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Introduction Les adultes gueris d’un cancer de l’enfance ou de l’adolescence sont a risque de complications cardiaques responsables d’une surmortalite a un âge jeune. Les anthracyclines et l’irradiation de l’aire cardiaque en sont des facteurs de risque majeurs. Les recommandations internationales preconisent un suivi medical pour ces patients par echographie cardiaque tous les cinq ans. Les objectifs de cette etude etaient de : – determiner si les survivants de cancer pediatriques definis comme a risque eleve de cardiomyopathies ont un suivi conforme aux recommandations ; – analyser les facteurs associes a la non-adhesion a ce suivi ; – etudier l’impact de la consultation de suivi a long-terme, un dispositif recemment cree, sur l’adhesion au suivi. Methodes Parmi les 7670 sujets de la cohorte FCCSS (« French Childhood Cancer Survivors Study ») survivants a cinq ans d’un cancer traite avant l’âge de 20 ans entre 1948 et 2000, 5249 etaient toujours vivants en 2019 et chaines aux donnees du SNDS, permettant d’identifier la realisation d’echographies cardiaques de 2006 a 2018, via les tables du DCIR et du PMSI. Les sujets exposes a la fois a une dose d’anthracycline ≥ 100 mg/m2 et a une dose de radiation ≥ 30 Gy sur le ventricule gauche (n = 75), ou exposes a une forte dose d’anthracycline (≥ 250 mg/m2, n = 757), ou exposes a une forte dose de radiation sur le ventricule gauche (≥30 Gy sur au moins 10 % du volume du ventricule gauche, n = 85), et n’ayant pas deja developpe une pathologie cardiaque avant ou pendant la periode d’etude ont ete definis comme etant a risque eleve de cardiomyopathie et ont ete inclus dans l’analyse (n = 917). Des modeles multivaries de regression logistique ont ete realises pour identifier les facteurs associes a l’absence d’echographie cardiaque au cours des cinq dernieres annees (i.e. de 2014 a 2018) chez ces sujets a risque, incluant des facteurs sociodemographiques (sexe, âge, niveau d’etude) et cliniques (âge du diagnostic du cancer pediatrique et traitements). L’association entre la venue en consultation de suivi a long-terme, proposee a partir de 2012 pour les sujets suivis a l’Institut Gustave Roussy (n = 650), et la realisation d’une echographie cardiaque chez les sujets a risque a ete etudiee par des modeles de Cox, afin de considerer la consultation de suivi comme une variable dependante du temps et pouvoir ainsi modeliser les periodes « sans » et « avec » une consultation de suivi, pour ensuite estimer plus finement l’association de cette derniere avec le temps de survenue d’une echographie cardiaque. Resultats Parmi les 917 sujets a risque eleve de cardiomyopathie (sexe-ratio H/F = 1,25, âge median au diagnostic de cancer = 7 ans [etendue : 0-19], âge median en 2019 = 41 ans [etendue : 19-73]), 291 (31,7 %) ont eu au moins une echographie cardiaque au cours des cinq dernieres annees, comme preconise par les recommandations. Les hommes (OR 1,73, p = 0,007) et les sujets âges de moins de 50 ans (OR 2,29, p = 0,006) avaient un risque plus eleve de ne pas suivre ces recommandations. Le fait de se rendre a une consultation de suivi a long-terme augmentait de 5,5 fois les chances d’avoir une echographie cardiaque chez ces sujets a risque (HR 5,51, p Conclusion Deux tiers des survivants a risque eleve de cardiomyopathie ne suivent pas les recommandations internationales en matiere de suivi medical. La mise en place d’un suivi a long terme et d’une consultation dediee ameliore leur chance de suivre les recommandations.

After the accidents of nuclear power plants at Chernobyl and at Fukushima, huge amounts of radioactive iodine were released into the atmosphere. We reviewed data on the health consequences of these accidents with a focus on thyroid consequences. Among the 2 million children who were living in highly contaminated regions in Belarus, Ukraine and Russia, 7000 cases of thyroid cancer had occurred in 2005. This is the most significant radiation-induced consequence of the Chernobyl accident. The increased incidence of thyroid cancer observed in adult population who lived in these highly contaminated regions is at least in major part related to screening and it is not possible to individualize among these thyroid cancers those that are potentially caused by radiation exposure. For populations who lived outside these regions at the time of the accident, there is no detectable consequence of the radiation exposure on the thyroid gland. Among children who lived nearby the Fukushima power plant in 2011, there is currently no evidence of an increased incidence of thyroid cancer. Ultrasonography screening in these individuals detected a number of thyroid cancers that are probably not related to the accident. Because thyroid cancer is frequent, studies have been carried out to distinguish radiation-induced from their sporadic counterparts, and genomic signatures might be helpful. The consequences of the Chernobyl accident clearly demonstrate that populations living nearby a nuclear power plant should be protected in case of accident by sheltering, food restrictions and prophylaxis of thyroid irradiation by potassium iodine administration, if the predicted estimated dose to the thyroid gland of children might be >50 mGy. These countermeasures should be applied in priority to children, adolescents and pregnant women; they are safe and effective.

STUDY QUESTION What are the consequences of radioactive iodine (RAI) therapy for testicular function? SUMMARY ANSWER A single activity of 3.7 GBq RAI for differentiated thyroid carcinoma (DTC) treatment in young men transiently altered Sertoli cell function and induced sperm chromosomal abnormalities. WHAT IS KNOWN ALREADY Few studies, mainly retrospective, have reported the potential impacts of RAI on endocrine and exocrine testicular function. STUDY DESIGN, SIZE, DURATION A longitudinal prospective multi-center study on testicular function performed in DTC patients before a single 131I ablative activity of 3.7 GBq (V0) and at 3 months (V3) and 13 months (V13) after treatment. PARTICIPANTS/MATERIALS, SETTING, METHODS Forty male patients, aged 18-55 years, with DTC participated. Hormonal analysis included FSH, LH, testosterone and inhibin B serum levels at V0, V3 and V13. Furthermore, sperm parameters, DNA fragmentation and sperm chromosomal abnormalities were evaluated at each time points. The differences in all parameters, between V0-V3, V0-V13 and V3-V13, were analyzed, using a Wilcoxon test. MAIN RESULTS AND THE ROLE OF CHANCE Prior to RAI administration, all patients had normal gonadal function. At V3, a statistically significant increase in FSH levels and a decrease in inhibin B levels were observed and sperm concentration, as well as the percentage of morphologically normal spermatozoa, were significantly decreased (P < 0.0001). These modifications were transient as both sperm concentration and normal morphology rate returned to baseline values at V13. However, at this later time point, FSH and inhibin B levels were still impacted by RAI administration but remained in the normal range. Although no DNA fragmentation was observed at V3 nor V13, our study revealed a statistically significant increase in the number of sperm chromosomal abnormalities both at V3 (P < 0.001) and V13 (P = 0.01). LIMITATIONS, REASONS FOR CAUTION Among the 40 patients included in the study, only 24 had all the parameters available at all visits. WIDER IMPLICATIONS OF THE FINDINGS Prospective studies with longer term follow up would be helpful to determine whether the chromosome abnormalities persist. These studies would be required before sperm banking should be suggested for all patients. However, sperm preservation for DTC patients who require cumulative radioiodine activities higher than 3.7 GBq should be proposed. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the Programme Hospitalier de Recherche Clinique, AP-HP (No. P040419). The authors report no conflict of interest in this work. TRIAL REGISTRATION NUMBER NCT01150318.

