Béatrice Fervers

Mycotoxins are widely consumed food contaminants. Mechanistic studies support potential carcinogenic effects of mycotoxins in the human intestine, yet no studies have investigated these associations in population-based settings. This study aimed to investigate associations between dietary mycotoxin exposures and colorectal cancer risk. Dietary questionnaire data from the European Prospective Investigation into Cancer and Nutrition (EPIC) were combined with mycotoxin food occurrence data from the European Food Safety Authority (EFSA). Associations between mycotoxin exposures and colorectal cancer (CRC) risk and its anatomical sub-sites were evaluated in multivariable Cox proportional hazards regression models to compute hazard ratios (HR) and their 95% confidence intervals (CI), accounting for potential confounders. Food groups that explained the greatest variation in mycotoxin intakes were cereal-based products, vegetables, non-alcoholic beverages and fruits. For individual mycotoxins, deoxynivalenol (DON) was positively associated with CRC risk (HR top vs. bottom tertiles [T3vsT1] = 1.14; 1.04–1.24), while patulin (PAT) was positively associated with rectal cancer risk only (HR^T3vsT1 = 1.18; 1.05–1.32). Sensitivity analyses indicated differential results for men versus women with significant positive associations for DON and CRC risk found only in men. In conclusion, dietary mycotoxin exposures may be related to higher CRC risk. Further investigation in independent cohorts and through mechanistic studies is warranted.

Patients with cancer usually report limitations of their functional capacity, which may range from subclinical impairment of cardiopulmonary exercise reserve to poor quality of life with physical, cognitive, or psychosocial consequences. Exercise training is a potent multi-targeted approach to control pre-existing and new risk factors. Preliminary evidence shows that it is associated with a lower risk of cancer therapy-related cardiotoxicity and increased self-reported well-being in patients with cancer. Current evidence demonstrates that supervised exercise therapy, including high-intensity interval training, is safe and well-tolerated and reduces risk in subjects with cancer in the pre-, active-, and post-treatment settings. The present consensus document will discuss the role of exercise training in cardio-oncology, focusing on patients with cardiovascular diseases induced by cancer treatment and on those who received cardiotoxic therapies.

Objective: To assess the association between parental occupational pesticide exposures at birth and adult testicular germ cell tumour (TGCT) by histological subtype and the agreement between two pesticide job-exposure matrices (JEM). Methods: TGCT cases (n=454) and matched controls (n=670) aged 18–45 years were recruited from 20 French university hospitals into the TESTIS national case-control study. Paternal and maternal jobs at birth were obtained from interviews of participants and their mothers/relatives and coded into official nomenclatures (International Standard Classification of Occupations, French nomenclature of activity-1999). Two complementary JEMs, ALOHA+ and FRIJEM, assessed occupational exposure to all pesticides, herbicides, insecticides, fungicides with ALOHA+ for each parent by linking job titles to JEM-derived probability and intensity estimates (no/low/high). Cohen’s Kappa coefficient (κ) assessed their agreement. ORs and 95% CIs comparing exposure and levels of exposure with no exposure were estimated using conditional logistic regression adjusted for literature-based covariates statistically associated with TGCT and stratified by histological subtypes. Results: Agreement between ALOHA+and FRIJEM was moderate to substantial (κ 0.52–0.80). A statistically non-significant higher TGCT risk was observed for high paternal occupational pesticide exposure with ALOHA+ (OR 1.95, CI 0.98 to 3.84) and FRIJEM (OR 1.70, CI 0.88 to 3.28). With ALOHA+, statistically significant positive associations were seen for high paternal occupational exposure to herbicides (overall: OR 4.23, CI 1.75 to 10.22; seminomas: OR 4.78, CI 1.79 to 12.77; non-seminomas: OR 3.53, CI 1.21 to 10.3) and fungicides (overall: OR 2.09, CI 1.05 to 4.18; seminomas: OR 2.31, CI 1.02 to 5.23). No statistically significant associations were observed for other levels of paternal exposure or pesticide groups nor for maternal exposure. Conclusion: Only high paternal occupational exposure to pesticides at birth, especially herbicides and fungicides, was positively associated with TGCT.

