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Two nationwide observational surveys were carried out in France in 2005 and 2008 with the aim of assessing the impact on attitudes towards cancer screening of a positive history of cancer among a person's close circle of acquaintances (relatives, friends or colleagues). In 2005, 67% (993/1482) of people interviewed reported having someone in their close circle of acquaintances affected by cancer and in 2008, the rate was 80% (1158/1454). In 2008, having someone within a person's close circle of acquaintances affected by cancer did not increase the rate of screening for breast cancer (already high at >80%). However, it did increase the rate of screening for colorectal cancer [odds ratio (OR)=2.3; 95% confidence interval (CI)=1.6-3.3] and prostate cancer (OR=2.2; 95% CI=1.4-3.5). Knowing someone affected by cancer within the close circle of acquaintances clearly increases awareness, and thus could be an incentive for undergoing cancer screening. With regard to cancer types, such as prostate cancer, for which there is no national programme or media communication, this awareness might be the main source of information and motivation. The impact of awareness on screening behaviour seems to be greatest for the same cancer location as that in the affected acquaintance, as opposed to cancers at other sites. Increased awareness as observed in our survey, which may be attributable to less social stigma associated with a diagnosis of cancer, might increase the rate of screening attendance in the general population.

Characteristics of primary-care providers have been associated with their patients' participation in breast cancer screening. A nationwide observational survey, 'EDIFICE', was conducted by telephone from December 2007 to January 2008 on a representative sample of 600 general practitioners (GPs) working in France, to investigate how a GP's characteristics may influence patient participation in screening for breast, colorectal and prostate cancer. For breast cancer screening, systematic recommendation was associated with female physicians [odds ratio (OR) =1.9; 95% confidence interval (CI) 1.2-3.1]. This systematic recommendation was also correlated with systematic referral for colorectal cancer (OR=1.5; 95% CI=1.0-2.5) and prostate cancer screening (OR=2.7; 95% CI=1.8-4.1). For colorectal cancer screening, the sex of the GP had no significant impact. However, systematic recommendation for both breast and prostate cancer screening was shown to be associated with systematic recommendation for colorectal cancer screening (OR=2.7; 95% CI=1.6-4.7 and OR=1.8; 95% CI=1.1-3.0, respectively). For prostate cancer screening, there was no significant sex specificity. However, systematic recommendation for both breast and colorectal cancer screening was associated with an advice on prostate cancer screening (OR=2.9; 95% CI=2.0-4.4 and OR=2.0; 95% CI=1.3-3.2, respectively). The age of the GP was not associated with a higher rate of systematic recommendation for screening for the three types of cancer. Male GPs were more likely than female GPs to perform digital rectal examinations on male patients (69 vs. 54%; OR=1.86; 95% CI=1.31-2.63). There is a global pattern of physicians being screening-prone (as suggested by the cross impact of recommendations from one cancer type to another). Although the frequency of systematic recommendation for breast cancer screening is higher with female GPs, systematic recommendation for prostate cancer is not higher among male GPs. The factors associated with systematic recommendation for screening are both a matter of concern and a target for action, to improve adherence of individuals through GP commitment.

In France, free faecal occult blood testing is offered to individuals aged between 50 and 74 years every 2 years as a method of screening for colorectal cancer (CRC). To assess how a proposed organized programme of CRC screening would be perceived among a representative sample of individuals living in France, aged between 40 and 75 years, and by a representative sample of general practitioners, two nationwide observational telephone surveys were carried out in 2005 (EDIFICE 1; 1601 individuals) and 2008 (EDIFICE 2; 1801 individuals). In 2008, 38% of individuals aged between 50 and 74 years reported undergoing screening for CRC; this corresponded to a statistically significant 13% increase in CRC screening rate compared with 2005 (P=0.01). When asked whether it was possible to screen for CRC, 94% of individuals who had undergone screening (N=350) responded positively compared with 87% of individuals who had not been screened. The main reason for individuals not to undergo screening was a lack of awareness (35% of men and 37% of women, P=not significant); the second reason was lack of advice and referral from their general practitioner (21% of women versus 15% of men, P=0.03). The French population is aware of the potential benefit of CRC screening; however, many do not undergo regular screening. It is therefore important to identify the hurdles associated with CRC screening.