Purpose Irradiation (>3 Gy) to the breast or axillae before 30 years of age increases the risk of secondary breast cancer (SBC). The purpose of this article is to describe the clinical characteristics of SBC and the way of diagnosis in young women (before the age of national screening) in France who had received previous radiotherapy for a childhood or a young adulthood cancer. Patients and methods This retrospective, multicentre study reviewed the medical records of women with SBC before the age of the national screening who had received irradiation (≥3 Gy) on part or all of the breast before 30 years of age, for any type of tumour except BC. Results A total of 121 SBC were detected in 104 women with previous radiotherapy. Twenty percent of SBC were detected during regular breast screening and 16% of the women had a regular radiological follow-up. Conclusion Our results points out that the main proportion of childhood cancer survivors did not benefit from the recommended breast cancer screening. This result is comparable to other previously published studies in other countries. A national screening programme is necessary and should take into account the patient’s age, family history, personal medical history and previous radiotherapy to reduce the number of SBC diagnosed at an advanced stage.

Resume Position du probleme En France, les maladies chroniques touchent 3 millions d’enfants et d’adolescents. Le devenir a long terme des enfants malades chroniques est souvent bien decrit au niveau somatique, mais mal connu dans ses aspects sociaux et psychologiques. Methodes Notre objectif etait de construire un auto-questionnaire d’evaluation du bien-etre d’adultes porteurs de maladie chronique dans ou depuis l’enfance, et non specifique d’une pathologie donnee. Le questionnaire a ete elabore en equipe pluridisciplinaire (epidemiologistes, cliniciens, sociologue, statisticien). Les items ont ete construits en adequation avec des donnees de reference en population generale francaise (issues d’enquetes nationales et en acces libre) pour permettre des analyses comparatives avec ajustement sur âge et sexe (et eventuellement d’autres facteurs confondants comme le niveau d’etudes) par standardisation indirecte (variables qualitatives) ou par Z-scores (variables quantitatives). Une premiere version du questionnaire a ete testee dans quatre etudes menees aupres d’adultes malades chroniques depuis l’enfance. Resultats Le GEDEPAC-2 comporte 108 items explorant 11 domaines du bien-etre : education, emploi, logement, securite materielle, liens sociaux, engagement civique, loisirs, environnement, sante physique/conduites a risque, qualite de vie liee a la sante, vie sexuelle. La vie sociale est abordee conjointement par des questions factuelles (donnees objectives) et des echelles de satisfaction (donnees subjectives). La qualite de vie est analysee en termes de qualite de vie physique, qualite de vie psychique, de fatigue et de poids du traitement de la maladie par trois questionnaires courts valides en francais (SF-12 ; MFI-20 ; « Treatment Burden Questionnaire »). Deroulement et vecu de la transition pediatrie-medecine d’adultes sont decrits a travers 21 items. Des versions papier et electronique ont ete construites. Conclusion Construit dans une approche multidimensionnelle du bien-etre et en adequation avec les donnees de reference disponibles, le questionnaire GEDEPAC-2 facilitera la mise en place de futures etudes sur le devenir a l’âge adulte des enfants malades chroniques.

Background After chest radiotherapy (RT) for Hodgkin lymphoma (HL), women experience a dose-dependent increased breast cancer (BC) risk. It is unknown whether endogenous and exogenous gonadal hormones affect the radiation dose-response relationship. Methods We conducted a nested case-control study among female 5-year HL survivors treated before 41 years between 1965-2000. Data were collected through medical records and questionnaires for 174 BC cases and 466 matched controls. RT charts, simulation films and mammography reports were used to estimate the radiation dose to the location of the breast tumor. Results The median interval between HL and BC diagnosis was 21.9 years. 98% of BC cases had received chest RT, compared to 92% of controls. We observed a linear radiation dose-response curve with an adjusted excess odd ratio (EOR) of 5.4%/Gray (95%CI:1.8%-13.37%). Women with menopause Conclusion HRT use did not appear to increase BC risk in female HL survivors with a therapy-induced early menopause. Moreover, there was no evidence for interaction between RT dose and years with intact ovarian function or HRT use. Citation Format: Krul IM, Opstal - van Winden AWJ, Aleman BMP, Janus CPM, van Eggermond AM, de Bruin ML, Hauptmann M, Krol ADG, Schaapveld M, Broeks A, Kooijman KR, Fase S, Lybeert ML, Zijlstra JM, van der Maazen RWM, Kesminiene A, Diallo I, de Vathaire F, Russell NS, van Leeuwen FE. Breast cancer after Hodgkin lymphoma: Influence of endogenous and exogenous gonadal hormones on the radiation dose-response relationship [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-06-04.

