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 200507). 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% [81.382.1]), 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. 1 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 cohortspecific 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 metaanalyses, 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: 2 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. 3 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 RhôneAlpes 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 Nos partenaires Avec soutien de : Pour tout abonnement/désabonnement à cet e-bulletin ou pour nous faire part d'informations à diffuser dans les prochains numéros, n’hésitez pas à nous écrire à l'adresse suivante : [email protected] Afin de respecter la législation sur la propriété intellectuelle, le bulletin de veille électronique renvoie l’internaute à la source d’origine de chacune des ressources répertoriées. 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