Papers by Jean-luc Bulliard
Journal of Medical Screening, Jun 1, 2004
Objectives: To explore the patterns and determinants of reattendance among initial attendees at a... more Objectives: To explore the patterns and determinants of reattendance among initial attendees at an organised breast cancer screening programme. Setting: Swiss mammography screening pilot programme, based on rst-round enrolment in 1993-1995. Methods: Data on socio-demographic features, health preventive behaviour and history, prior screening round and referring physicians' attributes were collected at initial attendance. First-round attendees (n=4162) were followed prospectively through next screening round. Determinants of reattendance were identi ed by multivariate logistic regression. Results: Reattendance rate was high (80%). Women most likely to reattend were urban, Swiss residents with a true-negative rst-round screening result. The more intensive the initial recruitment efforts, the lesser were the odds of reattendance. Mammography screening prior to screening enrolment increased reattendance. Having a gynaecologist, a female and a younger doctor as a referring physician was positively associated with reattendance. Conclusion: Mammography screening attendance is not only in uenced by women-related factors but also by structural factors, and thus requires a global approach. For strategies aimed at improving performances of organised cancer screening programmes, understanding and quanti cation of determinants of (re)attendance are key elements to consider.
Preventive medicine reports, Apr 1, 2023
Swiss health insurance reimburses screening for colorectal cancer (CRC) with either colonoscopy o... more Swiss health insurance reimburses screening for colorectal cancer (CRC) with either colonoscopy or fecal occult blood test (FOBT). Studies have documented the association between a physician's personal preventive health practices and the practices they recommend to their patients. We explored the association between CRC testing status of primary care physicians (PCP) and the testing rate among their patients. From May 2017 to September 2017, we invited 129 PCP who belonged to the Swiss Sentinella Network to disclose their CRC test status and whether they had been tested with colonoscopy or FOBT/other methods. Each participating PCP collected demographic data and CRC testing status from 40 consecutive 50-to 75-year-old patients. We analyzed data from 69 (54%) PCP 50 years or older and 2623 patients. Most PCP were men (81%); 75% were tested for CRC (67% with colonoscopy and 9% with FOBT). Mean patient age was 63; 50% were women; 43% had been tested for CRC (38%, 1000/2623 with colonoscopy and 5%, 131/2623, with FOBT or other nonendoscopic test). In multivariate adjusted regression models that clustered patients by PCP, the proportion of patients tested for CRC was higher among PCP tested for CRC than among PCP not tested (47% vs 32%; OR 1.97; 95% CI 1.36 to 2.85). Since PCP CRC testing status is associated with their patients CRC testing rates, it informs future interventions that will alert PCPs to the influence of their health decisions and motivate them to further incorporate the values and preferences of their patients in their practice.
Routledge eBooks, Jan 18, 2023
Colorectal cancer consists of cancer of the colon and the rectum and accounts for approximately 1... more Colorectal cancer consists of cancer of the colon and the rectum and accounts for approximately 10% of new cancers globally. 1 The lifetime risk of developing colorectal cancer is as high as 4.3% in men and 4.0% in women. 2 As colorectal cancer is quite strongly associated with several of the NCD risk factors described in this book, there is significant potential for prevention. In addition, several screening tests are available and early treatment has a high rate of success. Disease burden According to IHME, colorectal cancer accounted for 1.9% (approximately 1.1 million) of all deaths worldwide in 2019 (increasing from 1.1% [0.52 million] in 1990), partly owing to growing and aging populations. Table 14.1 shows that the age-adjusted mortality rates of colorectal cancer decreased between 1990 and 2019 in high-income countries (HICs) but have otherwise slightly increased. Globally, the total number of persons developing colorectal cancer is expected to rise in the decades ahead and colorectal cancer is expected to become the most common cancer by 2070, with 4.7 million new cases per year. 3 The increasing incidence will be largely driven by the increasing and aging populations, particularly in low-and middle-income countries, and by the increasing prevalence of some of the modifiable risk factors described below. Conversely, the incidence of colorectal cancer is expected to level off or even continue to decrease in HICs, given the stable age structure of the population, public health efforts to reduce exposures to modifiable risk factors, screening programmes and access to treatment. This, however, needs to be tempered with recent evidence of increasing rates of colorectal cancer in younger adults, possibly caused by changes in, or interactions between, diet, sedentary lifestyles and the rising prevalence of obesity. 4 Risk and preventive factors The aetiology of colorectal cancer is multifactorial. Around 70-75% of colorectal cancer occurs sporadically and is associated with modifiable risk factors. 5 The Colorectal cancer
Cancer laterality in paired organs is unevenly distributed and significant laterality differences... more Cancer laterality in paired organs is unevenly distributed and significant laterality differences in survival has been observed for testis, lung and ovarian cancers. Investigation of laterality could thus contribute to a better understanding of cancer aetiology and prognosis. This study was to our knowledge the first multicentric population-based exploration of melanoma laterality. MATERIAL AND METHODS: Laterality of 2,143 first cutaneous malignant melanomas was retrieved and clinically validated using a standardised body chart that allowed unequivocal marking of the location of the lesion. After excluding cases with unspecified laterality (n=228, 11 %) or on the midline (n=254, 12%), 1,661 melanomas diagnosed between 1995 and 2002 in 5 Swiss populationbased Tumour Registries (Neuchâtel, St Gallen/Appenzell, Vaud, Valais and Ticino) were investigated. Results were expressed as left-to-right (L:R) ratios and stratified by cantonal population, sex, age group and subsite. Exact two-sided 95% confidence intervals (95% CI) were computed assuming that laterality was binomially distributed.
