Background: The impact of the first coronavirus disease 2019 (COVID-19) wave on cancer patient management was measured within the nationwide network of the Unicancer comprehensive cancer centers in France.Patients and methods: The number of patients diagnosed and treated within 17 of the 18 Unicancer centers was collected in 2020 and compared with that during the same periods between 2016 and 2019. Unicancer centers treat close to 20% of cancer patients in France yearly. The reduction in the number of patients attending the Unicancer centers was analyzed per regions and cancer types. The impact of delayed care on cancer-related deaths was calculated based on different hypotheses. Results: A 6.8% decrease in patients managed within Unicancer in the first 7 months of 2020 versus 2019 was observed. This reduction reached 21% during April and May, and was not compensated in June and July, nor later until November 2020. This reduction was observed only for newly diagnosed patients, while the clinical activity for previously diagnosed patients increased by 4% similar to previous years. The reduction was more pronounced in women, in breast and prostate cancers, and for patients without metastasis. Using an estimated hazard ratio of 1.06 per month of delay in diagnosis and treatment of new patients, we calculated that the delays observed in the 5-month period from March to July 2020 may result in an excess mortality due to cancer of 1000-6000 patients in coming years. Conclusions: In this study, the delays in cancer patient management were observed only for newly diagnosed patients, more frequently in women, for breast cancer, prostate cancer, and nonmetastatic cancers. These delays may result is an excess risk of cancer-related deaths in the coming years.
The cost of treatment of recurrence of lung carcinoma is high, and is related to the number of lines of chemotherapy and the use of radiotherapy and surgery.
(Parkin et al., 1992). However, thyroid cancer incidence is known to be still higher in at least one population not covered by this IARC publication than in Maoris and Hawaiians, namely, another Pacific Island group, New Caledonia, which is located more than 4500 km from Mururoa (Ballivet et al., 1995). The five males and nine females who died from thyroid cancer between 1984 and 1992 resided in the Iles du Vent or in the Iles sous le Vent at time of death, i.e. more than 1000 km from Mururoa. All but one were born on islands located more than 1000 km from Mururoa, and one was born in the Tuamotu-Gambier, about 950 km from Mururoa. They were born between 1902 and 1944 and were, therefore, already aged 20 or more at the time of the first atmospheric test. Based on the experience of the Chernobyl accident in 1986 (Kazakov et al., 1992;Likhtarev et al., 1995) and of the Marshall Islands, which were contaminated by the Bravo nuclear test in 1954 (Hamilton et al., 1987), thyroid cancer caused by massive radioiodine fallout would be expected in individuals irradiated during childhood and residing either near the site or in clusters. Contamination by radioiodine from working in nuclear installations is also an unlikely explanation for our observations, since the excess is observed mainly among women, and very few native women worked on these test sites.The present analysis fails to show evidence of a generalised excess of cancer mortality in French Polynesia. However, this study is limited by the very small local population living less than 500 km away from the nuclear sites (about 4000 individuals), and the high rate of unknown causes of death. A cancer registry in French Polynesia has been in existence since 1980, and we are planning to analyse these data. Our results show that an incidence study is necessary, which would be more powerful and more precise than the present mortality study.
We present the data of the Cancer Registry of French Polynesia (FP) for the 1990-1995 period, highlighting the difference between the incidences among inhabitants born in FP and in immigrants. A total of 1606 incident cases of cancer were registered during the 6-year period from 1990 to 1995, about 90% of which were histologically confirmed. Among these incident cases, 1361 occurred in native French Polynesians (FPs) and 245 in immigrants. Overall cancer incidence was found to be very slightly higher among women in the native population (209/10(5)) than among immigrants (191/10(5)), and lower among men in the native population (186/10(5)) than in the immigrants (241/10(5)). Cervix, corpus uteri, and thyroid cancer incidence rates were higher among women born in FP than among immigrant women. In contrast, colorectal cancer and melanoma incidences rates were lower, and colorectal cancer was similar. Laryngeal cancer incidence was higher among men born in FP than among immigrant men. In contrast, cancers of the oral cavity, colon and rectum, prostate gland, bladder and melanoma were less frequent. This first report, based on the data from the Cancer Registry of French Polynesia, shows high cancer incidence rates in females and low incidence in males born in FP, as compared to those recorded in France; and low cancer incidence rates, as compared to New Zealand Maoris and Hawaiians. For certain cancers, for example colorectal cancer, the incidence in the immigrant population seems to be between that of the native FP population and that of the population living in France, and lower than in New Zealand Maoris and Hawaiians.
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