Regular mammography screening has been available in France, free of charge, for all women aged 50-74 years since 2005. Two nationwide surveys [EDIFICE 1 (507 women interviewed; age 50-74 years) and EDIFICE 2 (488 women)] recently collected data on individuals' access to cancer screening procedures. Two further surveys interviewed 600 general practitioners (GPs) each to determine their attitudes towards screening in general and screening for breast cancer in particular. The method of quotas ensured the populations surveyed were representative. In 2005, 93%, and in 2008, 94% of women reported having undergone a screening mammography. Anage-related effect was apparent in the 70-74 year subgroup in 2005, whereas in 2008, over 90% of women aged 50-74 years had had a mammography in their lifetime. In 2008, 66% of women had undergone a mammography as a part of an organized screening programme, versus 45% in 2005. In 2005, 15% of women reported having received no recommendation from their GP, whereas this figure fell to 4% in 2008. In both EDIFICE surveys, two thirds of GPs systematically recommended breast cancer screening to female patients aged 50-74 years; however, female GPs were more likely to systematically recommend this screening. In 2008, 77% of the GPs questioned were aware of the recommended frequency for breast cancer screening, compared with 71% in 2005. Results of studies such as EDIFICE may help increase the proportion of women who undergo breast cancer screening. Successful implementation of organized screening relies heavily on treating physicians. The impact of mammography in breast cancer screening may be further improved by systematic organized screening, by encouraging regular examination and by targeting women who give up screening.

In France, no official recommendations for or against systematic screening for prostate cancer have been issued yet. Therefore, individuals' choices with regard to screening or non-screening, and general practitioners' (GPs) recommendations for or against systematic screening should reflect personal preferences. Four nationwide observational studies (surveys) were conducted in France, two in 2005 and two in 2008, on a representative sample of participants aged between 40 and 75 years and a representative sample of GPs. In 2005, 36% of the male population interviewed, and aged between 50 and 75 years declared having undergone a screening test, compared with 49% in 2008 [odds ratio (OR)=1.63; 95% confidence interval (CI)=1.25-2.12]. In 2008, the number of men interviewed who reported having undergone screening less than 1 year earlier increased from 51% in 2005 to 74% (OR=2.18; 95% CI=1.40-3.40). The screening rate for young men (45-49 years) was only 7% in 2008 (data not available in 2005). In 2005, 58% of GPs systematically recommended prostate cancer screening for their patients aged 50-74 years, whereas in 2008, the figure was 65% (OR=1.32; 95% CI=1.04-1.66). The sex or age of the GPs had no significant impact on this rate. In France, we have observed a highly significant increase in prostate cancer screening: more men are screened, more often, at a younger age and more frequently using a prostate-specific antigen blood test. In our surveys, the observed threshold age for onset of prostate cancer screening is 50 years, almost the same as that for approved organized breast and colorectal screening programmes.

In France, mammography screening is offered to women aged between 50 and 74 years. EDIFICE, the iterative nationwide survey, collected data on a national level about consumers utilization of available cancer screening procedures. This analysis compared data from a subset of 241 women aged between 40 and 50 years with that of 488 women aged between 50 and 74 years. Multivariate analysis showed the following significant factors to be linked with screening attendance for women younger than 50 years: age, with a threshold value at 44 years; awareness of the recommended screening period (2 years); consultation within the last 12 months with a general practitioner or a gynaecologist; and long standing local programme for colon cancer screening. Notwithstanding the debate on risk/benefit of breast cancer screening for women in their 40s, we observed more differences with regard to attendance between women aged 40-45 years versus that of 46-74 years than between women aged 40-49 years versus that of 50-74 years. The issue that is unanswered as yet is, do women make a kind of heuristic for starting breast cancer screening, leading them to a threshold choice of 45 years or alternatively to a collective answer of standard age minus 5 years!