Thyroid and breast cancers share a lot of similarities in their biology: both are more frequent in women and are influenced by hormonal and reproductive factors. Moreover, individuals diagnosed with breast cancer are more likely to develop thyroid cancer as a secondary malignancy than patient diagnosed with other cancer types, and vice-versa (Nielsen et al., 2016). Genetic factors contributing to the incidence of breast cancer have been extensively studied, and 313 risk variants were identified (Mavaddat et al., 2019). On the other hand, GWAS studies on thyroid cancer have been scarce due to the lesser incidence of this disease as well as the lack of data, but it is known that thyroid cancer is the only cancer for which genetic factors contribute more than environmental factors. For thyroid cancer 10 loci were identified (Gudmundsson et al., 2017), and one of them (2q35) was previously reported to increase risk of breast cancer (Stacey et al., 2007). To date, no study has been conducted to identify common genetic factors between breast and thyroid cancer. We have access to GWAS results on thyroid cancer (EPITHYR consortium), which was coordinated by our team, and to the summary statistics of the most recent GWAS conducted by the Breast Cancer Association Consortium (BCAC, Michailidou et al., 2017). In this ongoing study, we aim at studying pleiotropy between both cancers at different scales. First, we will estimate the genome-wide genetic correlation using the LDscore and SumHer methods. Second, we will analyze the association of the polygenic risk scores of breast cancer in association to thyroid cancer risk and vice-versa. Third, we will identify the pleiotropic SNPs affecting both cancers. These analyses are still ongoing and the results will be presented. Evidence of carcinogenic pleiotropy will improve our understanding of the diseases etiology and will provide insights on the underlying common biology between both cancers. This work is supported by “La Ligue contre le Cancer” through the CCGIP (Cross Cancer Genomic Investigation of Pathway analysis and GxE interactions) project.

International audience; With the increase in survival from childhood cancer , research has increasingly focused on the educational and professional achievements of childhood cancer survivors. Yet , if large-­‐scale studies provide an acute description of the current situation of childhood cancer survivors , little is known about their trajectories and the social processes shaping these trajectories. Using a qualitative methodology , drawing from a life course perspective , this study sought to describe the role of childhood cancer and its side effects in educational trajectories , as perceived by the participants. We investigated related processes of social adjustment to cancer , that is to say , choices or decisions that survivors related to the illness in the making of their career plans. Eighty long-­‐term French childhood cancer survivors participating in the Euro2K longitudinal study were interviewed through in-­‐depth , face-­‐to-­‐face interviews undertaken in 2011-­‐2012. There were various types of impact described by respondents of the diagnosis of cancer on their occupational trajectories. These varied according to gender. In women , childhood cancer tended to result in poor educational achievement , or in steering the individual towards a health care or child care occupation. This was justified by a desire to return the support that had been offered to them as patients. In men , however , childhood cancer led to a shift in career plans , because of physical sequelae , or because of concerns about their future health. Paradoxically , this limitation had a positive impact in their occupational achievement , as most of these men disregarded blue-­‐collar jobs and chose more qualified white-­‐collar occupations. Overall , findings suggest that childhood cancer influenced educational trajectories and , thus , socioeconomic status in adulthood , through mechanisms embedded in gender norms. These mechanisms could explain gender inequalities in educational achievement after childhood cancer reported in large-­‐scale cohort studies .

Background: A marginal interaction between sex and the type of alkylating agent was observed for event‐free survival in the Euro‐EWING99‐R1 randomized controlled trial (RCT) comparing cyclophosphamide and ifosfamide in Ewing sarcoma. To further evaluate this interaction, we performed an individual patient data meta‐analysis of RCTs assessing cyclophosphamide versus ifosfamide in any type of cancer. Methods: A literature search produced two more eligible RCTs (EICESS92 and IRS‐IV). The endpoints were progression‐free survival (PFS, main endpoint) and overall survival (OS). The hazard ratios (HRs) of the treatment‐by‐sex interaction and their 95% confidence interval (95% CI) were assessed using stratified multivariable Cox models. Heterogeneity of the interaction across age categories and trials was explored. We also assessed this interaction for severe acute toxicity using logistic models. Results: The meta‐analysis comprised 1,528 pediatric and young adult sarcoma patients from three RCTs: Euro‐EWING99‐R1 (n = 856), EICESS92 (n = 155), and IRS‐IV (n = 517). There were 224 PFS events in Euro‐EWING99‐R1 and 200 in the validation set (EICESS92 + IRS‐IV), and 171 and 154 deaths in each dataset, respectively. The estimated treatment‐by‐sex interaction for PFS in Euro‐EWING99‐R1 (HR = 1.73, 95% CI = 1.00–3.00) was not replicated in the validation set (HR = 0.97, 95% CI = 0.55–1.72), without heterogeneity across trials (P = 0.62). In the pooled analysis, the treatment‐by‐sex interaction was not significant (HR = 1.31, 95% CI = 0.89–1.95, P = 0.17), without heterogeneity across age categories (P = 0.88) and trials (P = 0.36). Similar results were observed for OS. No significant treatment‐by‐sex interaction was observed for leucopenia/neutropenia (P = 0.45), infection (P = 0.64), or renal toxicity (P = 0.20). Conclusion: Our meta‐analysis did not confirm the hypothesis of a treatment‐by‐sex interaction on efficacy or toxicity outcomes. Refereed/Peer-reviewed

Background In retrospective case-control studies performed following nuclear tests or nuclear accidents, individual thyroid radiation dose reconstructions are based on fallout and meteorological data from the residential area, demographic characteristics, and lifestyle as well as dietary information. Collecting the latter is a controversial step, as dietary declarations may be affected by the subjects’ beliefs about their risk behavior. This report analyses the potential for such bias in a case-control study performed in eastern France. Methods The study included 765 cases of differentiated thyroid carcinoma matched with 831 controls. Risk perceptions and beliefs of cases and controls were compared using Chi2 tests and differences in dietary reports were analyzed using a two-way ANOVA. Results In general, atmospheric pollution and living near a nuclear power plant were the two major risks that may influence thyroid cancer occurrence cited by cases and controls. When focusing in particular on the consequences of the Chernobyl accident, cases were more likely to think that the consequences were responsible for thyroid cancer occurrence than controls. Vegetable consumption during the two months after the Chernobyl accident was correlated with the status of subjects, but not to their beliefs. Conversely, consumption of fresh dairy products was not correlated with the status or beliefs of subjects. Conclusion We found no evidence of systematic bias in dietary reports according to the status or beliefs held by subjects about the link between thyroid cancer occurrence and Chernobyl fallout. As such, these dietary reports may be used in further studies involving individual dosimetric reconstructions.

