Search

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 Comprehensive cancer care uses complementary approaches alongside specific anticancer therapy. Using a dedicated questionnaire, the Calista 2 national survey sought to assess the importance of supportive care and activities among breast cancer (BC) patients, how often these services are made available, the uptake rate, and the proportion of unmet needs. Methods Of the 82 physicians who accepted to take part in the survey, 29 recruited 257 patients with BC of whom 210 answered the patient-reported questionnaire. Patients meeting the inclusion criteria were adult females already on specific therapy for early or advanced BC. The patient-reported questionnaires covered drug management of pain, fatigue, adverse events (AE), sleep disorders, social and psychological support, physical activities, and complementary and alternative medicines. Items were rated on a scale of 0 – 10. Questionnaires were collected between September 2016 and October 2017. Results After exclusion of non-valid patient questionnaires, 197 were analyzed. The mean age of these patients was 56.8 years (SD 12.6); 53% had early stage disease and 41% advanced stage disease. Patients perceived the management of AE and pain, and self-image improvement techniques as the three most important items (8.0, 7.5, 6.7, respectively), followed by physical activity (6.3) and the management of fatigue (6.0), while preservation of fertility (2.3), spiritual support (2.5), counselling with regards to employment (3.2), and art therapy (3.3) were the least important. Most facilities were available at the point of care. Physicians frequently suggested management AE and pain (83% and 73%, respectively), self-image improvement techniques (73%) and psychological support for the patient (70%). Management of fatigue was however far less frequently proposed (30%). Management of AE (75%) and pain (60%), and self-image improvement (50%) were the most widely used support techniques. Only 19% of patients who were offered support in the management of fatigue declared actually using it. The management of fatigue nevertheless represented one of the three main unmet needs (for 27% of patients), together with complementary medicines (37%) and relaxation (29%). Conclusion These key findings highlight the fact that support for the management of AE and pain, together with self-image improvement techniques, are important for patients, are available, suggested and used. Although management of fatigue is available, it is rarely suggested by physicians and is therefore seen by patients as an unmet need. Patients also expressed the need for complementary medicines and relaxation techniques; these are however less frequently available at the point of care and seldom proposed. Citation Format: Simon H, Viguier J, Naman H, Touboul C, Lhomel C, Ganem G, Eisinger F, Morère J-F. Patient care in breast cancer: Unmet and fulfilled needs [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-23.

OBJECTIVE To assess awareness of bladder cancer (BCa) in France. METHODS The French nationwide observational survey EDIFICE 6 was conducted online (26 June-28 July 2017) in 12,046 individuals (age, 18-69 years). The present analysis focuses on laypersons' knowledge of the severity and frequency of BCa, signs and symptoms, associated risk factors and screening tests. Quantitative data were expressed as means and standard deviation, and categorical data as percentages. RESULTS Analyses were conducted on 11,313 questionnaires. Among the top five acknowledged risk factors for BCa, tobacco was ranked as having the second lowest impact (5.9/10 [2.5]). Only 28% of the study population were aware that active tobacco smoking is a major risk factor for BCa (rating ≥8/10); 61% of the study population was unaware of the existence of any signs or symptoms of BCa, and 69% was not able to cite any of the most widely used diagnostic tests. CONCLUSIONS We found that the French population has a poor knowledge of BCa risk factors, early signs and diagnostic tests. Effective prevention of BCa requires dissemination of clear information and prevention messages to the lay population, focusing particularly on tobacco consumption and early signs of the disease.

Objective Over recent decades, supportive care and patient quality of life, advocated by dedicated guidelines, have become a core focus of the concept of integrative medicine. The Calista 2 survey was conducted in France between September 2016 and October 2017 among oncologists and their patients being treated for early breast cancer, adjuvant colorectal cancer or advanced lung cancer. The present analysis sought to ascertain, understand and rank the expectations of cancer patients with regard to supportive care. Methods Data were collected from 467 questionnaires from patients recruited by 82 oncologists. Inclusion criteria were patients already on treatment for breast cancer, colorectal cancer or lung cancer. Most supportive care facilities were available at the point of care. Results Physicians were mainly seen to offer management of adverse events (81%), and pain (72%), psychological support (56%), and advice on diet/nutrition (49%). Patient uptake of supportive care related essentially to management of adverse events (72%) and pain (61%), diet/nutrition (34%), and self-image improvement techniques (31%). The main unmet needs voiced by patients were information on complementary medicines (28%), management of fatigue (27%), and relaxation techniques (24%). Conclusion Supportive care was essentially seen to satisfy patient requirements with regard to the management of adverse events and pain. However, patients highlighted the need for a wider access to fatigue management and information on complementary medicine and relaxation techniques.

