International Prevention Research Institute IPRI

Sainte-Foy-lès-Lyon, France

International Prevention Research Institute IPRI

Sainte-Foy-lès-Lyon, France
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Autier P.,International Prevention Research Institute IPRI | Gandini S.,Italian National Cancer Institute | Mullie P.,International Prevention Research Institute IPRI
Journal of Clinical Endocrinology and Metabolism | Year: 2012

Context: Few studies in subjects over 50 yr of age have evaluated the influence of variable doses of vitamin D supplementation on serum 25-hydroxyvitamin D levels. Objective: We performed a meta-analysis of changes in circulating 25-hydroxyvitamin D level associated with vitamin D supplementation in Caucasian subjects over 50 yr old. Data Sources: We conducted a systematic search in literature databases and in references of past reviews. Study Selection: Randomized placebo or open-label trials that evaluated the influence of vitamin D supplementation on clinical outcomes were included in the study. Data Extraction: We reviewed trial characteristics and serum 25-hydroxyvitamin D concentrations at baseline and during the trial. Data Synthesis: Seventy-six trials published from 1984 to March 2011 included 6207 subjects allocated to 101 intervention groups that tested supplement doses ranging from 5 to 250 μg/d (median, 20 μg/d). For similar doses, trials could obtain increases in 25-hydroxyvitamin D three to four times lower than other trials. A meta-regression showed that in the absence of concomitant use of calcium supplements, the average increase in serum 25-hydroxyvitamin D concentrations was 0.78 ng/ml (1.95 nmol/liter) per microgram of vitamin D3 supplement per day. Compared to the vitamin D3, the vitamin D2 was associated with significantly lower increases (P = 0.03). Concomitant use of calcium supplementation and high 25-hydroxyvitamin D concentration at baseline was nonsignificantly associated with lower increases in 25-hydroxyvitamin D concentrations. Conclusions: Dietary recommendations and randomized trials on vitamin D supplementation should evaluate whether increases in circulating 25-hydroxyvitamin D levels match expectations-for instance, the average increases obtained by trials on vitamin D3 without concomitant calcium supplements. Copyright © 2012 by The Endocrine Society.


Autier P.,International Prevention Research Institute IPRI | Esserman L.J.,University of California at San Francisco | Flowers C.I.,H. Lee Moffitt Cancer Center and Research Institute | Houssami N.,University of Sydney
Nature Reviews Clinical Oncology | Year: 2012

Early detection of cancer has long been thought to be the first step towards eradicating the mortality associated with the disease. National screening programmes for breast cancer have been implemented in many countries. However, there is controversy regarding the efficacy and optimal methods of screening, which is regularly discussed in articles, at conferences and is apparent in conflicting guidelines. In this article, Nature Reviews Clinical Oncology asks four experts their opinions on some of the pressing questions associated with breast cancer screening. © 2012 Macmillan Publishers Limited. All rights reserved.


Gandini S.,Italian National Cancer Institute | Boniol M.,International Prevention Research Institute IPRI | Haukka J.,University of Helsinki | Byrnes G.,International Agency for Research on Cancer | And 4 more authors.
International Journal of Cancer | Year: 2011