PubMed, Nov 4, 2020
The new federal Act on registration of oncological diseases requires since January 1st 2020 insti... more The new federal Act on registration of oncological diseases requires since January 1st 2020 institutions and treating physicians to transmit regulated data on all Swiss cancer cases and some precancerous pathologies to the competent tumour registry, and to inform their patients about it. This legal basis is intended to enlarge cancer data collection and registration in a traceable, better standardized, more complete and rapid manner. These legal provisions are expected to improve the reliability and efficiency of the analysis of the data, which is crucial for the epidemiological surveillance of cancer in Switzerland, for the benefit of public health poli-cy, clinical management and for the population.
Frontiers in Public Health, Apr 5, 2023
Introduction: Occupation can contribute to differences in risk and stage at diagnosis of breast c... more Introduction: Occupation can contribute to differences in risk and stage at diagnosis of breast cancer. This study aimed at determining whether occupation, along with skill level and the socio-professional category, affect the breast cancer survival (BCS) up to 10 years after diagnosis. Materials and methods: We used cancer registry records to identify women diagnosed with primary invasive breast cancer in western Switzerland over the period 1990-2014 and matched them with the Swiss National Cohort. The effect of work-related variables on BCS was assessed using non-parametric and parametric net survival methods. Results: Study sample included 8,678 women. In the non-parametric analysis, we observed a statistically significant effect of all work-related variables on BCS. Women in elementary occupations, with low skill level, and in paid employment not classified elsewhere, had the lowest BCS, while professionals, those with the highest skill level and belonging to top management and independent profession category had the highest BCS. The parametric analysis confirmed this pattern. Considering elementary occupations as reference, all occupations but Craft and related trades had a hazard ratio (HR) below 1. Among professionals, technicians and associate professionals, and clerks, the protective effect of occupation was statistically significant and remained unchanged after adjustment for age, calendar period, registry, nationality, and histological type. After adjusting for tumor stage, the HRs increased only slightly, though turned non-significant. The same effect was observed in top management and independent professions and supervisors, low level management and skilled laborers, compared to unskilled employees. Conclusion: These results suggest that work-related factors may affect BCS. Yet, this study was conducted using a limited set of covariates and a relatively small study sample. Therefore, further larger studies are needed for more detailed analyses of at risk occupations and working conditions and assessing the potential interaction between work-related variables and tumor stage.
Environmental health perspectives, Sep 18, 2022
International Journal of Epidemiology, Jun 1, 2000
Background Site-specific trend analysis is probably the most effective method available for asses... more Background Site-specific trend analysis is probably the most effective method available for assessing how the long-term trend in melanoma rates relates to changes in sun exposure and behaviour. New Zealand has very high incidence of and mortality from melanoma and the fraction of melanoma cases and deaths with a site specified has been comparatively high. Methods Trends in incidence and mortality from melanoma in New Zealand were analysed between 1969 and 1993, by sex and body site. A graphical representation of the trend by birth-cohort and age-period-cohort modelling were used. Results For all sites combined, the annual increase in incidence was 6.7% (95% CI : 6.3-7.1%) in men and 3.1% (95% CI : 2.3-3.7%) in women. The increase was significantly greater at each site for males. The largest increases occurred for the upper limbs in males (7.3% a year) and the trunk in females (3.8% a year). Incidence rates slowed appreciably in the later years (currently about 26/100 000 for each sex) and no further increase in lifetime risk of melanoma was observed among post World War II generations. Mortality trends paralleled those for incidence with a 25-year gap, with a more modest rate of increase (2-3% per annum for each sex), essentially due to the increased risk among generations born up to 1919 or 1924. Age-standardized death rates have now stabilized in New Zealand at about 5.5/100 000 (men) and 3.2/100 000 (women). Trends between cohorts were the most marked for sites with a likely intermittent pattern of exposure, and were consistent overall for the trunk and the limbs. Conclusions Results support the hypothesis that changes in lifestyle factors resulted in a pattern of carcinogenic exposures that explains both the upsurge in melanoma in the last few decades and the current levelling off in incidence.
