Bulletin électronique de veille Cancer Environnement

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Bulletin électronique de veille Cancer Environnement
N° 8 du 11/ 04/ 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 incidence and mortality in France over the 1980–2012 period: Solid tumors
Incidence et mortalité des cancers en France durant la période 1980–2012 : tumeurs solides
Binder-Foucard F et al., Revue d'Épidémiologie et de Santé Publique, Mars 2014
Position du problème : Cette étude présente les estimations d’incidence et de mortalité par cancer en France entre
1980 et 2012.
Méthodes : Parmi les tumeurs solides, 19 localisations cancéreuses ont été analysées. Les données d’incidence
proviennent de 21 registres départementaux et correspondent aux cancers invasifs diagnostiqués entre 1975 et
2009. Les données de mortalité par cancer sur cette période ont été fournies par l’Institut national de la santé et
de la recherche médicale. L’estimation nationale de l’incidence est basée sur l’utilisation de la mortalité comme
corrélat de l’incidence. Les données d’incidence et de mortalité ont été modélisées à l’aide d’un modèle âge-
période-cohorte. Les nombres de nouveaux cas de cancer et de décès entre 2010 et 2012 sont issus de projections
à court terme.
Résultats : En 2012, le nombre de nouveaux cas de cancer a été estimé à 355 000 et le nombre de décès par
cancer à 148 000. L’évolution des taux d’incidence n’était pas linéaire sur l’ensemble de la période. Après une
augmentation continue depuis 1980, l’incidence du cancer chez l’homme a diminué entre 2005 et 2012. Cette
diminution récente est en grande partie liée à la baisse de l’incidence du cancer de la prostate. Chez la femme, on
observe une stabilisation essentiellement due à la modification de l’évolution de l’incidence du cancer du sein.
La mortalité est en diminution sur l’ensemble de la période pour la majorité des localisations. L’analyse
conjointe de l’incidence et de la mortalité par localisation permet de distinguer les cancers dont l’incidence et la
mortalité ont diminué (ex. : estomac) des cancers dont l’incidence et la mortalité ont augmenté (ex. : poumon
chez la femme). D’autres cancers combinent une augmentation de l’incidence et une diminution de la mortalité
(ex. : thyroïde).
Conclusion : Ce travail met en évidence des modifications récentes et marquées de l’évolution de l’incidence,
plus particulièrement pour les cancers du sein et de la prostate.

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The AGRIculture and CANcer (AGRICAN) cohort study: enrollment and causes of death for
the 2005–2009 period
L'étude de cohorte AGRIculture et CANcer (Agrican): Effectif et causes de décès pour la période 2005-
2009
Levêque-Morlais N et al., Int Arch Occup Environ Health., March, 2014
Objective: To elaborate and describe a large prospective agricultural cohort including males and females in
France with various agricultural activities and to study causes of death.
Methods: To date, few large prospective cohorts have been conducted among agricultural population.
AGRIculture and CANcer cohort is a large prospective cohort of subjects in agriculture studying cancer among
active and retired males and females, farm owners and workers, living in eleven areas of France with a
population-based cancer registry.
Results: Enrollment was conducted from 2005 to 2007 with a postal questionnaire. In January 2008, 180,060
individuals (54 % males, 54 % farm owners, 50 % retired) were enrolled. Mortality was studied until December
2009 (605,956 person-years with standardized mortality ratio (SMR) by comparison with the general population
of the areas. Over this period, 11,450 deaths 6,741 in men and 4,709 in women were observed, including 3,405
cancer-related deaths. SMRs were significantly reduced for global mortality (SMR = 0.68, 95 % CI 0.67–0.70 in
males and SMR = 0.71, 95 % CI 0.69–0.73 in females) and for death by cancer (SMR = 0.67, 95 % CI 0.65, 0.70
in males and SMR = 0.76, 95 % C: 0.71, 0.80 in females). These results were mainly explained by less frequent
smoking-related causes of death (lung cancer, cardiovascular diseases). Nonsignificant excesses of death were
observed only for rheumatoid arthritis and arthrosis, suicides (in females), death for event of undetermined intent
(in males) and breast cancer in male agricultural workers.
Conclusions: These first results are the first ones obtained in France based on a large prospective agricultural
cohort showing that farmers would be in healthier condition than the general population
Occupation and thyroid cancer
Activité professionnelle et cancer de la thyroïde
Aschebrook-Kilfoy B et al. Occup Environ Med., Mar 2014
Numerous occupational and environmental exposures have been shown to disrupt thyroid hormones, but much
less is known about their relationships with thyroid cancer. Here we review the epidemiology studies of
occupations and occupational exposures and thyroid cancer incidence to provide insight into preventable risk
factors for thyroid cancer.
The published literature was searched using the Web of Knowledge database for all articles through August 2013
that had in their text 'occupation' 'job' 'employment' or 'work' and 'thyroid cancer'. After excluding 10 mortality
studies and 4 studies with less than 5 exposed incident cases, we summarised the findings of 30 articles that
examined thyroid cancer incidence in relation to occupations or occupational exposure. The studies were
grouped by exposure/occupation category, study design and exposure assessment approach. Where available,
gender-stratified results are reported.
The most studied (19 of 30 studies) and the most consistent associations were observed for radiation-exposed
workers and healthcare occupations. Suggestive, but inconsistent, associations were observed in studies of
pesticide-exposed workers and agricultural occupations. Findings for other exposures and occupation groups
were largely null. The majority of studies had few exposed cases and assessed exposure based on occupation or
industry category, self-report, or generic (population-based) job exposure matrices. The suggestive, but
inconsistent findings for many of the occupational exposures reviewed here indicate that more studies with larger
numbers of cases and better exposure assessment are necessary, particularly for exposures known to disrupt
thyroid homeostasis.