Epidemiological studies have suggested a reduced risk of several cancers associated with high vitamin D status. We performed a systematic review with meta-analyses of observational studies of serum 25-hydroxyvitamin D level and colorectal, breast and prostate cancer and colonic adenoma. The literature of December 2009 was searched without language restriction. The meta-regression analysis was done to compute dose-response effects. Because in case-control studies, serum 25-hydroxyvitamin D level is measured after the diagnosis of cancer, separate analyses for case-control and prospective studies were done. We identified 35 independent studies. The seven studies on colorectal adenomas were heterogeneous in terms of endpoint and control for major confounding factors, and we did not perform a meta-analysis of these data. The summary relative risk (SRR) and (95% confidence interval) for a 10 ng/ml increase in serum 25-hydroxyvitamin D was 0.85 (0.79; 0.91) for colorectal cancer (2,630 cases in 9 studies); 0.89 (0.81;0.98) for breast cancer (6,175 cases in 10 studies); and 0.99 (0.95;1.03) for prostate cancer (3,956 cases in 11 studies). For breast cancer, case-control studies (3,030 cases) had major limitations and obtained SRR of 0.83 (0.79; 0.87) whereas SRR of prospective studies (3,145 cases) was 0.97 (0.92; 1.03). For colorectal and breast cancer, differences between cases and controls in the season of blood draw or in overweight/obesity or physical inactivity could not explain the results. In conclusion, a consistent inverse relationship between serum 25-hydroxyvitamin D levels and colorectal cancer was found. No association was found for breast and prostate cancer. Copyright © 2010 UICC.


Autier P.,International Prevention Research Institute iPRI | Boniol M.,International Prevention Research Institute iPRI | Middleton R.,Queen's University of Belfast | Dore J.-F.,French Institute of Health and Medical Research | And 3 more authors.
Annals of Oncology | Year: 2011

Background: Breast cancer mortality is declining in many Western countries. If mammography screening contributed to decreases in mortality, then decreases in advanced breast cancer incidence should also be noticeable. Patients and methods: We assessed incidence trends of advanced breast cancer in areas where mammography screening is practiced for at least 7 years with 60% minimum participation and where population-based registration of advanced breast cancer existed. Through a systematic Medline search, we identified relevant published data for Australia, Italy, Norway, Switzerland, The Netherlands, UK and the USA. Data from cancer registries in Northern Ireland, Scotland, the USA (Surveillance, Epidemiology and End Results (SEER), and Connecticut), and Tasmania (Australia) were available for the study. Criterion for advanced cancer was the tumour size, and if not available, spread to regional/distant sites. Results: Age-adjusted annual percent changes (APCs) were stable or increasing in ten areas (APCs of -0.5% to 1.7%). In four areas (Firenze, the Netherlands, SEER and Connecticut) there were transient downward trends followed by increases back to pre-screening rates. Conclusions: In areas with widespread sustained mammographic screening, trends in advanced breast cancer incidence do not support a substantial role for screening in the decrease in mortality. © The Author 2011. Published by Oxford University Press on behalf of the European Society for Medical Oncology.


Autier P.,International Prevention Research Institute IPRI | Dore J.-F.,French Institute of Health and Medical Research | Eggermont A.M.M.,Cancer Institute Gustave Roussy | Coebergh J.W.,Erasmus University Rotterdam | Coebergh J.W.,Comprehensive Cancer Center South
Current Opinion in Oncology | Year: 2011

Purpose of review: Epidemiological data have contributed to the classification in 2009 of the full ultraviolet (UV) radiation spectrum as carcinogenic to humans. We reviewed the epidemiological evidence that UVA could be involved in the genesis of cutaneous melanoma. Recent findings: Use of artificial UV tanning devices (sunbeds) consists mainly of repeated exposure to high UVA doses. Epidemiological studies published over the last years confirmed the association between sunbed use and melanoma. Sunbed use is the most probable cause of an epidemic of melanoma that took place in Iceland from 1990 to 2006. The four-fold increase in melanoma incidence was not followed by an increase in melanoma mortality. Sunscreens were primarily devised for the prevention of sunburn, and UVB is the wavelength causing most sunburns. All observational studies and randomized trials show that sunscreen use may extend sun exposure intended for getting a tan, while it does not necessarily decrease sunburn occurrence. Sunscreen use for tan acquisition would thus lead to similar exposure to UVB and greater exposure to UVA, which could explain the slightly higher melanoma risk often found among sunscreen users. Summary: UVA could be involved in the occurrence of nonlife-threatening melanoma. The increasing use of sunbeds and of sunscreens may partly explain why melanoma incidence increases in most light-skinned populations without concomitant increase in mortality. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Autier P.,International Prevention Research Institute iPRI | Koechlin A.,International Prevention Research Institute iPRI | Smans M.,International Prevention Research Institute iPRI | Vatten L.,International Prevention Research Institute iPRI | Boniol M.,International Prevention Research Institute iPRI
Journal of the National Cancer Institute | Year: 2012

