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Resume Introduction Le cancer de la prostate (CaP) est le plus frequent des cancers masculins en 2018 en Europe. La question du depistage du CaP en population generale a ete debattue apres la publication d’etudes internationales europeenne (ERSPC) et nord-americaine (PLCO). Il n’existe pas aujourd’hui de depistage organise du CaP. L’objectif de cette analyse etait d’evaluer la pratique du depistage du CaP dans la population francaise sans antecedent de cancer entre 2005 et 2016. Methodes Les enquetes EDIFICE se sont interessees, depuis 2005, a la connaissance et aux comportements des Francais face au depistage des cancers. La pratique du depistage a ete evaluee selon la reponse a la question : « Avez-vous deja fait un depistage du CaP ? » Les reponses ont ete analysees en fonction de l’âge, de la categorie socioprofessionnelle et du niveau de precarite sociale. Resultats Apres une forte augmentation entre 2005 et 2008 (de 36 % a 49 %, p ≤ 0,01), une baisse significative du taux declare de depistage du CaP a ete observee entre 2014 (49 %) et 2016 (42 % ; p = 0,02). Cette baisse se repercute principalement dans les categories socialement favorisees et chez les plus jeunes (50–54 ans). Les pratiques de depistage restent identiques chez les hommes plus âges. Conclusion La perception de l’efficacite du depistage du CaP pourrait expliquer les changements de comportement dans la population francaise. Cette baisse de participation au depistage du CaP necessite une surveillance afin d’eviter une perte de confiance generale dans le depistage des cancers. Niveau de preuve 3.

Background The mean age at diagnosis of cervical cancer (CC) is 51 yrs old. Recommendations on cervical cancer screening has recently been implemented as a nationally organized program in France. Since 2018, women aged 25-65 yrs are now invited for a every 3 years pap smear test. It therefore appeared important to gain clearer insight into the characteristics of women who have had at least one Pap smear tests but have not returned after the recommended 3-year interval for a repeat test. Methods The French nationwide observational survey EDIFICE 6 was conducted online from 26 June to 28 July 2017 on 12 046 individuals (age, 18-69 yrs). Representativeness was ensured by quota sampling on age, gender, profession, and stratification by geographical area and type of urban district. Multivariate stepwise logistic regression analysis was conducted to identify factors likely to explain the non-uptake of subsequent CC screening. The present analysis included 4499 women (25-65 years) with no history of cancer. Results Of those who were in the target age range for CC screening, 15% (N = 671) did not return for the repeat examination within the recommended 3 years. Compared to those who were compliant with the recommendations, the population of non-compliant women was older (mean age 49.2 yrs vs 43.2 yrs). It was characterized by higher proportions of women living alone (single, widow or divorced, 40% vs 30%, P Conclusions Our findings highlight the need for novel awareness campaigns that specifically target the population which drops out CC screening (including, socially vulnerable women and smokers). Editorial acknowledgement Potentiel d’Action (France), funded by Roche. Legal entity responsible for the study Roche. Funding Roche. Disclosure T. de La Motte Rouge: Honoraria (self): Roche. F. Eisinger: Honoraria (self): Roche. S. Couraud: Honoraria (self): Roche. L. Greillier: Honoraria (self): Roche. C. Lhomel: Full / Part-time employment: Roche. M. Roupret: Honoraria (self): Roche. J. Morere: Honoraria (self): Roche. All other authors have declared no conflicts of interest. Scientific clarification and Linguistic correction

Objectifs Les enquetes EDIFICE, initiees en 2005, ont pour objectif d’ameliorer les connaissances des comportements des Francais sur les depistages des cancers, dont le depistage individuel du cancer de la prostate (CaP). Les precedentes analyses avaient montre une augmentation du taux declare de depistage entre 2005 et 2008 suivie d’une stabilisation jusqu’en 2014. Les resultats de la derniere enquete menee en 2016 sont presentes. Methodes Les enquetes EDIFICE, realisees par telephone en 2005, 2008, 2011, 2014 et 2016, ont ete menees sur des echantillons representatifs de la population francaise en utilisant la methode des quotas. Un total de 2554 hommes, âges de 50 a 75 ans, sans antecedent de cancer ont ete interroges sur leur participation a au moins un depistage du CaP au cours de leur vie, sur leur categorie socioprofessionnelle et sur le niveau de precarite (score EPICES). Resultats Apres une forte augmentation de 36 % en 2005 a 49 % en 2008 ( p ≤ 0,01), le taux declare de depistage du CaP s’est stabilisee en 2014 pour diminuer significativement a 42 % en 2016 ( p = 0,02). Ceci a ete observe dans toutes les categories d’âge. Les hommes les plus jeunes participent moins que leurs aines (50–54 ans : 20 % ; 55–59 ans : 36 % ; 60–64 ans : 47 % ; 65–69 ans : 55 % ; 70–75 ans : 60 %). La participation des hommes inactifs diminue en 2016 vs 2014 (60 % vs 50 %, p = 0,02). La precarite a un impact negatif en 2014 et 2016 (taux de depistes precaires vs non-precaires : 37 % vs 53 % en 2014, p p = 0,01). En 2016, le taux de depistes baisse significativement dans les populations non-precaires (53 % en 2014 vs 46 %, p = 0,05). Conclusion Pour la premiere fois en 2016, une baisse significative du taux declare de depistage du CaP a ete observee, en particulier chez les personnes non-precaires et les inactifs. Cette diminution necessite une surveillance afin d’eviter une perte de confiance generale dans le depistage des cancers et d’adapter les messages de sensibilisation, notamment pour les personnes a risque de CaP.