A nationwide cervical cancer (CC) screening program was implemented in France in 2018. Asymptomatic women are invited for a cytological test once every 3 years (age, 25-29 years), and an HPV test every 5 years (age, 30-65 years). We investigated the characteristics of women who are resistant to CC screening.Since 2005, the EDIFICE survey program has assessed attitudes toward cancer screening in France. The 6th edition (2017) included 12,046 representative women (age, 18-69 years). Social vulnerability was assessed using the EPICES score. Multivariate stepwise logistic regression analysis identified factors correlated with nonuptake of CC screening.Questionnaires from 4499 women (age, 25-65 years) with no history of cancer were analyzed; 88% (N = 3960) reported at least one test in their lifetime, and 73% (N = 3262) did the test in the previous 3 years. Compared to ever-screened women, never-screened women were younger (38 ± 11 yrs. vs 44 ± 12 yrs., P 0.05), and more likely to be single (48% vs 20%, P 0.05) and/or socially vulnerable (59% vs 38%, P 0.05). In multivariate analysis, items significantly (P 0.05) associated with never screening included living alone (OR = 2.26, 95% CI [1.85-2.75]) and social vulnerability (OR = 1.95 [1.59-2.40]). Women who were not compliant with recommendations were more likely to be older (mean age, 49.2 yrs. vs. 43.2 yrs), living alone (single, widowed or divorced, 40% vs. 30%, P 0.05), and/or socially vulnerable (55% vs. 35%, P 0.05; OR = 1.78, 95% CI [1.49-2.12]).This analysis identified several factors associated with never screening and under-screening. Effective prevention messages should specifically target these populations.

Background The EDIFICE surveys have been conducted since 2005 to provide a better understanding of the participation of the French population in cancer screening programs. The breast cancer (BC) screening program is nowadays widely implemented throughout the target female population: women aged 50-74 years are invited for a mammogram once every two years. We analyzed the behavior of women over time (between 2005 and 2016) regarding BC screening according to age-group, socioprofessional categories (SPC) and social vulnerability. Methods The fifth nationwide observational survey, EDIFICE 5, was conducted by phone interviews using the quota method. A representative sample of 1299 subjects aged 50-74 years with no history of cancer was interviewed between November 22 and December 7, 2016. Interviewees (women aged 50-74 yrs; N=657) were asked about their uptake of BC screening, and the date of the last examination to determine the follow-up rate. Demographic data on social characteristics and SPC were also collected to determine the level of social vulnerability (validated EPICES score). Results Compliance with BC screening (a mammogram within the past 2 years) decreased significantly from 81% in 2014 to 75% in 2016 (P=0.02). From 2014, a significant impact of age was observed (P=0.02 in 2014 and 2016). In 2016, and for the first time, a significant and disturbing decrease in follow-up rate was recorded among younger women (age 50-54 yrs: 88% in 2014 vs 74% in 2016, P=0.01). SPC had no effect on compliance with screening. However, since 2008, fluctuations have been observed among unemployed individuals (U), with a significant decline in compliance in 2016 (U: 81% in 2014 vs 73% in 2016, P=0.03). In 2016, social vulnerability was seen as a factor that negatively impacts on compliance with BC screening (P≤0.01), but not in 2011 or 2014. We also observed a significant overall decrease in 2016 among both vulnerable (76% in 2014 vs 65% in 2016; P=0.04) and non-vulnerable populations (85% in 2014 vs 79% in 2016, P=0.04), highlighting a general loss of confidence. Conclusion For the first time since 2005, compliance with BC screening dropped significantly in France in 2016. A significant overall decline was observed regardless of social vulnerability status. Disturbing significant decreases were observed among the younger age-group (women aged 50-54 yrs) of the target population of the organized program, and among unemployed women. Although organized programs have been shown to ensure equitable access to cancer screening, this achievement remains precarious and requires regular monitoring. Citation Format: Morère JF, Eisinger F, Blay J-Y, Greillier L, Brignoli-Guibaudet L, Lhomel C, Cortot AB, Couraud S, Viguier J. Decline in compliance to breast cancer screening in France: Results of the 5th EDIFICE survey [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-07.