Objectif de l’etude Etudier les facteurs predictifs d’une pathologie cerebrovasculaire apres cancer de l’enfant. Materiel et methode Il s’agissait d’un etude de cohorte French Childhood Cancer Survivor Study (FCCSS) : 7018 survivants a 5 ans d’un cancer de l’enfant traite avant 2001, dont 1193 pour une tumeur cerebrale, et suivis 24 ans en moyenne, par l’acces aux dossiers medicaux et aux donnees du Systeme national d’information interregimes de l’assurance maladie (Sniiram), ainsi qu’au moyen de l’envoi d’autoquestionnaires. Les radiotherapies recues par 4176 sujets, dont 1016, pour une tumeur cerebrale, ont ete reconstituees a l’aide de fantomes anthropomorphiques, et les doses de radiation recues au niveau des arteres cerebrales et d’autres structures d’interet ont ete estimees. Resultats Un total de 145 sujets a ete atteint d’un accident vasculaire cerebral, dont 72 apres une tumeur cerebrale et 134 apres la radiotherapie. Le type d’accident vasculaire cerebral n’a pas pu etre defini pour 24 patients, il etait ischemique pour 77 et hemorragique pour 44. Il n’a pas ete possible d’identifier de drogue ou de categorie de drogue augmentant le risque d’accident vasculaire cerebral. Dans une analyse multifactorielle, celui-ci etait plus important chez les sujets atteints d’une neurofibromatose de type I (NF1), et augmentait avec la dose de radiation recue au niveau des arteres cerebrales, le coefficient de risque etant plus eleve pour les accidents vasculaires cerebraux ischemiques, ainsi qu’avec la radiotherapie thoracique ou abdominale. Il n’a pas ete possible de mettre en evidence de role de la chirurgie des tumeurs cerebrales, que ce soit propre ou par interaction avec la radiotherapie, mais seuls 206 sujets traites pour une tumeur cerebrale n’avaient pas eu de chirurgie. Les sujets qui avaient recu de la radiotherapie, mais 30 Gy ou plus sur seulement moins de 5 % de la longueur des arteres cerebrales principales avaient un risque d’accident vasculaire cerebral augmente d’un facteur 2,8 (1,3–5,5). En revanche, il n’y avait pas d’evidence claire pour un role des doses faibles de rayonnements ionisants de un ou quelques Gy. Conclusion Cette etude n’a pas permis de mettre en evidence de role de la chimiotherapie ou de la chirurgie dans le risque de tumeur cerebrale, mais a permis de preciser et de quantifier le role de la radiotherapie cerebrale.

Introduction La question du recours au soin est a la fois centrale et complexe dans la comprehension de la formation des inegalites sociales et territoriales de sante (ISTS). Les comportements de recours au soin sont difficiles a apprehender en raison du differentiel d’etat de sante entre individus, qui entraine un besoin differencie en termes de services medicaux et donc de recours au soin : les inegalites de recours au soin peuvent de fait etre analysees uniquement par des variables mesurant le renoncement au soin ou dans un contexte de sante particulier ou les individus ont les memes risques et les memes besoins de sante. Nous proposons d’explorer cette seconde voie de recherche dans le contexte du recours au soin apres un cancer pediatrique. En France, on estime que la prevalence des adultes traites pour un cancer dans l’enfance ou l’adolescence est de l’ordre de 50 000 personnes. La prevalence est en constante augmentation en raison des progres tres importants realises en termes de survie, qui sont alles de pair avec l’utilisation de traitements multimodaux particulierement toxiques et entrainant des effets a long terme. Chez les adultes traites pour un cancer de l’enfant, le risque de deces par cancer ou pathologie cardiovasculaire est ainsi multiplie par 8 en comparaison de la population de meme âge et de meme sexe. Ces complications, qui n’apparaissent que 20 ou 30 ans apres le diagnostic, peuvent etre prevenues ou detectees precocement grâce a une surveillance medicale adaptee. Des consultations de « suivi a long terme », dispositifs innovants de prevention et de suivi des anciens malades devenus adultes, ont ete mises en place en 2012 dans cinq regions pilotes. Cependant, le premier bilan des consultations de suivi montre un taux de participation relativement faible. Un chainage possible entre les donnees de ces consultations et une cohorte nationale de sujets traites pour un cancer pediatrique rend possible une analyse des determinants associes au non-recours a ces consultations, au travers de donnees cliniques, residentielles et declaratives. L’objectif de cette presentation est ainsi d’analyser le poids relatif des determinants medicaux et sociaux, mesures a l’echelle individuelle ou ecologique, dans l’adhesion au programme de prevention tertiaire actuellement developpe en onco-pediatrie. Methodes Le recours a la consultation de suivi des deux centres franciliens a ete analyse en fonction de differentes variables disponibles a l’echelle de l’individu (donnees cliniques sur les traitements recus dans l’enfance, âge, sexe, type de 1er cancer, niveau d’etudes) et du territoire (caracteristique du lieu de residence determine par un index de desavantage social calcule a l’echelle de l’IRIS, le FDEP). Resultats Au total, 31 % des patients invites a venir aux consultations de suivi franciliennes se sont rendus a la consultation. Les analyses montrent que, malgre l’administration de traitements hautement toxiques dans l’enfance et un risque equivalent de developper des effets iatrogenes severes, on observe des inegalites de genre et des inegalites socioeconomiques dans le recours au soin et a la prevention, que ces dernieres se rapportent aux caracteristiques du territoire ou au statut socioeconomique individuel.

In France, chronic diseases affect 3 million children. In children with chronic conditions, long-term somatic outcome has been well described, but little is known about the psychosocial aspects of well-being.Our aim was to build a self-administered questionnaire of global well-being in adults who had a chronic disease since or during childhood using a multidimensional and nonspecific approach. The questionnaire was constructed by a multidisciplinary group (epidemiologists, clinicians, sociologist, statistician). Items were built in compliance with reference data from the French general population (national surveys, free access) to allow comparative analysis adjusted for age and sex (and eventually other confounding factors) by indirect standardization (qualitative variables) or Z-scores (quantitative variables).The GEDEPAC-2 includes 108 items exploring 11 domains: education, employment, housing, material security, social links, civic engagement, leisure, environment, physical health/risky behavior, health-related quality of life and sex life. Factual questions and satisfaction scales jointly explore social well-being. Quality of life is analyzed in terms of physical quality of life, mental quality of life, fatigue and burden of treatment by 3 questionnaires validated in French (SF-12; MFI-20; Burden of Treatment Questionnaire). Experience of transition from pediatric to adult healthcare is described in 21 items. Paper and electronic versions were developed.Built in a multidimensional approach to well-being and in line with the available reference data, GEDEPAC-2 will facilitate the implementation of future studies on impact in adulthood of chronic disease in childhood.

Exposure to ionising radiations during childhood increases the risk of thyroid cancer. Similar risk factors have been found after external radiation exposure or internal contamination with radioactive iodine isotopes. In case of contamination with radioiodines, administration of potassium iodide can prevent thyroid irradiation.