Background Swedish women aged 40-69 years were gradually offered regular mammography screening since 1974, and nationwide coverage was achieved in 1997. We hypothesized that this gradual implementation of breast cancer screening would be reflected in county-specific mortality patterns during the last 20 years. Methods Using data from the Swedish Board of Health and Welfare from 1960 to 2009, we used joinpoint regression to analyze breast cancer mortality trends in women aged 40 years and older (1 286 000 women in 1995-1996). Poisson regression models were used to compare observed mortality trends with expected trends if screening had resulted in breast cancer mortality reductions of 10%, 20%, or 30% among women screened during 18 years of follow-up after the introduction of screening. All statistical tests were two-sided. Results From 1972 to 2009, breast cancer mortality rates in Swedish women aged 40 years and older declined by 0.98% annually, from 68.4 to 42.8 per 100 000, and it continuously declined in 14 of the 21 Swedish counties. In three counties, breast cancer mortality declined sharply during or soon after the implementation of screening; in two counties, a steep decline started at least 5 years after screening was introduced; and in two counties, breast cancer mortality increased after screening started. In counties in which screening started in 1974-1978, mortality trends during the next 18 years were similar to those before screening started, and in counties in which screening started in 1986-1987, mortality increased by approximately 12% (P = .007) after the introduction of screening compared with previous trends. In counties in which screening started in 1987-1988 and in 1989-1990, mortality declined by approximately 5% (P = .001) and 8% (P < .001), respectively, after the introduction of screening. Conclusion County-specific mortality statistics in Sweden are consistent with studies that have reported limited or no impact of screening on mortality from breast cancer. © The Author 2009.


Autier P.,International Prevention Research Institute IPRI | Boniol M.,International Prevention Research Institute IPRI
European Journal of Cancer Prevention | Year: 2012

Breast screening of the West Midlands women of 50-64 years started in 1988. Reductions in breast cancer deaths induced by mammography screening should be preceded by reductions in the incidence of advanced breast cancer. We estimated incidence trends in advanced breast cancer from 1989 to 2004. We extracted numbers of cases of breast cancer found in the West Midlands women aged 50-64 years from the Cancer Incidence in Five Continent database. We used published data for estimating the incidence of advanced breast cancer. Then, annual percent changes in incidence rates were computed using join point regression. The incidence rates of lymph node-positive breast cancer increased from 1989 to 1992. In 1993-1995, they decreased below the prescreening level, but from 1996 to 2000, they returned to prescreening levels and then stabilized. From 1989 to 2004, annual percent changes (95% confidence interval) were 2.2% (1.1-3.2%) for node-negative cancers and -0.7% (-1.9 to 0.4%) for lymph node-positive cancers. The incidence of cancer greater than 50 mm remained stable from 1989 to 2004 [annual percent change: 0.2% (-2.2 to 2.7%)]. Results from the West Midlands suggest that the breast screening program did not play a significant role in reductions in mortality caused by breast cancer. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Autier P.,International Prevention Research Institute IPRI
Revue du Praticien | Year: 2013

Breast cancer screening in France is done though two parallel systems: individualized screening and a national programme of organized screening. The latter is free of charge and manages a double-reading of mammography films. Since 2004, a steadily greater proportion of French women 50 to 74 years of age participate to the national programme. Justification of screening in France is based on Swedish randomised trials that documented the ability of mammography screening to reduce the risk to die from breast cancer. However, since 3 years, a growing number of studies indicate that screening seems not to have much influence on the incidence of advanced breast cancer and on mortality from breast cancer. Moreover, numerous breast cancers are detected that would have never clinically surfaced and would have never been life threatening (overdiagnosis). In view of current doubts, it is better to inform women on health benefits, limitations and possible side effects of mammography screening. For women willing to be screened, it is recommended to invite them to participate to the national programme.