Background The EDIFICE surveys have been conducted every three years since 2005. The aim of the surveys is to provide a better understanding of the participation of the French population in cancer screening programs. The breast cancer screening program is nowadays widely implemented throughout the female population aged 50-74 years; however, the question of whether it could be adapted according to breast cancer risk factors is currently under debate. This analysis focuses on awareness of the nature of breast cancer risk factors among the lay population and physicians. Methods This fourth nationwide observational survey, EDIFICE 4, was conducted by phone interviews using the quota method. A representative sample of 1602 individuals aged between 40 and 75 years old was interviewed between June 12 and July 10, 2014. A mirror survey on a representative sample of 201 general practitioners (adjusted for age and geographical area) and 100 oncologists (adjusted for type of healthcare institution and geographical area) was conducted between July 9 and August 8, 2014. Interviewees were all asked to cite five main risk factors for breast cancer. Results For lay persons (737 women with no history of cancer), the breast cancer risk factors reported were: for 54%, heredity and family history; for 29%, unhealthy lifestyle, including smoking, poor diet, stress, alcohol, physical inactivity; for 15%, exposure to exogenous hormone therapy; for 4%, air pollution; for 4%, sunburn on breasts; for 4%, late childbearing or no childbearing, and for 2%, overweight/obesity. Among physicians (70 female general practitioners and 35 female oncologists), the breast cancer risk factors reported were: for 98%, heredity and family history; for 51%, exposure to exogenous hormone therapy; for 39%, late childbearing or no childbearing; for 32%, unhealthy lifestyle, including smoking, poor diet, stress, alcohol, physical inactivity; for 22%, overweight/obesity; for 20%, age; for 22%, no breast feeding, and for 2%, air pollution. Conclusion We observed a relatively satisfactory level of understanding regarding the different risk factors for breast cancer despite the lack of indication of any qualitative ranking. Although overweight is a known risk factor for breast cancer, this fact is still not clearly understood among physicians and not widely known by the general public. On the other hand, both physicians and also half of the lay population were well aware of the fact that heredity is a risk factor for breast cancer. Citation Format: Morère J-F, Viguier J, Blay J-Y, Touboul C, Lhomel C, Eisinger F, Pivot X. Awareness of brest cancer risk factors among lay persons and physicians. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-09-14.

Background The aim of EDIFICE surveys is to improve insight into the behavior of the French population with regard to cancer prevention and participation in screening programs. Via the colorectal cancer screening program, all average-risk individuals in the 50-74-year age group are invited every 2 years to do a guaiac-based or, since April 2015, an immunochemical fecal occult blood test. Methods The fifth edition of the nationwide observational survey was conducted by phone interviews using the quota method. A representative sample of 1299 individuals with no history of cancer (age, 50-74 years) was interviewed between 22 November and 7 December 2016. The present analysis focuses on minimum lifetime uptake of screening tests, compliance to recommended repeat-screening intervals, and reasons for non-participation. Results In 2016, 64% survey participants had been screened at least once and 38% had been screened in the previous 2 years, suggesting a trend towards increasing participation rates, particularly in the younger age categories and among men. The 2016 data also suggest that the newly implemented FIT-based screening program has been well perceived by the population. Up to one in four individuals cited ``no risk factors'' as the reason for not undergoing screening. This reveals ignorance of the fact that the colorectal cancer screening program actually targets all average-risk individuals in a given age group, without individual risk factors. Conclusion We suggest the next step should be dedicated to educational approaches to explain exactly what screening involves and to persuasive messages targeting those who to date have remained unreceptive to information campaigns.

Background The general population is nowadays well aware that tobacco smoking dramatically increases the risk of developing lung cancer. We hypothesized that a personal history of smoking and the level of nicotine dependence in current smokers may affect the perception of this risk among healthy individuals. Methods The fourth French nationwide observational survey, EDIFICE 4, was conducted by telephone among a representative sample of individuals (N = 1602) aged between 40 and 75 years. Interviewees were asked about their smoking habits, perception of the risk of lung cancer, and nicotine dependence (Fagerstrom test). Results Regardless of their smoking status or level of nicotine dependence, the majority (96%) of our study population (N = 1463) acknowledged that tobacco smoking is a major risk factor for lung cancer. For 34% of all respondents, smoking

Background Primary prevention of cancer relies on awareness of and consequent identification of risk factors. We investigated knowledge of breast cancer risk factors not only among laywomen but also among female physicians. Methods The EDIFICE 4 nationwide observational survey was conducted by phone interviews of a representative female population (737 laywomen and 105 female physicians) aged 40-75 years, using the quotamethod. This analysis focuses on spontaneous replies to the question ``In your opinion, what are the five main risk factors that increase the risk of breast cancer?''. Results Heredity/Family history of breast cancer was the most widely recognized risk factor in both study populations (98.1% physicians vs. 54.2% laywomen; P