Colorectal cancer (CRC) is an important public health issue in France, justifying a screening policy adapted to individual risk. The general practitioner (GP) is most commonly the initiator of CRC screening. The EDIFICE 2 survey, carried out in 2008 among 600 GPs, showed that 83% of GPs were convinced of the importance of screening, but that only 30% of GPs systematically recommended the procedure. The main underlying reasons were that only 50% of GPs declared themselves sufficiently trained, GPs needed clear guidelines and information supports for patients and a better implication in the programme's overall organization. This important role was confirmed by patients as the second most important reason for not undergoing screening: the absence of recommendation from their treating physician. The optimization of the screening procedure thus requires a stronger implication of GPs, by confirming their pivotal role in CRC screening and by relying on clear reference documentation guaranteeing quality assurance of a national organized screening programme.

Introduction: The practices of screening and the parameters influencing these practices are not well known in France. The objectives of the Edifice study were to analyze a large cohort of patients and doctors in order to further characterize these parameters., Patients and Methods: The study was performed by the Institute TNS Healthcare-SOFRES, and included 2 parallel studies: 1) on 1 609 healthy persons representative of the global French population and aged 40 to 75 years (N = 1 509), with an over representation of patients aged 50 to 74 years living in the 22 pilot French departments pilots; 2) on 600 generalist practitioners. Data were collected and analyzed by the expert panel..., Results: Ninety-three, 25, 36 and 6% of the patients in the general population declared to have performed at least one a screening exam for breast, colon, prostate, and lung carcinoma respectively. Seventy, 20, 60 and 4% of GP declare to propose systematically to a 40-75-year-old patient a screening test for breast, colon, prostate, or lung cancer. For breast cancer screening the adhesion of the GP is independent of the date of implementation of a general screening in their own regions, while for colorectal screening, 34 and 20% of the patients living in the pilot versus other departments were screened. Overall, prostate cancer screening is recommended by the GP panel for 77.1% of patients aged 50 to 75 years., Conclusions: This study shows a good adhesion of screening procedures for GP and patients, shows that screening is improved by general screening policy in colorectal cancer, but that prostate cancer screening practices exceed what is recommended according to evidence based medicine.

Objective: Since screening for cancer has been advocated, funded, and promoted in France, it is important to evaluate the attitudes of subjects in the general population and general practitioners (GPs) toward cancer screening strategies., Methods: EDIFICE is a nationwide opinion poll that was carried out by telephone among a representative sample of 1,504 subjects living in France and aged between 40 and 75 years and among a representative sample of 600 GPs. The questionnaire administered to subjects queried about previous screening for cancer., Results: Ninety-three percent of women stated that they had undergone at least one mammography. Although rated "A" recommendation-strongly recommended-by the US Preventive Services Task Force, screening for colorectal cancer received less attention than prostate cancer screening which is rated "I"-insufficient evidence-(reported screening rates of 25% and 36%, respectively). Six percent of subjects stated that they had undergone lung cancer screening. GPs' attitudes toward cancer screening showed similar inconsistencies., Conclusions: It thus appears that understanding of cancer screening practices in the French general population does not match scientific evidence. To a lesser extent, this also holds for GPs.

Purpose: Colorectal cancer (CRC) screening has been shown to decrease CRC mortality. Organised mass screening programs are being implemented in France. Its perception in the general population and by general practitioners is not well known., Methods: Two nationwide observational telephone surveys were conducted in early 2005. First among a representative sample of subjects living in France and aged between 50 and 74 years that covered both geographical departments with and without implemented screening services. Second among General Practionners (Gps). Descriptive and multiple logistic regression was carried out., Results: Twenty-five percent of the persons(N = 1509) reported having undergone at least one CRC screening, 18% of the 600 interviewed GPs reported recommending a screening test for CRC systematically to their patients aged 50-74 years. The odds ratio (OR) of having undergone a screening test using FOBT was 3.91 (95% CI: 2.49-6.16) for those living in organised departments (referent group living in departments without organised screening), almost twice as high as impact educational level (OR = 2.03; 95% CI: 1.19-3.47)., Conclusion: CRC screening is improved in geographical departments where it is organised by health authorities. In France, an organised screening programs decrease inequalities for CRC screening.