BACKGROUND: Between 1966 and 1974, France conducted 41 atmospheric nuclear tests in Polynesia, but their potential health effects have not previously been investigated. METHODS: In a case-control study, we compared the radiation exposure of almost all the French Polynesians diagnosed with differentiated thyroid carcinoma between 1981 and 2003 (n = 229) to the exposure of 373 French Polynesian control individuals without cancer from the general population. Radiation exposures were estimated using measurements after the nuclear tests, age at time of each test, residential and dietary information. RESULTS: The average thyroid dose before 15 years of age was about 1.8 mGy, and 5% of the cases and 3% of the controls received a dose above 10 mGy. Despite this low level of dose, and after adjusting for ethnic group, level of education, body surface area, family history of thyroid cancer and number of pregnancies for women, we observed an increasing risk (P = 0.04) of thyroid cancer with increasing thyroid dose received before age of 15 years, which remained after excluding non-aggressive differentiated thyroid micro-carcinomas. This increase of risk per unit of thyroid radiation dose was higher (P = 0.03) in women who later experienced four or more pregnancies than among other women. CONCLUSION: The risk estimate is low, but is based on limited exposure data. The release of information on exposure, currently classified, would greatly improve the reliability of the risk estimation. British Journal of Cancer (2010) 103, 1115-1121. doi: 10.1038/sj.bjc.6605862 www.bjcancer.com Published online 31 August 2010 (c) 2010 Cancer Research UK

Ankle sprains are the most frequent injuries in sport and daily life, and are usually treated with anti-inflammatory drugs or compounds that have an effect on microcirculation. The efficacy and tolerability of a novel plaster containing both diclofenac epolamine (DHEP) and heparin in the treatment of acute painful ankle sprains with oedema was investigated in a randomized, double-blind, placebo-controlled study.This study, carried out in 32 French medical centres, enrolled 233 patients (148 male and 86 female, aged 18-65 years) with an ankle sprain that had occurred within the previous 48 hours. Patients were treated once daily with DHEP heparin or placebo plaster for 7 days.Reduction in ankle joint swelling measured by submalleolar circumference was the primary efficacy endpoint; secondary endpoints were pain (at rest, in active mobilization, by passive stretch and by pressure), functional disability and global judgement of efficacy and tolerability.DHEP heparin-treated patients experienced a significantly greater reduction in joint swelling compared with placebo (p = 0.005). The reduction in pain was also in favour of DHEP heparin patients, with significantly lower pain in DHEP heparin-treated than placebo-treated patients within 3 hours of the first application (p0.05). Only two patients in the DHEP heparin plaster group and six in the placebo group experienced minor adverse events, all of which resolved spontaneously. By design, the study was limited to a placebo-controlled comparison, and there was no test for possible selection bias (subsequently ruled out by choice of efficacy parameters and measures) that may have resulted in a baseline imbalance between patient groups.Results confirm the efficacy of DHEP heparin plaster compared with placebo for the treatment of painful ankle sprain with oedema. Prompt control of pain and oedema may shorten the time to initiation of a rehabilitation programme, thus reducing the risk of ankle disability recurrence and the development of chronic injury.

Poster-Abstract

This Workshop was organised by the Organisation of European Cancer Institutes (OECI) to provide a forum for discussing the late side-effects resulting from different cancer treatments. One of the main Workshop objectives was to generate recommendations on how to improve knowledge and, consequently, long-term care for cancer survivors.

Depuis maintenant plus de 20 ans, on assiste a une augmentation reuliere de la survie des patients apres le diagnostic d’un cancer. Malgre les efforts pour cibler leur action sur les cellules cancereuses, la chimiotherapie et la radiotherapie atteignent les tissus sains et ont des effets cancerogenes sur ces tissus. L’etude des cancers secondaires aux radiotherapies a fait l’objet d’un grand nombre d’etudes, avec ou sans estimation de la dose de radiation recue a leur siege, mais les resultats sont sou-vent contradictoires. Il n’existe tou-jours pas de modele capable de predire le risque de cancer secondaire associe a une radiotherapie donnee, ce qui implique qu’on ne peut anticiper les consequences des techniques nouvelles de radiotherapie telles que l’IMRT.

Si la publication 99 de la CIPR et le BEIR VII recommandent de maintenir l’usage d’une relation lineaire sans seuil (RLSS) pour estimer l’exces de risque relatif de cancer lie a de faibles doses de rayonnements ionisants (RI), le rapport conjoint de l’Academie des sciences et de l’Academie de medecine (2005) conclut qu’elle conduit a une forte surestimation des risques des faibles et des tres faibles doses. Les fondements de la RLSS sont remis en question par de nouvelles donnees biologiques et de l’experimentation animale qui montrent que la defense contre les RI met en jeu le micro-environnement cellulaire et le systeme immunitaire, et que les mecanismes de defense contre les faibles doses de RI sont differents et plus efficaces. Ces cellules lesees par une irradiation a faible dose sont eliminees ; la reparation s’impose a forte dose pour preserver les fonctions tissulaires. Les organismes pluricellulaires realisent ainsi une defense au moindre cout et au moindre risque contre les RI et les degâts du metabolisme oxydatif. Les differences entre les defenses contre les faibles et fortes doses sont particulierement nettes dans le cas de contamination par des emetteurs alpha qui montrent chez l’homme et l’animal des effets a seuil de plusieurs grays. Ces differences remettent en question les resultats des etudes epidemiologiques qui, pour des raisons de puissance statistique, estiment les risques en fusionnant des donnees obtenues pour des gammes de doses tres etendues, ce qui sous entend implicitement que les mecanismes de cancerogenese sont similaires quelle que soit la dose. L’estimation des risques des faibles doses de RI doit reposer sur des etudes specifiquement limitees aux faibles doses, avec une evaluation precise de facteurs de confusion potentiels. La synthese des etudes de cohorte pour lesquelles on dispose des coefficients de risque fondes sur les seules doses inferieures a 100 mSv chez l’adulte ne montre pas d’exces de risque relatif significatif, ni pour les tumeurs solides ni pour les leucemies.