Background We studied cancer screening over time and social vulnerability via surveys of representative populations. Methods Individuals aged 50-75 years with no personal history of cancer were questioned about lifetime participation in screening tests, compliance (adherence to recommended intervals [colorectal, breast and cervical cancer]) and opportunistic screening (prostate and lung cancer). Results The proportion of vulnerable/non-vulnerable individuals remained stable between 2011 and 2016. In 2011, social vulnerability had no impact on screening participation, nor on compliance. In 2014, however, vulnerability was correlated with less frequent uptake of colorectal screening (despite an organised programme) and prostate cancer screening (opportunistic), and also with reduced compliance with recommended intervals (breast and cervical cancer screening). In 2016, the trends observed in 2014 were substantiated and even extended to breast, colorectal and cervical cancer screening uptakes. Social vulnerability has an increasingly negative impact on cancer screening attendance. The phenomenon was identified in 2014 and had expanded by 2016. Conclusion Although organised programmes have been shown to ensure equitable access to cancer screening, this remains a precarious achievement requiring regular monitoring. Further studies should focus on attitudes of vulnerable populations and on ways to improve cancer awareness campaigns.

Background The EDIFICE surveys have assessed cancer screening behavior in the French population since 2005. Methods The 2016 edition was conducted among a representative sample of 1501 individuals (age, 50-75 years). The current analysis focuses on breast, colorectal, prostate, lung, and cervical cancer screening. Results The rate of women (50 to 74 years) declaring having had at least one breast cancer screening test in their lifetime remained stable and high between 2005 and 2016. Compliance with recommended screening intervals improved between 2005 and 2011 from 75 to 83%, respectively, then decreased significantly to 75% in 2016 (P = 0.02). Uptake of at least one lifetime colorectal cancer screening test procedure declared (individuals aged 50-74 years) increase from 25% in 2005 to 59% in 2011, stabilized at 60% in 2014, then reached 64% in 2016. Opportunistic prostate cancer screening (men aged 50-75 years) rose between 2005 and 2008 from 36 to 49%, plateaued until 2014 then dropped to 42% in 2016. The proportion of women aged 5065 declaring having undergone one cervical cancer screening test dropped significantly between 2014 and 2016 from 99 to 94% (P < 0.01). Lastly, 11% of our survey population in 2014 and 2016 (55-74 years) declared having already undergone lung cancer screening. Conclusion Cancer screening behavior fluctuates in France, regardless of the context, i.e., organized programs or opportunistic screening. This observation highlights the need for constant analysis of population attitudes to optimize public awareness campaigns.

Participation is key to the success of cancer screening. Identifying the reasons for nonparticipation is therefore essential. The present analysis of the EDIFICE (etude sur le depistage des cancers et ses facteurs de compliance [survey on cancer screening and compliance factors]) surveys (n = 1463) found 36.4% of current smokers and 26.3% of former smokers intended to participate in a lung cancer screening program. Discrepancies exist between the screening program target populations and the individuals who actually intend to undergo screening. Background: Lung cancer (LC) screening (LCS) with annual low-dose computed tomography scans has been seen to reduce the specific and overall mortality in selected populations. However, participation is key to successful screening programs. The EDIFICE (etude sur le depistage des cancers et ses facteurs de compliance [survey on cancer screening and compliance factors]) nationwide observational surveys are used to assess behavior related to cancer screening programs in France. Materials and Methods: Using comprehensive multivariate stepwise logistic regression analyses of data from current and former cigarette smokers, we sought to identify the explanatory factors associated with the intention to participate in an LCS program. Results: Of the 1463 respondents with no personal history of cancer, 263 (36.4%) of the current cigarette smokers and 170 (26.3%) of the former cigarette smokers stated their willingness to participate in an LCS program. The explanatory factors differed between current cigarette smokers (already screened for LC: odds ratio PRI, 2.81; < 30 pack-years: OR, 2.69; intention to quit smoking: OR, 1.96; no social vulnerability: OR, 2.15) and former cigarette smokers (comorbidities: OR, 0.31). The usual eligibility criteria were not significantly explanatory. Conclusion: Our findings highlight the discrepancy that exists between target populations and individuals who actually intend to participate in a screening program for LC, with subsequent potential effects on the participation rates and, thus, on the efficacy of screening. (C) 2018 Elsevier Inc. All rights reserved.