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Alcohol and liver cancer: a systematic review and meta-analysis of prospective studies.
Alcool et cancer du foie : une revue systématique et une méta-analyse d'études prospectives.
Turati F et al. Ann Oncol. Mar 2014
Despite several studies support a positive association between heavy alcohol consumption and liver cancer risk,
a consistent dose-risk relationship has not yet been established. We carried out a systematic review and a meta-
analysis of the association between alcohol intake and liver cancer occurrence, following the Meta-analysis Of
Observational Studies in Epidemiology guidelines.
We searched for cohort and nested case-control studies on the general population published before April 2013,
using PubMed and EMBASE. Summary meta-analytic relative risks (RRs) were estimated using random-effect
models. We included 16 articles (19 cohorts) for a total of 4445 incident cases and 5550 deaths from liver
cancer. Compared with non-drinking, the pooled RRs were 0.91 (95% confidence interval, CI, 0.81-1.02) for
moderate drinking (<3 drinks per day) and 1.16 (95% CI, 1.01-1.34) for heavy drinking (≥3 drinks per day), with
significant heterogeneity among studies. The dose-risk curve suggested a linear relationship with increasing
alcohol intake in drinkers, with estimated excess risk of 46% for 50 g of ethanol per day and 66% for 100 g per
day.
This systematic review suggests a moderate detrimental role of consumption of 3 or more alcoholic drinks per
day on liver cancer, and a lack of association with moderate drinking. Our results have to be taken with due
caution on account of the possible limitations of the original studies included in the meta-analysis.
Adherence to Mediterranean diet and risk of cancer: A systematic review and meta-analysis of
observational studies.
Pratique du régime méditerranéen et risque de cancer: Une revue systématique et méta-analyse d'études
observationnelles.
Schwingshackl L et al, Int J Cancer. Mar 2014
The aim of this research study was to meta-analyze the effects of adherence to Mediterranean diet (MD) on
overall cancer risk, and different cancer types.
Literature search was performed using the electronic databases MEDLINE, SCOPUS and EMBASE until
January 10, 2014. Inclusion criteria were cohort or case-control studies. Study specific risk ratios (RRs) were
pooled using a random effect model by the Cochrane software package Review Manager 5.2. Twenty-one cohort
studies including 1,368,736 subjects and 12 case-control studies with 62,725 subjects met the objectives and
were enclosed for meta-analyses.
The highest adherence to MD category resulted in a significantly risk reduction for overall
cancermortality/incidence (cohort; RR: 0.90, 95% CI 0.86-0.95, p < 0.0001; I2 = 55%), colorectal (cohort/case-
control; RR: 0.86, 95% CI 0.80-0.93, p < 0.0001; I2 = 62%], prostate (cohort/case-control; RR: 0.96, 95% CI
0.92-0.99, p = 0.03; I2 = 0%) and aerodigestive cancer (cohort/case-control; RR: 0.44, 95% CI 0.26-0.77,
p = 0.003; I2 = 83%). Nonsignificant changes could be observed for breast cancer, gastric cancer and pancreatic
cancer. The Egger regression tests provided limited evidence of substantial publication bias. High adherence to a
MD is associated with a significant reduction in the risk of overall cancer mortality (10%), colorectal cancer
(14%), prostate cancer (4%) and aerodigestive cancer (56%).