AIM: The goal of this study was to estimate the cumulative activity of (131)I to be administered to patients with distant metastases from thyroid carcinoma. METHODS: A total of 444 patients were treated from 1953-1994 for distant metastases from papillary and follicular thyroid carcinoma: 223 had lung metastases only, 115 had bone metastases only, 82 had both lung and bone metastases, and 24 had metastases at other sites. Treatment consisted of the administration of 3.7 GBq (100 mCi) (131)I after withdrawal of thyroid hormone treatment, every 3-9 months during the first 2 yr and then once a year until the disappearance of any metastatic uptake. Thyroxine treatment was given at suppressive doses between (131)I treatment courses. RESULTS: Negative imaging studies (negative total body (131)I scans and conventional radiographs) were attained in 43% of the 295 patients with (131)I uptake; more frequently in those who were younger, had well-differentiated tumors, and had a limited extent of disease. Most negative studies (96%) were obtained after the administration of 3.7-22 GBq (100-600 mCi). Almost half of negative studies were obtained more than 5 yr after the initiation of the treatment of metastases. Among patients who achieved a negative study, only 7% experienced a subsequent tumor recurrence. Overall survival at 10 yr after initiation of (131)I treatment was 92% in patients who achieved a negative study and 19% in those who did not. CONCLUSION: (131)I treatment is highly effective in younger patients with (131)I uptake and with small metastases. They should be treated until the disappearance of any uptake or until a cumulative activity of 22 GBq has been administered. In the other patients, other treatment modalities should be used when tumor progression has been documented.

International audience; We performed a geographical analysis of cancer mortality in the communes surrounding an industrial mining complex (Salsigne, France) where suspicious levels of pollution due to arsenic were measured. Compared with that observed in a control area, we showed a significant excess of mortality due to all cancer types (ratio of standard mortality ratios (ratio of SMRs)=1.1), lung cancer (ratio of SMRs=1.8), pharynx cancer (ratio of SMRs=2.1) in the whole population, and due to digestive system cancer (ratio of SMRs=1.3) among women. The results were similar after controlling for the occupation distribution in the populations. Excluding mining complex workers deaths from the deaths in the studied populations did not modify the pattern of our results. We concluded that the excess of cancer deaths could not be exclusively due to potential professional exposures among the workers of the mining complex and are probably explained by environmental contamination.

The purpose of this paper was to determine the cardiac status in children 15 years or more after adriamycin therapy for a solid tumour. Of the 447 pts, 229 pts were fully studied and 218 were not. The following cardiac evaluations were proposed to all the 447 consecutive patients (pts): (1) cardiac Doppler US by one of two expert cardiologists; (2) cardiac rhythm and conduction abnormalities including 24-hour holter ECG; (3) (131)l-mlBG myocardial scintigraphy; (4) serum brain natriuretic peptide levels at rest; (5) an exercise test with VO(2) max measurement. The radiation doses delivered to 6 points in the heart were estimated for all patients who had received radiotherapy. Congestive heart failure was diagnosed in 24 of 229 (10%) evaluated pts, with a median interval of 15 years (0.3-24 years) from the first symptom after adriamycin treatment. Among the 205 remaining pts, 13 asymptomatic pts (6%) had severe (n=4) (FS

OBJECTIVE: To analyse trends in diagnostic practices of thyroid diseases and to relate them to the increase in thyroid cancer incidence in France over time. DESIGN: From 1980 to 2000, a French retrospective multicentric (three endocrinology and three nuclear medicine centres) study of thyroid diseases was conducted on 20 consecutive unselected patients' records, sampled every 5 years in each centre. METHODS: Characteristics of the population and diagnosis procedures (thyroid ultrasonography (US), radionuclide scan, cytology and hormonal measurements) were described over time. Changing trends in operated patients and in cancer prevalence were analysed as well as the impact of practices on cancer incidence. RESULTS: The study included 471 patients (82% female, mean age 46.7, range 9-84 years), referred for nodular thyroid diseases (66.7%) or thyroid dysfunctions (33.3%). A significant increase in US (3 to 84.8%) and cytological practices (4.5 to 23%), and a decrease (89.4 to 49.6%) in radionuclide scan procedures were observed over time. Although the proportion of patients undergoing surgery remained constant (24.8%), the prevalence of cancer increased among operated patients from 12.5 to 37% (P=0.006). In a Cox's proportional hazard model stratified on the clinical characteristics of patients, only the cytological practice, regardless of its results, was significantly associated with the occurrence of cancer: relative risk (RR)=4.4 (95% confidence interval (CI): 1.1-16; P=0.04). CONCLUSIONS: From 1980 to 2000, a major evolution in clinical practices has led to the increase in thyroid cancer reported in France. Such changes in medical, as well as in surgical and pathological, practices must be taken into account in incidence measurement.

The late health effects associated with radioiodine ((131)I) given as treatment for thyroid cancer are difficult to assess since the number of thyroid cancer patients treated at each centre is limited. The risk of second primary malignancies (SPMs) was evaluated in a European cohort of thyroid cancer patients. A common database was obtained by pooling the 2-year survivors of the three major Swedish, Italian, and French cohorts of papillary and follicular thyroid cancer patients. A time-dependent analysis using external comparison was performed. The study concerned 6841 thyroid cancer patients, diagnosed during the period 1934-1995, at a mean age of 44 years. In all, 17% were treated with external radiotherapy and 62% received (131)I. In total, 576 patients were diagnosed with a SPM. Compared to the general population of each of the three countries, an overall significantly increased risk of SPM of 27% (95% CI: 15-40) was seen in the European cohort. An increased risk of both solid tumours and leukaemias was found with increasing cumulative activity of (131)I administered, with an excess absolute risk of 14.4 solid cancers and of 0.8 leukaemias per GBq of (131)I and 10(5) person-years of follow-up. A relationship was found between (131)I administration and occurrence of bone and soft tissue, colorectal, and salivary gland cancers. These results strongly highlight the necessity to delineate the indications of (131)I treatment in thyroid cancer patients in order to restrict its use to patients in whom clinical benefits are expected.

In total, 281 of the 7711 women who were initially treated for breast cancer between 1954 and 1983 at the Gustave Roussy Institute developed a second malignant neoplasm (SMN) other than second primary breast cancer and nonmelanoma skin cancer at least 1 year after breast cancer treatment. We carried out a nested case-control study to determine the overall relationship between the dose of radiotherapy received at a given anatomical site and the risk of SMN at the same site. In total, 75% of the cases of SMN were previously treated by radiotherapy, as compared to 73% of the controls. In the irradiated patients, the median local dose was higher among cases (3.1 Gy) than among controls (1.3 Gy). More than 40% of the irradiated patients received a local dose of less than 1 Gy. A purely quadratic relationship was observed between the dose of radiation received at an anatomical site and the risk of SMN at this site. According to the quadratic model, the excess risk of SMN was 0.2% (95% CI 0.05-0.5%) when the target organ received 1 Gy. This risk did not differ significantly according to age at the time of radiotherapy (40 vsor=40 years). The risk of SMN was 6.7-fold higher for doses of 25 Gy or more than in the absence of radiotherapy. No carcinogenic effect of chemotherapy was observed and a dose-effect relationship between the length of tamoxifen treatment and SMN occurrence was found. This relationship was limited to endometrial cancers and did not modify the relationship with radiation dose. Our results suggest that high radiation doses slightly increase the risk of second malignancies after breast cancer.