This analysis aimed to assess the extent to which exposure to cancer risk factors and attendance of screening programmes are influenced by social characteristics. The validated Evaluation of deprivation and health inequalities in public health centres (EPICES) index was used to measure social deprivation. A sample of the general population (N=1603) was assessed to search for potential correlations between screening attendance, risk factors and any components of the EPICES score. In 2011, 33% of the population studied was classified as 'vulnerable'. Sex had no significant impact on this rating (32% men, 35% women), whereas occupational status did. Vulnerable individuals were more likely already to have cancer (10 vs. 7%; nonsignificant difference; odds ratio 1.43 [0.98-2.10]). The mean BMI was 26.0 kg/m (SD 4.9) for the vulnerable population versus 24.8 kg/m (SD 3.9) in the nonvulnerable population (P

The EDIFICE programme began in 2005 and set out to provide a clearer insight over time into the participation of the French population in cancer screening. EDIFICE 3 was conducted in 2011 by phone interviews among a representative sample of 1603 individuals aged between 40 and 75 years using the quota method. The analysis focused on the target populations (50-74 years) of the national screening programmes for breast and colorectal cancer. The same populations were also assessed with respect to prostate cancer screening. In 2005, 93% of the sample population had undergone at least one mammogram in their lifetime; this figure reached 94% in 2008 and 95% in 2011. Compliance with recommended intervals improved between 2005 and 2011, and significantly so for women aged 65-74 years. In 2005, 25% of respondents reported having undergone at least one colorectal cancer screening test; this figure reached 38% in 2008 and 59% in 2011. Recommended intervals were respected by 30 and 51% in 2008 and 2011, respectively. In 2005, 2008 and 2011, a total of 36, 49 and 50% of men reported having undergone at least one prostate cancer screening test. This rate decreased significantly in men aged 50-59 years between 2008 and 2011 (44 vs. 37%, P≤0.05). Attendance rates in national screening programmes are high and stable for breast cancer, and although currently improving for colorectal cancer, the European guideline target has not yet been reached. Despite the absence of recommendations for prostate cancer screening, participation remains constant.

Objectives The incidence of skin cancers, melanoma in particular, is increasing rapidly. Consequently, specific recommendations for sun-protection measures now exist. This survey set out to assess the compliance of the general population with these guidelines. Methods The French nationwide observational survey, EDIFICE Melanoma, was conducted (28 September to 20 October 2011) through phone interviews of a representative sample of 1502 subjects aged ≥ 18 years, using the quota method. Sun-protection was defined as frequent or systematic use of clothes or sunscreen. The group of individuals who declared exposure to the sun (N = 1172) was subdivided: risk-takers (N = 442), and those who used sun protection (N = 730). Results Risk-takers were significantly more often male (62% vs. 44%, P

Background Routine sun protection is recommended to prevent skin cancer. The aims of the present analysis were to assess and compare modalities of sun protection in parents and their children. Methods EDIFICE Melanoma is a French nationwide observational survey. It was conducted through phone interviews among a representative sample of 1502 individuals aged ≥18 years, using the method of quotas. The survey took place shortly after the summer, from 28 September to 20 October 2011. Results Of the 1502 subjects interviewed, 1067 reported sun exposure (SE) at least 10 days per year, 748 were parents and 319 had no children. Sun protection measures seemed adequate in both the ‘parents’ and ‘non-parents’ groups: 74% used clothing and 43% used sunscreen, which was reapplied regularly in 57% of cases. Sun protection measures used by SE parents for SE children were superior, both qualitatively and quantitatively, to those used for themselves, i.e., 50% of parents reported using clothing, sunglasses and hats for their children vs. 23% for themselves. In 87% of cases, parents reported regular re-application of sunscreen for their children vs. 44% for themselves. The sunscreen SPF (Sun Protection Factor) was significantly lower for parents than for their children. Conclusions Sun protection awareness appears to be globally satisfactory in the French population, with no difference between adults who are parents and those who are not. From both qualitative and quantitative standpoints, French parents use sun protective measures more efficiently for their children than for themselves.

Resume L’acces au depistage du cancer en France a ete facilite par la mise en place de programmes organises (cancer du sein et cancer colorectal) et de recommandations nationales (cancer du col de l’uterus). Des arbitrages personnels peuvent egalement motiver la participation au depistage du cancer de la prostate. Cet article presente une analyse des comportements de la population generale francaise sur plus de 10 ans face au depistage du cancer et de la perception de cette demarche par les medecins generalistes. On peut ainsi noter que si le depistage du cancer du sein est etabli de maniere stable et relativement homogene dans la population, d’autres, comme celui du cancer colorectal et de la prostate sont sous une dependance plus forte de facteurs sociologiques et de la precarite. Le monitoring de l’adhesion est ainsi d’autant plus important que la participation pourrait etre affectee par l’impact des conditions sociales et de la precarite dans un contexte de crise economique.