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Effects of exercise on treatment-related adverse effects for patients with prostate cancer
receiving androgen-deprivation therapy: a systematic review.
Conséquence de l’activité physique sur les effets indésirables liés au traitement anti-androgénique chez
des patients atteints de cancer de la prostate : une revue systématique.
GardnerJR et al., J Clin Oncol. Feb. 2014
PURPOSE: Androgen-deprivation therapy is a commonly used treatment for men with prostate cancer; however,
the adverse effects can be detrimental to patient health and quality of life. Exercise has been proposed as a
strategy for ameliorating a range of these treatment-related adverse effects. We conducted a systematic review of
the literature regarding the effects of exercise on treatment-related adverse effects in men receiving androgen-
deprivation therapy for prostate cancer.
METHODS: An online electronic search of the Cochrane Library, EMBASE, MEDLINE, CINAHL,
SPORTDiscus, and Health Source databases was performed to identify relevant peer-reviewed articles published
between January 1980 and June 2013. Eligible study designs included randomized controlled trials as well as
uncontrolled trials with pre- and postintervention data. Information was extracted regarding participant and
exercise intervention characteristics as well as the effects of exercise on bone health, body composition, physical
performance, cardiometabolic risk, fatigue, and quality of life.
RESULTS: Ten studies were included, with exercise interventions involving aerobic and/or resistance training.
Exercise training demonstrated benefits in muscular strength, cardiorespiratory fitness, functional task
performance, lean body mass, and fatigue, with inconsistent effects observed for adiposity. The impact of
exercise on bone health, cardiometabolic risk markers, and quality of life are currently unclear.
CONCLUSION: Among patients with prostate cancer treated with androgen-deprivation therapy, appropriately
prescribed exercise is safe and may ameliorate a range of treatment-induced adverse effects. Ongoing research of
high methodologic quality is required to consolidate and expand on current knowledge and to allow the
development of specific evidence-based exercise prescription recommendations.
Association between physical activity and mortality among breast cancer and colorectal cancer
survivors: a systematic review and meta-analysis.
Association entre pratique d’activité physique et taux de décès chez des patients atteints de cancer du sein
et de cancer colorectal : une revue systématique et méta-analyse.
Schmid D et al., Ann Oncol. 2014 Mar 18
BACKGROUND: Physical activity improves physical function during and after cancer treatment, but whether
physical activity imparts survival benefit remains uncertain.
DESIGN: Using prospective studies published through June 2013, we conducted a systematic review and
random-effects meta-analysis of pre- and post-diagnosis physical activity in relation to total and cancer mortality
among breast or colorectal cancer survivors.
RESULTS: Sixteen studies of breast cancer survivors and seven studies of colorectal cancer survivors yielded
49095 total cancer survivors, including 8129 total mortality cases and 4826 cancer mortality cases. Comparing
the highest versus lowest levels of pre-diagnosis physical activity among breast cancer survivors, the summary
relative risks (RRs) of total and breast cancer mortality were 0.77 [95% confidence interval (CI) = 0.69-0.88]
and 0.77 (95% CI = 0.66-0.90, respectively. For post-diagnosis physical activity, the summary RRs of total and
breast cancer mortality were 0.52 (95% CI = 0.42-0.64) and 0.72 (95% CI = 0.60-0.85), respectively. For pre-
diagnosis physical activity among colorectal cancer survivors, the summary RRs of total and colorectal cancer
mortality were 0.74 (95% CI = 0.63-0.86) and 0.75 (95% CI = 0.62-0.91), respectively. For post-diagnosis
physical activity, the summary RRs of total and colorectal cancer mortality were 0.58 (95% CI = 0.48-0.70) and
0.61 (95% CI = 0.40-0.92), respectively. Each 10 metabolic equivalent task-hour/week increase in post-diagnosis

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physical activity (equivalent to current recommendations of 150 min/week of at least moderate intensity activity)
was associated with 24% (95% CI = 11-36%) decreased total mortality risk among breast cancer survivors and
28% (95% CI = 20-35%) decreased total mortality risk among colorectal cancer survivors. Breast or colorectal
cancer survivors who increased their physical activity by any level from pre- to post-diagnosis showed decreased
total mortality risk (RR = 0.61; 95% CI = 0.46-0.80) compared with those who did not change their physical
activity level or were inactive/insufficiently active before diagnosis.
CONCLUSION: Physical activity performed before or after cancer diagnosis is related to reduced mortality risk
among breast and colorectal cancer survivors.