Resume Les cancers de la thyroide de l'enfant sont rares. Le seul facteur etiologique connu est l'irradiation externe ou metabolique, confirmee lors de l'accident de Tchernobyl. Le diagnostic doit etre evoque en presence d'un nodule thyroidien isole ou associe a une adenopathie. La cytoponction pre-operatoire est indispensable pour planifier une chirurgie complete en un temps associant une thyroidectomie totale a des curages cervicaux adaptes a l'extension de la maladie. Une iratherapie postoperatoire est frequemment indiquee. Le pronostic est bon. La surveillance est basee sur le dosage de la thyroglobuline et doit etre poursuivie toute la vie en raison de la possibilite de rechutes tres tardives.

Le traitement du carcinome differencie de la thyroide est chirurgical. Il est souvent complete par l’administration d’iode radioactif. A ce jour, les consequences de ce traitement sur la fonction testiculaire sont mal connues. Patients et methodes Notre etude prospective multicentrique PHRC N°P040419 a evalue (1) les dosages de FSH, LH, testosterone, inhibine B, (2) le spermogramme, (3) la fragmentation de l’ADN spermatique, (4) le taux d’aneuploidie analyse par FISH. Ces analyses ont ete realisees de base (V0), 3 mois (V3) et 13 mois (V13) apres une dose unique de 3,7 GBq d’I131. Resultats Quarante patients ont ete inclus. Leurs taux de LH et testosterone sont restes identiques. Au contraire, les taux de FSH ont augmente entre V0 et V3 (4 UI/L ± 3 (N : 3–7 UI/L) versus 9 UI/L ± 4,8 (p Discussion et conclusion Cette etude prospective montre une alteration de la FSH, de l’inhibine B et de la concentration spermatique, ainsi qu’un taux eleve d’anomalies chromosomiques. Ces resultats suggerent la necessite d’informer les hommes devant recevoir une dose de 3,7GBq 131I et d’evoquer avec eux une preservation de la fertilite.

We present the data of the Cancer Registry of French Polynesia (FP) for the 1990–1995 period, highlighting the difference between the incidences among inhabitants born in FP and in immigrants. A total of 1606 incident cases of cancer were registered during the 6-year period from 1990 to 1995, about 90% of which were histologically confirmed. Among these incident cases, 1361 occurred in native French Polynesians (FPs) and 245 in immigrants. Overall cancer incidence was found to be very slightly higher among women in the native population (209/105) than among immigrants (191/105), and lower among men in the native population (186/105) than in the immigrants (241/105). Cervix, corpus uteri, and thyroid cancer incidence rates were higher among women born in FP than among immigrant women. In contrast, colorectal cancer and melanoma incidences rates were lower, and colorectal cancer was similar. Laryngeal cancer incidence was higher among men born in FP than among immigrant men. In contrast, cancers of the oral cavity, colon and rectum, prostate gland, bladder and melanoma were less frequent. This first report, based on the data from the Cancer Registry of French Polynesia, shows high cancer incidence rates in females and low incidence in males born in FP, as compared to those recorded in France; and low cancer incidence rates, as compared to New Zealand Maoris and Hawaiians. For certain cancers, for example colorectal cancer, the incidence in the immigrant population seems to be between that of the native FP population and that of the population living in France, and lower than in New Zealand Maoris and Hawaiians.

To determine the incidence of haematological malignancies in French Polynesia from 1990 to 1995, we collected cases from the local cancer registry, sanitary evacuation files and all the histopathology and clinical biology laboratories. All leukaemias, non Hodgkin's lymphomas, and multiple myelomas incidence was slightly lower among French Polynesians than among Maoris from New-Zealand and Hawaiians of Hawaii. Standardised Incidence Ratio (SIR) for Hodgkin's disease among females was 0.08 when comparing to Hawaiians and 0.33 when comparing to Maoris. Other salient features were a high proportion of high grade and Burkitt's lymphoma, the absence of Hodgkin's disease after 40 years of age, a low incidence of chronic lymphoid leukaemia, and a high non lymphoblastic/lymphoblastic acute leukaemia ratio in childhood. This study stresses the peculiar incidence of some haematological malignancies in this south pacific area.

The variation in the risk of solid second malignant neoplasms (SMN) with time since first cancer during childhood has been previously reported. However, no study has been performed that controls for the distribution of radiation dose and the aggressiveness of past chemotherapy, which could be responsible for the observed temporal variation of the risk. The purpose of this study was to investigate the influence of the treatment on the long-term pattern of the incidence of solid SMN after a first cancer in childhood. We studied a cohort of 4400 patients from eight centres in France and the UK. Patients had to be alive 3 years or more after a first cancer treated before the age of 17 years and before the end of 1985. For each patient in the cohort, the complete clinical, chemotherapy and radiotherapy history was recorded. For each patient who had received external radiotherapy, the dose of radiation received by 151 sites of the body were estimated. After a mean follow-up of 15 years, 113 children developed a solid SMN, compared to 12.3 expected from general population rates. A similar distribution pattern was observed among the 1045 patients treated with radiotherapy alone and the 2064 patients treated with radiotherapy plus chemotherapy; the relative risk, but not the excess absolute risk, of solid SMN decreased with time after first treatment; the excess absolute risk increased during a period of at least 30 years after the first cancer. This pattern remained after controlling for chemotherapy and for the average dose of radiation to the major sites of SMN. It also remained when excluding patients with a first cancer type or an associated syndrome known to predispose to SMN. When compared with radiotherapy alone, the addition of chemotherapy increases the risk of solid SMN after a first cancer in childhood, but does not significantly modify the variation of this risk during the time after the first cancer. © 1999 Cancer Research Campaign