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

11616 Background: Advances in therapy and early detection, by population-based screening in particular, have significantly increased the number of patients cured from cancer. However, cancer patients’ chances of being cured varies strongly from one cancer to another. We studied the understanding of the concept of cure in the lay population and the factors associated with believing that cancer can be cured. Methods: The French nationwide observational survey, EDIFICE 6, was conducted online (June 26-July 28, 2017) on a core sample of 12 046 individuals (age, 18-69y). Representativeness was ensured by quota sampling on age, sex, profession, and stratification by geographical area/type of urban district. This analysis focused on understanding of the meaning of cure in breast (BC), cervical (CC), colorectal (CRC), lung (LC) and bladder (BLC) cancer for individuals with no history of cancer. Results: The majority of respondents believed that cure exists (BC 95%; CC 91%; CRC 89%; BLC 87%, LC 71%). Some agreed with the definition that cure is the disappearance of the disease (BC 42%; CC 38%; CRC 35%; BLC 33%, LC 25%), while others preferred the definition that cure is several years without disease (BC, CC 53%; CRC, BLS 54%; LC 46%). More men than women (P < 0.05) believed that cure exists for CRC, BLC and LC. Socially non-vulnerable individuals were more likely to believe in cure than their vulnerable counterparts (P < 0.05), as were individuals aged 50-69y (P < 0.05) versus those of 18-50y, and for all cancer types except LC. In multivariate analysis, the variable “clinical research enables progress” was correlated with believing that cure exists (BC, OR = 2.93; CC, OR = 1.86; CRC, OR = 2.22; LC, OR = 1.57, BLC, OR = 2.06), as was “progress is rapid” (BC, OR = 1.61; CC, OR = 1.66; CRC, OR = 1.7; LC, OR = 1.84; BLC OR = 1.68), and also social non-vulnerability. However, the variables “prevention”, respectively screening/treatments, “are important for cancer control” had a low impact on the belief in cure (OR~1). Conclusions: The lay population is relatively optimistic about the cure for cancer. Confidence in the existence of cure relies on medical progress. However, factors related to individual behavior, e.g., prevention and screening, did not affect the perception of cure.

Background The prevention of melanoma can be significantly improved by targeting information directly towards the subpopulation of children and, as a means to achieve it, towards young parents. Objectives The objective of this analysis was to determine the evolution over time of the sun-protection measures adopted by parents for their young children. Methods The Edifice Melanoma survey was based on telephone interviews of a representative sample of 1502 subjects aged ≥18 years. This particular analysis focuses on 864 adults whose children are exposed to the sun for more than 10 days a year. We compared the characteristics and attitudes of two sub-groups of parents with regard to sun protection of young children: current-day behaviour of parents with children

Accessibility to cancer screening in France has been facilitated by the implementation of organised programs (breast cancer and colorectal cancer) and by national recommendations (cervical cancer). Personal motivation may also trigger participation in prostate cancer screening. This paper proposes an overview of attitudes toward cancer screening among the general population over a period of more than 10 years and the perception of this behaviour by general practitioners. It is noteworthy that although certain cancer screening programmes, such as for breast cancer, are widely established throughout the population, uptake of others, such as for colorectal or prostate cancer, is contingent on sociological factors and vulnerability. Monitoring of compliance is thus all the more important since participation may be more acutely affected by the impact of social conditions and vulnerability in the current critical economic climate.

The question of returning to work and pursuing professional activity during cancer treatment is an increasingly important consideration. The present work focuses on factors affecting the feasibility of maintaining professional activity during treatment for breast cancer, for women who wished to do so. Written questionnaires were collected from 216 patients between March and November 2012. Since the onset of their treatment, 31.4% of the women (68/216) had not been on sick-leave. The main factors associated with the pursuit of professional activity were: considering the availability of their physician to answer questions as unimportant [OR = 18.83 (3.60-98.53); P ≤ 0.05]; considering the diagnosis of cancer as likely to have a weak impact on career perspectives [OR = 4.07 (2.49-6.64); P ≤ 0.05]; not having any children in the household [OR = 3.87 (2.38-6.28); P ≤ 0.05]; being in a managerial position [OR = 3.13 (1.88-5.21); P ≤ 0.05]. Negative predictive factors were: physician mentioning adverse effects of the treatment [OR = 0.31 (0.16-0.58); P ≤ 0.05], and patient rating workload as high [OR = 0.26 (0.15-0.46); P ≤ 0.05]. As a result of advances in therapeutic strategies, more patients will expect healthcare professionals, as well as employers and occupational health societies, to prioritise issues pertaining to the maintenance of professional activities during cancer treatment.

e13555Background: Many factors affect decisions regarding cancer screening. Risk perception depends on individual behavior but also on emotional, social and cultural issues. We studied individuals ...

e18821Background: In addition to increasing treatment efficacy and reducing adverse effects, appropriate supportive care can improve patient quality of life. The Calista2 survey sought to identify,...