Early life exposure to pesticides, in particular through pesticides drift in residents nearby agricultural crops, is suspected to increase testicular germ cell tumors (TGCT) risk. We conducted a hospital‐based case–control study of 472 TGCT cases and 683 matched controls aged 18–45 years in France and estimated adult TGCT risk associated with agricultural surfaces around residence as a surrogate for environmental exposure to agricultural pesticides at time of birth. Surface of arable lands, orchards and vineyards in 500 m buffer around the participants’ residential address at birth was assessed using geographic information system (GIS) methods and software semi‐automatic processing of historical aerial images. Odds ratios (OR) for TGCT (overall and by histological subtype) and 95% confidence intervals (CI) were estimated using conditional logistic regression. No increased risk of TGCT was observed for presence of arable lands (OR = 1.14, CI = 0.86–1.52), vineyards (OR = 0.88, CI = 0.56–1.36) and agricultural surfaces overall (OR = 1.13, CI = 0.84–1.51) in 500 m buffer around residence at birth. Presence of orchards (prevalence: 8.7%) was associated with a modest increase in TGCT risk (OR = 1.51, 95% CI = 0.99–2.32), slightly stronger for seminoma (OR = 1.78, 1.07–2.97) and in participants conceived or in their first trimester after conception during spring–summer (OR = 1.70, 1.03–2.82). In conclusion, the study found no overall association between adult TGCT risk and agricultural crops around residence at birth, except for the presence of orchards, with a possible increase in seminoma risks, as well as TGCT risk in participants for whom the first trimester after conception fell into spring–summer.

Background: Despite the proven benefits of physical activity during breast cancer treatment, many women reduce their practice after diagnosis. A better understanding of how the neighborhood environment influences physical activity behavior could help optimize strategies for physical activity in breast cancer patients undergoing cancer treatment. This study examined associations between perceived neighborhood environment and physical activity among breast cancer patients undergoing treatment and engaged in a physical activity program. Methods: Participants were 313 breast cancer patients enrolled in the DISCO physical activity intervention trial (NCT03529383). In the present observational analysis (DiscoSpace), cross-sectional (at baseline) and longitudinal (during intervention) associations between perceived neighborhood environment and physical activity were investigated. The perceived neighborhood environment was assessed using the ALPHA questionnaire, physical activity and physical functioning were evaluated through the Recent Physical Activity Questionnaire (self-reported physical activity) and the 6-Minute Walk Test (to measure the 6-Minute Walk Distance (6MWD)). Associations were estimated through mixed linear regression models. Results: Better perceived cycling and walking infrastructures and network were associated with higher self-reported physical activity at baseline (total infrastructures: β = 0.226, 95% CI (0.063;0.388); network: β = 0.161, 95% CI (0.008;0.314)). Perceived distance to local facilities was inversely associated with 6MWD at baseline (β=-11.363, 95% CI (-20.607;-2.118)). The perception of densely populated neighborhoods (β=-0.306, 95% CI (-0.494;-0.117)) was associated with a smaller increase in self-reported physical activity during the intervention, after adjustment for trial arm. These associations varied according to women’s socioeconomic status and municipality class. Conclusions: The perceived neighborhood environment and socioeconomic characteristics of women with breast cancer should be given greater consideration for developing effective programs to promote physical activity in this population.