Boniol M.,International Prevention Research Institute IPRI | Boyle P.,International Prevention Research Institute IPRI | Autier P.,International Prevention Research Institute IPRI | Ruffion A.,Service dUrologie Center Hospitalier Lyon Sud | Perrin P.,Service dUrologie Center Hospitalier Lyon Sud
BJU International | Year: 2012

Study Type - Therapy (data synthesis) Level of Evidence 2b What's known on the subject? and What does the study add? The efficacy of prostate cancer screening using PSA testing is still being debated, with conflicting results in randomized trials. The study shows that, even using the hypothesis most favourable to prostate cancer screening with PSA, the net number of years of life does not favour screening. OBJECTIVE To evaluate the impact of the implementation a prostate-specific antigen (PSA) screening programme using the European Randomized Study of Screening for Prostate Cancer (ERSPC) results and taking into account the impact of prostate biopsy and over-treatment on mortality. MATERIALS AND METHODS We used a model based on the number of years of life gained and lost owing to screening, using data reported in the ERSPC. We conducted a critical evaluation of the ERSPC results and of the Swedish arm of the study. RESULTS Accounting for biopsy-specific mortality and for over-treatment, the balance of number of years of life was negative in the ERSPC study, with an estimated loss of 3.6 years of life per avoided death. The number of years of life becomes positive (real gain) only when fewer than 666 screened individuals are required to avoid one death. We found that in the Swedish arm of the ERSPC there was a biopsy rate of 40% compared with 27% in the ERSPC overall. The over-treatment rate was also greater with 4.1% compared with 3.4% overall. For the last 20 years, there has been a marked difference in prostate cancer-specific mortality between Sweden and the rest of Europe: in 2005, for the age group 65-74 the rate was 140 per 100 000 person years in Sweden and â80 per 100 000 for the rest of Europe. CONCLUSION Overall, PSA testing in Europe is associated with a loss in years of life and should thus not be recommended. © 2012 BJU INTERNATIONAL.


Boniol M.,International Prevention Research Institute IPRI | Autier P.,International Prevention Research Institute IPRI
European Journal of Cancer | Year: 2010

Background: Estimation of changes in cancer incidence possibly induced by primary prevention policies requires knowledge of the level of exposure to risk factors targeted by these policies. Materials and methods: We collected comparable exposure data from 30 European countries for five lifestyle cancer risk factors: tobacco smoking, alcohol drinking, overweight and obesity, physical activity and fruit and vegetable consumption. We obtained original reports for years 1995-2005 and the present manuscript reports results around year 2000. Results: This work revealed the important heterogeneity in the quality and possibility to compare data between and within countries. Overall, we observed a clustering of lifestyle factors: highest tobacco consumption in Eastern Europe up to 61.6% in men in Latvia; high alcohol consumption in central Europe, particularly in Czech Republic in which the average daily consumption was 56.9 g/l in men and 14.6 g/l in women; low fruit and vegetable consumption (less than 150 g/d) in Finland, Sweden, Norway and United Kingdom. Obesity was the most prevalent and exceeded 18% for men in United Kingdom, Malta and Greece; and for women in UK, Greece, Luxembourg and Hungary. Conclusion: We conclude that data on tobacco smoking and alcohol consumption are reasonably comparable and match the pattern of cancer incidence. Interpretation of data related to physical activity and fruit and vegetable consumption should be cautious because of considerable between-country variations in the way these data were collected. Recent efforts for harmonisation of health survey questionnaires and sampling methods across European countries should be pursued in order to increase comparability of results. © 2010 Elsevier Ltd. All rights reserved.

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