1557Background: The efficacy of cancer screening (cost effectiveness, reduced mortality) relies on a minimum threshold uptake rate. Target populations are asymptomatic with only average risk, and t...

2533Background: Clinical research is a major aspect of drug development and requires patient participation. Family and friends are known to play a role in medical decision-making, the extent of whi...

565 Background: The aim of EDIFICE surveys is to improve insight into the behavior of the French population with regard to cancer prevention and participation in screening programs. Via the colorectal cancer (CRC) screening program, all average-risk individuals in the 50-74-yr age group are invited every 2 years to do a guaiac-based or immunochemical fecal occult blood test. This analysis focuses on lay-population reasons for not undergoing the test. Methods: The 5th nationwide observational survey was conducted by phone interviews using the quota method. A representative sample of 1299 individuals with no history of cancer (age, 50-74 yrs) was interviewed between 22 November and 7 December 2016. Those who had never undertaken a screening test were asked for their reasons. Results: In total, 64% reported having undergone a screening test (colonoscopy, fecal occult blood test) at least once in their lifetime (coverage). There was a non-significant (NS) increase in coverage rates over the period 2014-2016. In 2016, the most frequently (36%) cited reason for not being screened was “individual negligence/not a priority”. This figure was significantly higher than in 2014 (24%, P < 0.05). Between one in four and one in five respondents answered “no risk factor” in both 2014 and 2016. Approximately one in ten respondents gave “pointlessness” as their reason for not being screened (12% in 2016 vs 8% in 2014, NS) while “fear of the examination or fear of the results”, “reasons related to the physician (he never suggested it” [3.8% in 2016] or “he recommended against screening” [2.5% in 2016]), or “refusal to participate”, all dropped significantly between 2014 and 2016. Conclusions: The issue of “individual negligence” requires further analysis so as to clearly define the categories of individuals who remain unreceptive to screening and identify how best to involve them. The significant mention of “no risk factors” reveals ignorance of the fact that the colorectal cancer screening program actually targets all individuals in a given age group, regardless of individual risk factors. The decrease in reasons involving “fear" or related to the physician may be a result of awareness campaigns and GP mobilization.

One of the current goals of the French national cancer plan is to reduce healthcare inequalities. This study investigated the potential links between vulnerable social status, exposure to lung cancer risk factors and access to healthcare to highlight ways to improve lung cancer control in this population. The nationwide observational study EDIFICE 3 was carried out through phone interviews of a representative sample of 1603 individuals (age 40-75 years). The EPICES validated questionnaire was used to assess and classify vulnerable respondents. The vulnerable population identified represented 33% of the sample. Compared with nonvulnerable individuals, they had more risk factors for cancer: a higher BMI (26.0 vs. 24.8, P≤0.01), 38% were active smokers (vs. 23%, P≤0.01) with a heavier and longer-lasting tobacco consumption (16.0 cigarettes/day vs. 10.1, P≤0.01 and 29.4 vs. 26.3 years of smoking, P≤0.01) and they were less likely to undertake any physical activities (42 vs. 77%, P≤0.01). They also presented more comorbidities (on average 2.2 vs. 1.8, P≤0.01). Access to healthcare, however, was not discriminatory: vulnerable individuals declared consulting a general practitioner or an oncologist more often than the nonvulnerable subgroup (5.4 vs. 3.7 and 6.7 vs. 2.5 consultations in the previous 12 months, respectively, P≤0.01). Because access to healthcare and screening attendance show no signs of discrimination against vulnerable populations, efforts to reduce inequities in lung cancer control should focus on prevention.

International audience; Purpose Our previously published data showed rapidly increasing rates of prostate cancer screening in men aged 50-74, which rose from 36 % in 2005 to 48 % in 2008. Based on men's reported intentions at that time, this was expected to rise to 70 % in 2011. Here we report the actual rate of prostate cancer screening. Method Three nationwide observational telephone surveys (EDIFICE opinion polls) were conducted in 2005, 2008, and 2011. The overall target was a representative sample of [1,500 individuals living in France and aged 40-75 years, including 481 men aged 50-74 years. Results Within this male population, the rate of screening reported remained stable between 2008 and 2011 (48 and 49 %, respectively). However, comparison of privileged versus disadvantaged populations showed significant differences, with a relative decrease in screening among those of higher socioprofessional status (p = 0.03) and from higher-income groups (p = 0.02). For households with a monthly income above 2,500€, the screening rate decreased from 61 % in 2008 to 51 % in 2011 (p = 0.05), while for those with an income below 2,500€, it increased from 36 % in 2008 to 44 % in 2011 (p = 0.18). Conclusion A plateau or even a reduction in prostate cancer screening is currently being observed; this is possibly due to progressive recognition among the population at large of the controversy surrounding prostate cancer screening, whereas this speculation was formerly limited to health-care professionals. After previously being more likely to undergo prostate cancer screening, it is the younger, wealthier populations that are currently showing the most noteworthy step backwards.

