Socioeconomic and geographic disparities of breast cancer incidence according to stage at diagnosis in France

PURPOSE

Low socioeconomic background (SB) has been associated with lower breast cancer (BC) incidence and higher BC mortality. One explanation of this paradox is the higher frequency of advanced BC observed in deprived women. However, it is still unclear if SB affects similarly BC incidence. This study investigated the link between SB and early/advanced BC incidence from Loire-Atlantique/Vendee Cancer registry data (France).

MATERIALS AND METHODS

Fourteen thousand three hundred fifty three women living in the geographic area covered by the registry and diagnosed with a primary BC in 2008-2015 were included. SB was approached by a combination of two ecological indexes (French European Deprivation Index and urban/rural residence place). Mixed effects logistic and Poisson regressions were used, respectively, to estimate the odds of advanced (stage ≥ II) BC and the ratio of incidence rates of early (stage 0-I) and advanced BC according to SB, overall and by age group (< 50, 50-74, ≥ 75).

RESULTS

Compared to women living in affluent-urban areas, women living in deprived-urban and deprived-rural areas had a higher proportion of advanced BC [respectively, OR = 1.11 (1.01-1.22), OR = 1.60 (1.25-2.06)] and lower overall (from - 6 to - 15%) and early (from - 9 to - 31%) BC incidences rates Advanced BC incidence rates were not influenced by SB. These patterns were similar in women under 75 years, especially in women living in deprived-rural areas. In the elderly, no association between SB and BC frequency/incidence rates by stage was found.

CONCLUSION

Although advanced BC was more frequent in women living in deprived and rural areas, SB did not influence advanced BC incidence. Therefore, differences observed in overall BC incidence according to SB were only due to higher incidence of early BC in affluent and urban areas. Future research should confirm these results in other French areas.

Socioeconomic background in relation to stage at diagnosis in women with breast cancer

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Background: Breast cancer (BC) has been associated with socioeconomic deprivation and rural residence. However, it’s still unclear how these factors interplay to affect the frequency and incidence of early and advanced BC. Methods: Taking advantage of the Loire-Atlantique/Vendée cancer registry (France), we investigated the association between early (TNM stage < 2) and advanced (TNM stage ≥2) BC and the socio-economic background (SB) of women diagnosed in the study region from 2008 to 2015. Socioeconomic status was studied using the residence information of every patient linked to the European Deprivation Index (EDI), an ecological index constructed to reflect individual deprivation experienced at the smallest geographical unit of France (IRIS = 2000 inhabitants). To investigate SB, we created a composite variable using the EDI and the urban/rural context information, to define 4 categories: affluent-urban, affluent-rural, deprived-urban, and deprived-rural. Two statistical approaches were implemented: i) mixed-effects logistic regression models to examine the likelihood (relative risk, RR) of being diagnosed with advanced BC, and ii) Poisson regression for modeling incidence rates of early and advanced stages. Analyses were stratified by age ( < 45, 45 to 74, > 75 years) with a random intercept at the IRIS level. For the strata 45 to 74, the models were adjusted for organized screening. Results: During the study period, 14,542 BC cases were recorded. Compared to the women diagnosed in the most affluent-urban areas, a higher proportion of cancer diagnosed at an advanced stage was observed in the women living in more deprived-rural areas (aged < 45 years, RR = 1.48 95% CI 1.17 - 1.73; aged 45 to 74 years, RR = 1.22, 95% CI 1.02-1.42; aged > 74 years, RR = 1.08, 95% CI 0.85-1.27). Furthermore, while in the population under 74 years, incidence rates of early BC in deprived-rural women were reduced by 25-85 % in comparison to affluent-urban women (IRR: 0.33 to 0.97 95% CI 0.16 -0.98), the rates of advanced BC were unaffected by deprivation-rurality (Deprived rural vs Affluent urban, IRR: 1.06 to 1.13 95% CI 0.79 -1.72). For the population over 74 years, we were unable to detect any associations between SB and BC incidence by stage at diagnosis. Conclusions: Advanced stage at diagnosis was more frequent among deprived–rural women aged under 74 years and coincided with the low incidence rates of early stages in this population. No disparities in the incidence rates of advanced BC were detected according to their SB in any age classes, suggesting other factors may be stronger contributors to the advanced stage at diagnosis. Future research should investigate whether screening practices may influence the disparities in the early stage at diagnosis for women under 74.

