Summary Numerous epidemiological studies have shown that alcohol and tobacco consumption are the main risk factors for oesophageal cancer in Western countries. In these studies, the consumption of both alcohol and tobacco has almost always been measured as current mean intake. The present case-control study investigates the association between alcohol and tobacco consumption and the risk of oesophageal cancer by assessing exposure as total lifetime intake, mean weekly intake, duration of consumption and former and current consumption. Between 1991 and 1994, 208 cases and 399 control subjects were selected from three French university hospitals (Caen, Dijon and Toulouse). Eligible cases were men aged less than 85 years admitted to one of these hospitals with histologically proven squamous cell carcinoma of the oesophagus. During the interview, complete tobacco and alcohol consumption histories were recorded. Our findings suggest that alcohol consumption and tobacco consumption influence the risk of oesophageal cancer in different ways. In the case of alcohol, the relationship between the odds ratio and mean weekly intake was linear, the risk depending solely on mean weekly intake, with former and current consumption having similar effects. With regard to tobacco, the relationship between the odds ratio and mean weekly intake was loglinear; the risk depended mainly on the duration of consumption and former consumption had a lesser effect than current consumption. Our study suggests that total lifetime intake is not a correct measure of exposure for either alcohol or tobacco: for a given lifetime consumption of tobacco, a moderate intake during a long period carries a higher risk than a high intake during a shorter period and, conversely, for a given lifetime consumption of alcohol, a high intake during a shorter period carries a higher risk than a moderate intake during a longer period. Our results confirm the very low risk associated with a low alcohol intake, even over long periods. In contrast, there is a steep increase in the risk associated with smoking at even low mean intakes if these are continued over long periods. Our findings also suggest that even heavy smokers may benefit from quitting.

IntroductionColonoscopy can prevent deaths due to colorectal cancer (CRC) through early diagnosis or resection of colonic adenomas. We conducted a prospective, nationwide study on colonoscopy practice in France.MethodsAn online questionnaire was administered to 2,600 French gastroenterologists. Data from all consecutive colonoscopies performed during one week were collected. A statistical extrapolation of the results to a whole year was performed, and factors potentially associated with the adenoma detection rate (ADR) or the diagnosis of polyps or cancer were assessed.ResultsA total of 342 gastroenterologists, representative of the overall population of French gastroenterologists, provided data on 3,266 colonoscopies, corresponding to 1,200,529 (95% CI: 1,125,936-1,275,122) procedures for the year 2011. The indication for colonoscopy was CRC screening and digestive symptoms in 49.6% and 38.9% of cases, respectively. Polypectomy was performed in 35.5% of cases. The ADR and prevalence of CRC were 17.7% and 2.9%, respectively. The main factors associated with a high ADR were male gender (p=0.0001), age over 50 (p=0.0001), personal or family history of CRC or colorectal polyps (p<0.0001 and p<0.0001, respectively), and positive fecal occult blood test (p=0.0005). The prevalence of CRC was three times higher in patients with their first colonoscopy (4.2% vs. 1.4%; p<0.0001).ConclusionsFor the first time in France, we report nationwide prospective data on colonoscopy practice, including histological results. We found an average ADR of 17.7%, and observed reduced CRC incidence in patients with previous colonoscopy.

In an analysis of data from the CESAME cohort in France, patients with anal and/or perianal Crohn's disease have a high risk of anal cancer, including perianal fistula-related cancer, and a high risk of rectal cancer.

In France, major geographic variation exists in the incidence of oesophageal cancer, the highest incidence being reported in Normandy and Brittany. The role of alcohol in the risk of oesophageal cancer is well established in Western countries. One possible explanation for geographical variation of incidence is that higher incidence of oesophageal cancer is due to specific local alcoholic beverages. The aim of this study was to determine whether different types of alcoholic beverages exert different effects on the risk of oesophageal cancer, and whether the variation of incidence in France is due to variation in local drinking behaviour. We conducted a multicentre case-control study in 3 regions of France (Normandy, Burgundy and Midi-Pyrené es), among which there is a 5-fold variation in incidence. We selected 208 cases and 399 controls, all males. During the interview, the subject's entire alcohol history was reconstituted, noting each type of alcoholic beverage consumed throughout life. The link between the risk of oesophageal cancer and alcohol varies greatly according to the type of alcoholic beverage, with aniseed aperitifs, hot spirits (especially hot Calvados) and beer carrying the highest risk. Consumption of hot Calvados appeared to explain about 2 ⁄3 of the inter-regional and urban/ rural differences in incidence, whereas total alcohol intake explained less than 1 ⁄5. Even after adjustment for all other alcoholic beverages, consumption of hot calvados explained almost half of the peak in incidence of oesophageal cancer in the Northwest of France, as well as half of the urban/rural differences in incidence. Int.

Overweight patients had a prolonged OS compared with normal weight patients with mCRC. The association of overweight with better OS was only observed in men. The pejorative prognosis of BMI <18.5 was confirmed.