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.

536 Background: The aim of EDIFICE surveys is to improve insight into the behavior of the French population with regard to cancer prevention and participation in screening programs. The colorectal cancer (CRC) screening program is in place and targets the 50-74-yr age group. CRC prevention also relies on increased awareness of known risk factors (behavioral [BRF] or non-behavioral [NBRF]). This analysis focuses on awareness of CRC risk factors among the lay population and physicians. Methods: The 4th nationwide observational survey was conducted by phone interviews using the quota method. A representative sample of 1463 individuals with no history of cancer (age, 40-75 yrs) was interviewed between June 12 and July 10, 2014. A mirror survey on a representative sample of 301 physicians was conducted between July 9 and August 8, 2014. Interviewees were asked to cite the five main RF for CRC. Results: Heredity/family history of CRC was widely cited by physicians but far less by laypersons (LP) (95.3% vs. 26.1%, P < 0.01). Digestive disorders, age, polyps and Crohn’s disease were also cited as NBRF by 38.2%, 22.9%, 15.3% and 12.3% of physicians, respectively. In comparison, these RF were very rarely cited by LP (5.4%, 1.5%, 1.7% and 0.1%, respectively, P < 0.01). Unhealthy-lifestyle RF were cited by 86.4% and 52.7% of physicians and LP, respectively (P < 0.01): poor eating habits, ranked first for both physicians and LP (80.1 vs 46.8%, P < 0.01), including unbalanced or excessively rich diet (52.8% vs. 41.2%, P < 0.01) and excessive quantities of red meat (12.6% vs. 2.2%, P < 0.01). Among unhealthy-lifestyle RF, after poor eating habits, physicians cited first tobacco (24.3%), then alcohol (19.9%), and lack of exercise (14.6%) as other BRF. These were cited by 12.2% (P < 0.01), 16.0% (NS) and 4.7% (P < 0.01) of LP, respectively. Overweight/obesity was cited by 19.6% of physicians but by only 1.8% of LP. Conclusions: Overall, there is a lower level of awareness of CRC risk factors in lay persons than in physicians. Physicians are generally aware that heredity/family history and unhealthy lifestyle are the major RF for CRC, in line with the widely recognized RF. In contrast, lay persons rank BRF highest, and notably those related to poor eating habits.

Background In addition to natural sunlight, indoor tanning has emerged as a common source of ultraviolet (UV) radiation associated with an increased risk of melanoma. It is classified as a class I human carcinogen by the World Health Organization. Objectives This analysis presents data on the prevalence of sunbed use in France, on factors associated with sunbed use, and on risk factors, attitude and awareness of risk among sunbed users and non-users. Methods Edifice Melanoma, a nationwide observational survey, was conducted in France via telephone interviews among a representative sample of 1502 subjects aged ≥18 years, using the quota method. Sunbed users were defined as individuals who reported having used a sunbed at least once in their lifetime. Logistical regressions were conducted in order to identify which factors differentiate the population of sunbed users from that of non-users. Results One in ten respondents was a sunbed user and three out of four declared having used tanning facilities for over one year. In multivariate analysis, factors significantly associated with the sunbed-user group were female gender (OR = 3.897 [2.573–5.903], P

Background The efficiency of skin cancer prevention programmes is strongly correlated with the information dispensed, and with the level of risk awareness, of the overall population on one hand, and on the other, of specific sub-populations, according to their risk profiles. Objectives The primary objective of this analysis was to establish a correlation between individual perceptions of the risk of developing a melanoma, and the recognized intrinsic risk factors for a given individual. Secondary objectives were to assess factors that are potentially associated with acceptable, high or low perception of melanoma risk. Methods The EDIFICE Melanoma survey was conducted in 2011 via telephone interviews of a representative sample of 1502 individuals aged 18 and older in the French population. Results Although most respondents (73%) had a true estimation of their intrinsic risk for melanoma, those who did not (underestimation, 17%; overestimation, 10%) had an attitude towards environmental risk factors (sun exposure, sun protection, sunbed use) that did not compensate for this misplaced perception. Conclusions Skin cancer prevention messages need to be reinforced, new methods of evaluating understanding of the messages need to be implemented, and both need to be included into personal risk assessment.