among the highest in France. General practitioners can play a key role in prevention and early detection of cancer. The aim of this study was to assess their current clinical practices concerning risk factors like tobacco, alcohol, diet, sun exposure and cancer screening. A questionnaire on primary prevention and cancer screening practices of general practitioners (GP) in the Picardy area was administered to 480 GP (31%). Questions concerned primary prevention (tobacco, alcohol, diet, sun exposure) and cancer screening (breast, uterine cervix, colon-rectum, prostate, other cancers). In addition, the GP were also interviewed on difficulties encountered in their practice and about their perception of the prevention actions. Smoking prevention is the best structured primary prevention action, unlike alcohol prevention and advice on diet seem to be more difficult strategies. We noted a great diversity for screening, even for cancers with a consensus, like breast, uterine cervix and colon-rectum cancers. Lot of physicians reported ordering prostatic specific antigen test (91%) but are only 5% to have fecal occult blood tests. 83% of the GP screened their patients on skin cancer at least once a year. These findings suggest that general practitioners can play a key role in prevention and early detection of cancer, but have difficulties like lack of time, lack of expertise or non compliance of their patients.

Delay to diagnosis following an abnormal screening result is associated with morbidity such as anxiety, but its effect on prognosis is unknown. Using data from the Somme area breast cancer screening programme (France), we identified 29,511 women aged 50–69 years who underwent screening between 1996 and 2000. We prospectively followed women with an abnormal screening result until completion of the assessment process and evaluated the effect of delay to notification, diagnosis and treatment on prognostic indicators. Women with high-suspicion screens (n=976) compared with those with intermediate-suspicion screens (n=1008) were investigated more promptly, presented larger tumours (62% vs 42%, p=0.03), and were more likely to be lymph node positive (36% vs 17%, p=0.02). Compared with a delay to diagnosis ≤1 month, the odds ratio for tumour size greater than 10 mm was 1.4 (95% confidence interval[CI], 0.90–1.90) for a delay of 1 to ≤6 months, and 1.8 (95% CI, 1.02–2.85) for a delay >6 months. Similarly, a 1.4-fold and 2-fold increased risk of lymph node involvement was observed for delays of >3 to ≤6 months and >6 months, respectively, compared with the reference interval. The authors' findings suggest that women with high-suspicion mammograms were investigated more promptly, and that delays to diagnosis of asymptomatic breast carcinoma >6 months were associated with progression of the cancer measured by tumour size >10 mm and lymph node metastasis.