Evaluation of a biocide footbath solution in the occurrence and healing of digital dermatitis lesions in dairy cows: A clinical trial

The objective of this study was to evaluate the effect of the implementation of different footbathing practices using a new biocide solution (Pink-Step™, Qalian, France) in the healing and the occurrence of bovine digital dermatitis (bDD) lesions. The investigation was conducted through a controlled within cow clinical trial in which the hind feet of cows from each farm were allocated either to the control group or to a moderate (MR) or (IR) intensive footbath-regimen groups. The trial involved 1036 cows (2072 feet) from 10 dairy farms located in western France where bDD was endemic. Split-footbaths were placed at the exit of the milking parlor of each farm, allowing the biocide to be administered to one side of the cows while using the other empty side as a negative control. The administration frequency for MR was of 2 days/week/1st-month, then 2 days/2 weeks/2nd-month, and then 2 days/month, and for IR was of 2 days/week/1st-2nd months, and then 2 days/2 weeks. Footbaths were administered during 140 days (approx.), and feet were evaluated for the at least once a month in the milking parlor. Nested survival models were used to estimate the relative impact of the footbath regimens and other concomitant risk factors on the time that bDD lesions occurred or healed. No effect of Pink-Step™ was evidenced on the bDD occurrence during the trial. The risk for bDD occurrence was increased by poor feet cleanliness at both the cow (HR 1.69, CI 1.21-2.39) and farm level (HR 2.06, CI 1.44-2.94). Otherwise, the use of Pink-Step™ in an IR was effective in improving the healing of bDD lesions (HR 1.79, CI 1.12-2.88). The time to healing was also improved in inactive lesions (HR 2.19, CI 1.42-3.37). Conversely, the time to healing was delayed in feet receiving hoof-trimming (HR 0.41, CI 0.26-0.62), in cows with a contralateral bDD lesion (HR 0.32, CI 0.22-0.46) or in late lactation (HR 0.61, CI 0.43-0.85), and finally in farms with more than 100 cows (HR 0.48, CI 0.34-0.67). These findings reinforce the crucial role of hygiene in bDD dynamics and highlight the importance of implementing multiple control measures simultaneously, such as hygiene improvements in the barn, early detection and treatment of bDD lesions and the correct usage of individual and collective treatments. The implementation of Pink-Step™ represents a promising strategy for reducing the persistence of bDD lesions in affected herds.

Does feeding extruded linseed to dairy cows improve reproductive performance in dairy herds? An observational study

Feeding n-3 fatty acids (FA) is often cited as a promising strategy to tackle impaired reproduction in dairy cows. However, the scientific literature shows conflicting results that may be explained by the nature of n-3 FA used, the amount supplemented and the timing of supplementation. In addition, designing a proper experimental design to study n-3 FA and reproduction is subjected to other difficulties such as the choice of the control diet or gaining enough statistical power. The objective of this retrospective observational study was to quantify the average effects of supplementing extruded linseed (EL), a feed rich in α-linolenic acid, to dairy cows on reproductive performances under field conditions in French commercial farms. Exposure measurement to EL feeding was particularly challenging as exact cow diets are not traced in farms. Therefore, to investigate the potential dose-effect relationship, we defined a proxy of EL intake per day by using deliveries of EL based feeds from 22 companies in the study period 2008-2015 in France. An artificial insemination (AI) was considered exposed only if the cow was supplemented with EL from the calving until 17 days after AI. Based on recommendations for EL use on the field, 4 exposures classes were created: [1-50] (n = 14,126 AIs), [50-300] (n = 88,261 AIs), [300-600] (n = 66,136 AIs), and [600-1500] (n = 28,287 AIs) g/cow/d. The reference population was composed of cows that did not receive any EL between calving until 17 days after AI within herds that were supplied, but not continuously during the study period (n = 226,795 AIs). Mean daily EL intake in exposed population was 337 g/cow/d (±239.4). Reproductive performance was studied on 423,605 AIs from 1096 herds and 158,125 cows using Cox models for days to first AI and days to conception, and logistic regression models for risk of return-to-service, adjusted for factors likely to influence the reproductive performance and for a herd random effect. Risk of return-to-service between 18 and 78 days after first and second AI did not differ between exposed and reference populations, Nevertheless, the effect on the days to first AI was higher with the lowest EL intake (HR: 1.14; 95% CI: 1.11, 1.17) than with higher EL intake levels (HR ranging from 1.06 to 1.07; 95% CI: 1.04, 1.09). Similarly, for the effect on the time from calving to conception from the lowest EL intake (HR: 1.19; 95% CI: 1.15, 1.23) compared to the higher EL intake levels (HR ranging from 1.08 to 1.11; 95% CI: 1.06, 1.14). This original large-scale epidemiological study provides new insights into the effects of feeding EL at a commercially sustainable level to dairy cows.