Background Reducing cancer inequalities is one of the most critical goals of the current National Cancer Plan. The French health system allows fair access to care for all affected persons. In contrast, exposure to risk factors is far worse for underserved populations. The issue of cancer screening attendance distribution according to social factors, deserves to be assessed and regularly monitored. Methods Accurate data on cancer screening in the population is available; however it is difficult to assess who belongs to an underserved/vulnerable subgroup. Many indicators could be used, such as the validated questionnaire “EPICES” with eleven yes/no questions. We analysed a sample of the general population (N = 1603) to assess if screening attendance is correlated with this validated synthetic score or by any of its components. Results Breast 40–74 Breast 50–74 Official program CRC 40–74 CRC 50–74 Official program Prostate Contact with social workers ns ns ns ns ns Additional health insurance ns ns ns ns ns Living alone ns ns p ns p Home ownership p ns p p ns Financial difficulties p ns p ns ns Practicing sport p ns ns ns ns Performance attendance p ns ns ns ns Taking vacations ns ns p ns p Family ties ns ns ns ns p Housing support ns ns p ns ns Social support ns ns p ns ns EPICES Synthetic score ns ns ns ns ns Conclusions It appears that social determinants of vulnerability are not key determinants for screening behaviour. However, there is still an impact on cancer screening attendance outside the official target age group. Under these circumstances, vulnerable populations use less health screening resources. Social support and home ownership are the most powerful predictors for screening attendance. Our data support the dramatic impact of organised programs which reduce or even remove inequities in access to cancer screening. Disclosure All authors have declared no conflicts of interest.

Aim: Society now makes it easier for women with breast cancer to make important decisions about their disease management. The likelihood of long survival makes the issue of pursuing work during treatment a genuine reality for women and their physicians. Methods: In 2012, we conducted a survey of 97 physicians involved in breast cancer treatment (medical oncologists, radiotherapists, surgeons) and 216 women who declared their intention to pursue their professional activity despite the diagnosis and treatment of breast cancer. Results: Thirty one percent (N = 68) achieved their objective and 61% (N = 132), with at least one day off work, did not (no answers for 7%, N = 16). Comparison of these two groups reveals many factors associated with an increased success rate: job satisfaction (77.9% vs. 56.8%; p ≤ 0.05), a higher perceived benefit of work on both psychological well-being (average 8.60/10 vs. 7.69/10; p ≤ 0.05) and social life (average 8.36/10 vs.7.59/10; p ≤ 0.05), flexibility of medical encounters (80.9% vs. 65.9%; p ≤ 0.05) and information received from the physician (85.3% vs. 70.5%; p ≤ 0.05). Interestingly, women who achieved their objective were likely to have more people under their supervision (mean = 26.9 versus 7.3; p ≤ 0.05) suggesting that social responsibility may be an impetus for working during treatment. The type of treatment also had an impact on the rate of success: positive impact for radiotherapy alone (35.3% vs. 19.7%; p ≤ 0.05) and negative for chemotherapy (30.9% vs. 47.0%; p ≤ 0.05). Positions with a high level of perceived psychological stress were associated with a lower success rate (20.6% vs. 36.4%; p ≤ 0.05). Interestingly, with no clear, direct causal link, women who achieved their objective were more likely, at the end of their treatment, to still be in the same job (69.1% versus 37.9 % p ≤ 0.05). The declared motivations for maintaining a professional activity (personal, social, financial) had no significant impact on the success rate. Conclusions: With the anticipated improvement in the benefit/adverse effects ratio of therapy and the increasing move towards therapeutic de-escalation, the question of working during treatment is likely to become more widespread and physicians should be more aware of this aspiration. Disclosure: E. Antoine: Consultant fees from Roche. All other authors have declared no conflicts of interest.

Aim: Early detection is one of the essential tools of cancer control. Once a population has been adequately informed, primary prevention and screening are reliant upon individual behavior. There is thus, a complex interaction between knowledge, belief and psychological characteristics, which defines actual behavior. Using data from the population survey EDIFICE, we analyzed the subtle balance between fear and reassurance associated with breast cancer screening (BCS) and the impact of the recent controversy triggered by the Cochrane analysis of effectiveness and usefulness of population-based screening Methods: A nationwide observational study, recorded in the EDIFICE iterative surveys, on a representative sample of 451 women (aged 40-75 years) living in France, was conducted in January 2013, using the quota method. The survey questionnaire was given via the computer-assisted telephone interviewing (CATI) technique 3 months after the beginning of the controversy. Our analysis focused on women with no history of cancer, and took into account individual awareness of the controversy. Results: Although the vast majority of women are reassured by BCS (299/405 [74%]), 160/405 (39%) declared it worried them. Interestingly, the rate of women who declared being both worried and reassured was high (105/405 [25.8%]). This ambiguity was less frequent in the group aware of the breast cancer controversy: 10/69 (15.2%) vs 93/334 (27.9%) for those who were not aware of it, P Conclusions: For one out of four women, BCS is both worrying and reassuring. The perceived balance between fear and reassurance among those who were aware of the controversy is less favorable to screening since the recent media coverage. Communication around BCS should make allowances for women's potentially ambiguous feelings. A more subtle, less forthright approach may prove more appropriate and more relevant. Disclosure: F. Eisinger: Board honorarium from Roche; J. Morere: Board honorarium from Roche X. Pivot: Board honorarium from Roche. All other authors have declared no conflicts of interest.