Objective To determine the efficacy and safety of using natural platelet-activating factor receptor antagonist (PAFra), BN 52021, to treat patients with severe Gram-negative bacterial sepsis. Design A prospective, randomized, double-blind, placebo-controlled, multicenter clinical trial. Setting Fifty-nine academic medical center intensive care units in Europe. Patients Six hundred nine patients with severe sepsis, suspected to be related to Gram-negative bacterial infection, who received PAFra or placebo. Interventions Patients were randomized to receive either a dose of PAFra (120 mg iv) every 12 hrs over a 4-day period or placebo over a 4-day period. Measurements and Main Results The patients were well matched at study entry for severity of illness and for risk factors known to influence the outcome of sepsis. Among all randomized patients, the 28-day, all-cause mortality rate was 49% (152/308) in the placebo group, and 47% (140/300) in the PAFra group (p = .50). When analyzed on the basis of the previously defined target population, the 28-day, all-cause mortality rate was 50% (115/232) in the placebo group and 44% (94/212) in the PAFra group, yielding a 12% reduction in mortality rate (p = .29). In patients with documented infection involving other organisms, there was no difference between treated and placebo groups. When the outcomes of organ dysfunctions were examined in the overall population and in the documented Gram-negative bacterial infection population, the number of patients who resolved hepatic dysfunction tended to be higher in the treated group than in the placebo group (p = .06). The number of adverse events reported were not different between the two groups. Conclusions A 4-day administration of the studied PAFra (BN 52021) failed to demonstrate a statistically significant reduction in the mortality rate of patients with severe sepsis suspected to be related to Gram-negative bacterial infection. If PAFra treatment has any therapeutic activity in severe Gram-negative bacterial sepsis, the incremental benefits are small and will be difficult to demonstrate in a patient population as defined by this clinical trial. (Crit Care Med 1998; 26:1963-1971)

The Japanese atomic bomb survivor cancer incidence dataset and data on five groups exposed to radiation for medical reasons in childhood are analysed and evidence found for a reduction in the radiation-induced relative risk of cancers other than leukaemia with increasing time since exposure and age at exposure. The rate of the reductions in relative risk with time since exposure are not significantly different for those exposed in childhood and for those exposed in adulthood, if adjustment is made for the effects on the relative risk of age at exposure. For those irradiated in childhood, there is a statistically significant annual reduction of 5.8% (95% CI 2.8, 8.9) in excess relative risk, and there are no strong indications of inter-cohort heterogeneity in the speed of reduction of relative risk. After adjustment for the effects of age at exposure, there is a significant annual reduction of 3.6% (95% CI 1.6, 5.6) in excess relative risk in all age-at-exposure groups. There are significant reductions of 5.2% (95% CI 3.7, 6.8) in excess relative risk per year of age at exposure. There are statistically significant ( P = 0.04) interactions between the exponential adjustments to the excess relative risk for age at exposure and time since exposure in the Japanese data, but no indications ( P = 0.38) of such interactions when powers of time since exposure and attained age are used to adjust the excess relative risk, so that the fit of the model with power adjustments is to be preferred to that of the model with exponential adjustments. There is no significant heterogeneity by cancer type within the Japanese atomic bomb survivor data in the variation of relative risk with time and age. There are indications that the model which assumes a variation in risk dependent only on attained age fits all the datasets analysed together significantly worse ( P = 0.11) than one which allows for different rates of change of risk as a function of time since exposure and age at exposure. The lack of fit of the attained-age model is much more striking in the Japanese bomb survivor incidence data ( P = 0.02), which has much the greatest power of any of the datasets analysed to differentiate time and age trends in excess risk. A variety of relative risk models are used to evaluate solid cancer mortality and incidence risks for a current UK population. High dose-rate solid cancer mortality risks are estimated to lie in the range 6.9% - 13.8% Sv-1. High dose-rate solid cancer incidence risks are calculated to lie in the range 12.1% - 22.0% Sv-1. The preferred generalised relative risk model, with adjustments to the excess relative risk proportional to a product of powers of time since exposure and attained age, predicts solid cancer mortality risks of 9.0% Sv-1 and solid cancer incidence risks of 15.0% Sv-1.

We studied 1771 patients treated for a thyroid cancer in two institutions. None of these patients had been treated with external radiotherapy and 1497 had received (131)I. The average (131)I cumulative activity administered was 7.2 GBq, and the estimated average dose was 0.34 Sv to the bone marrow and 0.80 Sv to the whole body. After a mean follow-up of 10 years, no case of leukaemia was observed, compared with 2.5 expected according to the coefficients derived from Japanese atomic bomb survivors (P = 0.1). A total of 80 patients developed a solid second malignant neoplasm (SMN), among whom 13 developed a colorectal cancer. The risk of colorectal cancer was found to be related to the total activity of (131)I administered 5 years or more before its diagnosis (excess relative risk = 0.5 per GBq, P = 0.02). These findings were probably caused by the accumulation of (131)I in the colon lumen. Hence, in the absence of laxative treatment, the dose to the colon as a result of (131)I administered for the treatment of thyroid cancer could be higher than expected from calculation of the International Commission on Radiological Protection (ICRP). When digestive tract cancers were excluded, the overall excess relative risk of second cancer per estimated effective sievert received to the whole body was -0.2 (P = 0.6). Images Figure 1

Introduction Une sante degradee pendant l’enfance ou l’adolescence, parce qu’elle peut avoir un impact sur la reussite scolaire ou les strategies educatives, peut reduire les chances de mobilite sociale et peut, par consequent, contribuer a la formation des inegalites sociales de sante. Cependant, les etudes tendent a confondre les pathologies, rendant difficile l’exploration des mecanismes a l’œuvre. Nous proposons d’etudier ici le cas des cancers de l’enfant et de l’adolescent au travers d’une recherche a methodes mixtes. Methodologie Le volet quantitatif repose sur les resultats d’une cohorte retrospective de 2406 adultes traites avant l’âge de 18 ans pour une tumeur solide, entre 1948 et 1985, dans cinq centres francais. La position sociale de ces anciens malades a ete comparee a celle attendue dans une cohorte de meme âge et de meme sexe, en s’appuyant sur des statistiques de la population generale francaise. Parallelement, des entretiens approfondis ont ete menes aupres de 80 membres de la cohorte, selectionnes de maniere aleatoire. Resultats L’analyse des donnees de la cohorte montre que les survivants d’un cancer pediatrique ont une position sociale plus elevee que celle attendue, a l’exception des personnes traitees pour des tumeurs cerebrales. L’analyse de leur mobilite sociale intergenerationnelle, prenant en compte leur origine sociale, montre egalement une mobilite ascendante superieure a celle attendue. L’etude qualitative met en relief des mecanismes d’ascension sociale passant par des choix scolaires et professionnels qui se declinent differemment selon le genre. En particulier, les hommes disent avoir renonce a des carrieres trop physiques, souvent situees au bas de l’echelle sociale, en raison d’un handicap physique en lien avec la maladie, ou dans le but de preserver leur sante. Discussion Les resultats mettent en relief des mecanismes negatifs de selection par la sante.