Bulletin électronique de veille Cancer Environnement

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Bulletin électronique de veille Cancer Environnement
N° 5 du 09 / 01/ 2014
Ce bulletin de veille signale mensuellement une sélection de documents identifiés dans le cadre de la
veille cancer environnement. La méthodologie mise en œuvre est présentée dans la fiche du site cancer
environnement : http://www.cancer-environnement.fr/334-Veille-scientifique.ce.aspx
Publications récentes
Cancer survival in Europe 1999—2007 by country and age: results of EUROCARE-5—a
population-based study
Taux de survie au cancer en Europe 1999-2007 par pays et par âge: les résultats de Eurocare-5 une étude
en population générale
De Angelis R, Lancet Oncol., 2014
Cancer survival is a key measure of the effectiveness of health-care systems. EUROCARE—the largest
cooperative study of population-based cancer survival in Europe—has shown persistent differences between
countries for cancer survival, although in general, cancer survival is improving. Major changes in cancer
diagnosis, treatment, and rehabilitation occurred in the early 2000s. EUROCARE-5 assesses their effect on
cancer survival in 29 European countries.
Methods: In this retrospective observational study, we analyzed data from 107 cancer registries for more than 10
million patients with cancer diagnosed up to 2007 and followed up to 2008. Uniform quality control procedures
were applied to all datasets. For patients diagnosed 2000—07, we calculated 5-year relative survival for 46
cancers weighted by age and country. We also calculated country-specific and age-specific survival for ten
common cancers, together with survival differences between time periods (for 1999-2001, 2002-04, and 2005-
07).
Findings: 5-year relative survival generally increased steadily over time for all European regions. The largest
increases from 1999-2001 to 2005-07 were for prostate cancer (73.4% [95% CI 72.9-73.9] vs 81.7% [81.3-
82.1]), non-Hodgkin lymphoma (53.8% [53.3-54.4] vs 60.4% [60.0-60.9]), and rectal cancer (52.1% [51.6-52.6]
vs 57.6% [57.1-58.1]). Survival in eastern Europe was generally low and below the European mean, particularly
for cancers with good or intermediate prognosis. Survival was highest for northern, central, and southern Europe.
Survival in the UK and Ireland was intermediate for rectal cancer, breast cancer, prostate cancer, skin melanoma,
and non-Hodgkin lymphoma, but low for kidney, stomach, ovarian, colon, and lung cancers. Survival for lung
cancer in the UK and Ireland was much lower than for other regions for all periods, although results for lung
cancer in some regions (central and eastern Europe) might be affected by overestimation. Survival usually
decreased with age, although to different degrees depending on region and cancer type.

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Interpretation: The major advances in cancer management that occurred up to 2007 seem to have resulted in
improved survival in Europe. Likely explanations of differences in survival between countries include:
differences in stage at diagnosis and accessibility to good care, different diagnostic intensity and screening
approaches, and differences in cancer biology. Variations in socioeconomic, lifestyle, and general health
between populations might also have a role. Further studies are needed to fully interpret these findings and how
to remedy disparities.
Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22
European cohorts within the multicentre ESCAPE project
Effets de l'exposition à long terme à la pollution atmosphérique sur les décès par cause naturelle: une
analyse de 22 cohortes Européennes au sein du projet multicentrique ESCAPE
Beelen R, The Lancet, 2014
Background : Few studies on long-term exposure to air pollution and mortality have been reported from Europe.
Within the multicentre European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to investigate
the association between natural-cause mortality and long-term exposure to several air pollutants. Methods : We
used data from 22 European cohort studies, which created à total study population of 367 251 participants. All
cohorts were general population samples, although some were restricted to one sex only. With a strictly
standardised protocol, we assessed residential exposure to air pollutants as annual average concentrations of
particulate matter (PM) with diameters of less than 2.5 μm (PM2.5), less than 10 μm (PM10), and between 10
μm and 2.5 μm (PMcoarse), PM2.5 absorbance, and annual average concentrations of nitrogen oxides (NO2 and
NOx), with land use regression models. We also investigated two traffic intensity variables —traffic intensity on
the nearest road (vehicles per day) and total traffic load on all major roads within a 100 m buffer. We did cohort-
specific statistical analyses using confounder models with increasing adjustment for confounder variables, and
Cox proportional hazards models with a common protocol. We obtained pooled effect estimates through a
random-effects meta-analysis. Findings: The total study population consisted of 367 251 participants who
contributed 5 118 039 person-years at risk (average follow-up 13.9 years), of whom 29 076 died from a natural
cause during follow-up. A significantly increased hazard ratio (HR) for PM2.5 of 1.07 (95% CI 1.02–1.13) per 5
μg/m3 was recorded. No heterogeneity was noted between individual cohort effect estimates (I2 p value=0 ·95).
HRs for PM2.5 remained significantly raised even when we included only participants exposed to pollutant
concentrations lower than the European annual mean limit value of 25 μg/m3 (HR 1.06, 95% CI 1.00–1.12) or
below 20 μg/m3 (1.07, 1.01–1.13). Interpretation : Long-term exposure to fine particulate air pollution was
associated with natural-cause mortality, even within concentration ranges well below the present European
annual mean limit value. Funding : European Community's Seventh Framework Program (FP7/2007–2011).
Alcohol drinking and second primary cancer risk in patients with upper aerodigestive tract
cancers: A systematic review and meta-analysis of observational studies.
Consommation d'alcool et deuxième risque de cancer primaire chez des patients atteints de cancers des
voies aérodigestives supérieures: une revue systématique et une méta-analyse d'études observationnelles.
Druesne-Pecollo N, Cancer Epidemiol Biomarkers Prev., 2013
Background: We conducted a systematic review and meta-analysis of existing data from observational studies to
assess the strength of the association of alcohol drinking with second primary cancer risk in patients with upper
aerodigestive tract (UADT: oral cavity, pharynx, larynx and oesophagus) cancer. Methods: PubMed and Embase
were searched up to July 2012 and the reference lists of studies included in the analysis were examined. Random
effects models were used to estimate summary relative risks (RRs) and 95% confidence interval (CIs). Results:
Nineteen studies, eight cohort and eleven case-control studies, were included. In highest versus lowest meta-
analyses, alcohol drinking was associated to significantly increased risk of UADT second primary cancers (RR =
2.97, 95% CI: 1.96-4.50). Significantly increased risks were also observed for UADT and lung combined (RR =
1.90, 95% CI: 1.16-3.11) and all sites (RR = 1.60, 95% CI: 1.22-2.10) second primary cancers. For an increase in
alcohol intake of 10 g/day, dose-response meta-analyses resulted in significantly increased RR of 1.09 (95% CI:

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1.04-1.14) for UADT second primary cancers. Conclusions: Alcohol drinking in patients with UADT cancer is
associated with an increased risk of second primary cancers. Studies conducted in alcohol drinking UADT
cancer patients and evaluating the effect of alcohol cessation on second primary cancer and other outcomes are
needed. Impact: Our results emphasize the importance of prevention policies aiming to reduce alcohol drinking.
Health care professionals should encourage alcohol drinking UADT cancer patients to reduce their consumption
and reinforce the surveillance of this at-risk subpopulation
Silica: A lung carcinogen.
Silice : un carcinogène pulmonaire
Steenland K, CA Cancer J Clin., 2013
Silica has been known to cause silicosis for centuries, and evidence that silica causes lung cancer has
accumulated over the last several decades. This article highlights 3 important developments in understanding the
health effects of silica and preventing illness and death from silica exposure at work. First, recent epidemiologic
studies have provided new information about silica and lung cancer. This includes detailed exposure-response
data, thereby enabling the quantitative risk assessment needed for regulation. New studies have also shown that
excess lung mortality occurs in silica-exposed workers who do not have silicosis and who do not smoke. Second,
the US Occupational Safety and Health Administration has recently proposed a new rule lowering the
permissible occupational limit for silica. There are approximately 2 million US workers currently exposed to
silica. Risk assessments estimate that lowering occupational exposure limits from the current to the proposed
standard will reduce silicosis and lung cancer mortality to approximately one-half of the rates predicted under
the current standard. Third, low-dose computed tomography scanning has now been proven to be an effective
screening method for lung cancer. For clinicians, asking about occupational history to determine if silica
exposure has occurred is recommended. If such exposure has occurred, extra attention might be given to the
early detection of silicosis and lung cancer, as well as extra emphasis on quitting smoking.

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Actualités et lettres d’information des acteurs Santé Environnement
Région Rhône-Alpes
National
Agence Régionale de Santé Rhône-Alpes
Agence nationale de sécurité sanitaire, de
l’alimentation, de l’environnement et du
travail
Air Rhône-Alpes
Bulletin de veille bibliographique Nota Bene
Cancer de l’Institut National du Cancer
(INCa)
Lettre d’information de l’INCa
Espace Régional de Santé Publique Rhône-
Alpes
Institut national de recherche en sciences et
technologies pour l’environnement et
l’agriculture
Fédération Rhône-Alpes de Protection de la
Nature
Lettre d’information de l’Institut National de
Recherche et de Sécurité pour la prévention
des accidents du travail et des maladies
professionnelles
Institut de Recherche en Santé Publique
Lettre d’information “Ademe et vous”
Lettre Santé-Environnement Rhône-Alpes de
l’ORS Rhône-Alpes
La lettre de la Société Française de Santé
Environnement
Société Française de Santé Publique Bulletin
Flash e-mail SFSP
Société Française de Médecine du Travail
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« La relecture et sélection des publications de ce bulletin électronique est réalisée par des membres du comité éditorial du
portail cancer-environnement.fr avec la participation des professionnels de santé du Centre Léon Bérard et ses partenaires,
sur la base de leur pertinence dans le champ ‘cancer, environnement et nutrition’. Dans la mesure où le contenu des sources et
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