Estimation of the epidemiological impact of the organized screening program for colorectal cancer

Introduction

Colorectal cancer (CRC) is the third most common cancer and the second most deadly in France. A CRC national organized screening (OS) program was set up in France in 2009. It targets asymptomatic people aged 50 to 74 year with medium risk of CRC. OS program is based on fecal immunochemical test (FIT) followed by colonoscopy. Participation rate over the last period showed a participation rate of 34%, far from the European standards and the 45% target objective of the French cancer plan.

Methods

The epidemiological impact of the DO-CCR was estimated from the results of an individual simulation model adapted from the MISCAN-Colon model, calibrated and transposed to the French context. The model simulates the natural history of CRC in a cohort of 5,000,000 individuals from birth to death. The simulated population reproduced the age and sex structure of the French population. Current screening strategy was simulated for the entire population. A first analysis was conducted to estimate the individual impact of screening by sex and by age of screening initiation and cessation. A second analysis was carried out to estimate the global impact of the based on various participation rates.

Results

FIT every 2 years, from the age of 50, is associated with a reduction in the CRC incidence of 21% for women and 24% for men and a reduction in CRC mortality of 43% for women and 51% for men. At the current level of participation, the OS reduces incidence by 5% and mortality by 14% (2,200 CCR and 2,600 deaths per year) compared to no OS. The impact would be reduced by an additional 3% and 8% for participation rates of 45% and 65% respectively, a decrease of 1,300 and 3,500 cases per additional year. Similarly, mortality would decrease by an additional 8% and 22% for participation rates of 45% and 65%, respectively additional decreases of 1,400 and 4,000 deaths per year.

Key messages

These results confirm that in a population at medium risk for CRC, the OS is an effective strategy for reducing incidence of CRC. Increasing participation rate to reach the Cancer Plan’s objectives remains a key issue in France.

Evaluation of additional benefits of HPV vaccination to cervical cancer screening in France

Background

The National Cancer Institute (INCa) undertook the evaluation of the expected impact of HPV vaccination in the context of the recent marketing of nonavalent vaccine (Gardasil®9) and the implementation of organized screening (OS) of cervical cancer (CC) in France.

Methods

The study is based on a microsimulation model that replicates the natural history of CC. A cohort of 14-year-old women is generated and followed until death. Others HPV-infection related diseases (condyloma, anal cancer, penile cancer and oropharynx cancer) are not modelled. Different strategies were compared with the current vaccination coverage rate (VCR) of 21.4% (2017): impact of increased VCR alone and increased VCR combined with correction of inequalities (CI). Results are presented according to two hypotheses for the duration of protection offered by the vaccine (limited to 20 years and lifelong) and according to two hypotheses for price of the vaccine (French price and average European prices).

Results

The incremental cost-effectiveness ratio (ICER) was less than 15 000 euros per QALY (quality-adjusted life year) in all the assessed strategies. For each 14-year-old women cohort, 85% VCR with CI would prevent at least: 2 546 conations, 2 347 precancerous lesions CIN 2 / 3 diagnosed, 377 CCs, 139 deaths per CC (20 years vaccine protection). Scenarios based on increasing VCR with CI are the most cost-effective.

Conclusions

The study quantifies the increased risk of CC-related outcomes associated with current sub-optimal VCR and the possible investment to implement actions in order to improve the efficiency of the current strategies and tackle health inequalities (communication campaign, actions toward underserved women).

Key messages

Improving HPV vaccination uptake is a cost-effective measure, even considering only the cervical cancer prevention. Including health inequalities participation in modeling is crucial as underserved women are both less vaccinated and screened.

Evidence against a role for NLRP3-driven islet inflammation in db/db mice

Objectives

Type 2 diabetes (T2D) is associated with chronic, low grade inflammation. Activation of the NLRP3 inflammasome and secretion of its target interleukin-1β (IL-1β) have been implicated in pancreatic β cell failure in T2D. Specific targeting of the NLRP3 inflammasome to prevent pancreatic β cell death could allow for selective T2D treatment without compromising all IL-1β-associated immune responses. We hypothesized that treating a mouse model of T2D with MCC950, a compound that specifically inhibits NLRP3, would prevent pancreatic β cell death, thereby preventing the onset of T2D.

Methods

Diabetic db/db mice were treated with MCC950 via drinking water for 8 weeks from 6 to 14 weeks of age, a period over which they developed pancreatic β cell failure. We assessed metabolic parameters such as body composition, glucose tolerance, or insulin secretion over the course of the intervention.

Results

MCC950 was a potent inhibitor of NLRP3-induced IL-1β in vitro and was detected at high levels in the plasma of treated db/db mice. Treatment of pre-diabetic db/db mice with MCC950, however, did not prevent pancreatic dysfunction and full onset of the T2D pathology. When examining the NLRP3 pathway in the pancreas of db/db mice, we could not detect an activation of this pathway nor increased levels of its target IL-1β.

Conclusions

NLRP3 driven-pancreatic IL-1β inflammation does not play a key role in the pathogenesis of the db/db murine model of T2D.

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Inhibition of NLRP3 via MCC950 in db/db mice did not improve glucose tolerance.

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MCC950 treatment did not prevent beta cell loss of function.

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Expression of IL1beta and NLRP3 does not appear increased in db/db islets.

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We conclude against a role for NLRP3 in db/db pancreatic dysfunction.

Tuning the conductivity type in a room temperature magnetic oxide: Ni-doped Ga0.6Fe1.4O3 thin films

The mechanism responsible for conduction in pulsed laser deposited thin films of room temperature ferrimagnetic Ga_0.6Fe_1.4O₃ is fully elucidated. The conduction type can be tuned from n to p through doping with bivalent Ni ions.