BACKGROUND Despite significant improvements in cancer survival, late complications from oncological treatments remain inadequately managed in routine clinical practice. Standard oncology follow-up prioritizes disease recurrence detection over systematic assessment of treatment-related sequelae, resulting in underdiagnosis of physical, psychological, metabolic, and social complications that substantially impair survivors' quality of life. The temporal dynamics of complication emergence remain poorly characterized, limiting development of evidence-based surveillance schedules. Objective: This study aims to determine the time-specific incidence of 19 predefined treatment-related complications at 1, 6, 24, and 60 months following completion of first-line chemotherapy in adult cancer survivors who achieved complete response. Secondary objectives include characterizing temporal trajectories to identify critical surveillance windows, evaluating the feasibility and performance of a standardized guideline-based referral system integrated within a regional healthcare network, and identifying predictive factors for complication occurrence and timing. OBJECTIVE This study aims to determine the time-specific incidence of 19 predefined treatment-related complications at 1, 6, 24, and 60 months following completion of first-line chemotherapy in adult cancer survivors who achieved complete response. Secondary objectives include characterizing temporal trajectories to identify critical surveillance windows, evaluating the feasibility and performance of a standardized guideline-based referral system integrated within a regional healthcare network, and identifying predictive factors for complication occurrence and timing. METHODS PASCA-c is a single-center, prospective, interventional cohort study conducted at Centre Léon Bérard (Lyon, France). Over 36 months, 500 adults aged 18–65 years with complete responses to first-line therapy for lymphomas (Hodgkin/non-Hodgkin), acute myeloid leukemia, testicular germ cell tumors, non-metastatic breast cancer, or sarcomas will undergo systematic screening at 1 month (T1), 6 months (T2), 24 months (T3), and 60 months (T4) post-treatment. Each assessment includes validated questionnaires, biomarker analyses, cardiovascular evaluations, spirometry, and functional performance tests covering 19 complication domains. Clinical decision trees based on French and international guidelines generate standardized referral recommendations. Patients are referred to a regional network of 120+ healthcare professionals for complication management while continuing standard oncological follow-up. The primary outcome is the time-specific incidence of each complication at T1, T2, T3, and T4, distinguishing new-onset cases from persistent complications detected at prior assessments. RESULTS Patient enrollment began in September 2020 and is ongoing. Final results are anticipated in 2027 upon completion of 60-month follow-up assessments for the last enrolled participant. CONCLUSIONS PASCA-c represents the first large-scale European study systematically evaluating the temporal dynamics of 19 treatment-related complications across multiple cancer types. By characterizing time-specific incidence patterns, this study will identify critical surveillance windows for each complication, informing the development of evidence-based, temporally-optimized survivorship care protocols that can be adapted to diverse healthcare settings. CLINICALTRIAL The study protocol (version_3_03-15-2022) was approved by the French ethics committee (Comité de protection des personnes Ile de France IV, ID-RCB: 2020-A01130-39). The study is registered on ClinicalTrials.gov (NCT04052126). All participants will be asked to sign and date an informed consent form. The results will be published in peer-reviewed journals and academic conferences. The study data have been declared to the ‘Commission nationale de l'informatique et des libertés’ via the reference methodology MR-001 n° R201-001-006.

Background/Objectives: Recent preclinical studies suggest that acute exercise induces immune modulation, enhances tumor blood perfusion, and is associated with reduced tumor growth. Adding exercise to immunochemotherapy treatment (ICT) has been proposed as a strategy to increase treatment effectiveness. The ERICA trial (NCT04676009) aimed to assess the feasibility of acute aerobic exercise performed immediately before the administration of ICT in patients with metastatic non-small cell lung cancer (mNSCLC) and to explore hypothesis-generating outcomes related to physical fitness and patient-reported outcomes. Methods: Newly diagnosed mNSCLC patients were randomly assigned (2:1) to the exercise or control group. The exercise intervention included supervised acute exercise before each of four ICT cycles plus a 3-month home-based walking program with an activity tracker and step goals. The feasibility of the exercise protocol was assessed through adherence, acceptability, tolerability, and safety. Clinical, physical, and patient-reported outcomes were assessed at baseline and after 3 months. Results: Twenty-six patients (mean age 60.6 years; SD 10.65) participated, with an 87.5% acceptance rate. In the exercise group (n = 17), 80.9% of participants completed the acute exercise sessions, with a median interval of 38 min [IQR, 20–60] between exercise and ICT. No exercise-related adverse effects were reported. After 3 months, 60% of participants in the exercise group were classified as active and maintained their step goals. Self-reported measures suggest that maintaining physical fitness is favorable for reducing fatigue and insomnia, and therefore improving quality of life. Conclusions: Acute exercise performed immediately before each ICT administration in patients with mNSCLC appears feasible and safe.

Objectives: This article explores the methods and benefits of involving patients and the public in primary prevention (PP) cancer research. Through the experience of the CANCEPT PP research network, it aims to clarify practices and propose methodological guidelines for developing interventions tailored to the needs of populations. Methods: The Methodological Exchange Group GEM MIXTE, made up of 9 researchers and 9 co-researchers, met monthly (2023–2024, France) in order to define public and patient involvement in PP, take stock of participatory practices among CANCEPT members via a questionnaire (14 researchers, 8 institutions, 22 projects), and develop methodological guidelines in the form of a mind map. The participatory approaches were evaluated using the Public and Patient Engagement Evaluation Tool (PPEET) questionnaire. Results: GEM MIXTE has enabled us to clarify the methodology of participatory research in PP and to propose practical guidelines. This work highlights the importance of diversifying the profiles of the co-researchers to enhance the relevance of interventions, while emphasizing the role of the group coordinator in structuring and facilitating exchanges. The PPEET evaluation confirmed that the co-researchers were committed to the objectives, although socio-cultural diversity remains a challenge. Conclusion: This work proposes a methodological framework for integrating lived experience into research. The guidelines developed provide tools to inspire other networks to structure their approaches effectively, thereby strengthening citizen participation in public health.