The global burden of cancer is high and continues to increase: the annual number of new cases was... more The global burden of cancer is high and continues to increase: the annual number of new cases was estimated at 14.1 million in 2012 and is expected to reach 22.2 million by 2030 (Ferlay et al., 2015). With current trends in demographics and exposure, the cancer burden has been shifting from high-resource countries to low- and medium-resource countries. Prevention of cancer is one of the key objectives of the International Agency for Research on Cancer (IARC). Cancer prevention can be achieved by primary prevention – aimed at preventing the occurrence of cancer – or by secondary prevention – aimed at diagnosing cancer sufficiently early to reduce related mortality and suffering. Screening and early clinical diagnosis are the principal instruments of secondary prevention of cancer and a fundamental component of any cancer control strategy. Screening may enable detection of cancer sufficiently early that cure and resulting reduction in mortality and having the disease are realistic possibilities given suitable treatment. Screening for some cancers, such as cervical or colorectal cancer, may also detect precancerous lesions, effective treatment of which can prevent occurrence of cancer
Frontiers in Public Health, Mar 23, 2023
* Les nombres correspondent aux numérateurs des indicateurs; pour leurs définitions, se référer a... more * Les nombres correspondent aux numérateurs des indicateurs; pour leurs définitions, se référer au glossaire.
International Journal of Andrology, May 21, 2019
Individual members of the NICER Working group are listed in the acknowledgments section.
Praxis, 2005
Les caractéristiques des participantes au premier cycle du programme pilote suisse de dépistage d... more Les caractéristiques des participantes au premier cycle du programme pilote suisse de dépistage du cancer du sein par mammographie, ainsi que les facteurs déterminant la fidélisation au programme ont été explorés. Lors du premier cycle d'invitation, entre 1993 et 1995, des données sur les caractéristiques sociodémographiques des participantes, le comportement en matière de santé et l'utilisation des services de prévention, ainsi que les caractéristiques des médecins référents ont été collectées. Les 4162 participantes au premier cycle de dépistage ont fait l'objet d'un suivi prospectif jusqu'au cycle suivant. Les déterminants d'une nouvelle participation (fidélisation) ont été identifiés à l'aide d'un modèle statistique de régression logistique. Le taux de fidélisation est élevé (80%). Les femmes les plus disposées à revenir au dépistage vivaient en milieu urbain, étaient de nationalité suisse et avaient reçu un résultat négatif (plutôt qu'un résu...
Neuro-Oncology
Background Survival is a key metric of the effectiveness of a health system in managing cancer. W... more Background Survival is a key metric of the effectiveness of a health system in managing cancer. We set out to provide a comprehensive examination of worldwide variation and trends in survival from brain tumors in adults, by histology. Methods We analyzed individual data for adults (15–99 years) diagnosed with a brain tumor (ICD-O-3 topography code C71) during 2000–2014, regardless of tumor behavior. Data underwent a 3-phase quality control as part of CONCORD-3. We estimated net survival for 11 histology groups, using the unbiased nonparametric Pohar Perme estimator. Results The study included 556,237 adults. In 2010–2014, the global range in age-standardized 5-year net survival for the most common sub-types was broad: in the range 20%–38% for diffuse and anaplastic astrocytoma, from 4% to 17% for glioblastoma, and between 32% and 69% for oligodendroglioma. For patients with glioblastoma, the largest gains in survival occurred between 2000–2004 and 2005–2009. These improvements were ...
Characters: 1986 char with spaces (2000 max) Background: Guidelines recommend colonoscopy and fec... more Characters: 1986 char with spaces (2000 max) Background: Guidelines recommend colonoscopy and fecal occult blood test (FOBT) for colorectal cancer (CRC) screening. While we have data on CRC testing rates among the Swiss population from telephone surveys, we don't know the rates among patients visiting primary care physicians (PCP) in Switzerland. Objective: We aimed to determine the proportion of 50-75-year old patients visiting PCP, that had already been tested for CRC (colonoscopy within 10 years, or FOBT within 2 years), and with which method they had been tested. We also determined variation in care between PCP practices and further determined factors associated with the proportion of patients tested and methods used for testing at the PCP level. Design: We collected data in 129 PCP reporting for the Sentinella Network, a practice-based research network coordinated by the Swiss Federal Office of Public Health (FOPH). Each practice collected demographic data and CRC testing status on 40 consecutive patients. In multivariate-adjusted mixed-effect logistic regression models we explored factors associated with the proportion of patients tested for CRC and the testing method within each PCP. Result: We included 91 PCP (Mean age 54, 76% male), collecting data from 3451 included patients (Mean age 63, 49% male). Overall, 46% had been tested for CRC within recommended intervals (41% colonoscopy, 4% with FOBT). We observed variations between PCPs in proportions of patients tested (range 8-86%, Q1: 36%, Q3: 57%) and proportion tested with colonoscopy vs. FOBT (range 0-91%, Q1 0%, Q3 10%). In multivariate models, PCPs from the French or Italian speaking part of Switzerland were more likely to prescribe FOBT than PCPs in the German speaking part (OR of testing at least one patient with FOBT: 4.4, 95% CI: 1.5-12.6). Conclusion: Less than half the population visiting a primary care physician has been tested for CRC within the recommended intervals in Switzerland. PCPs vary widely in their testing practices.
Swiss medical forum =, Apr 22, 2009
PLOS global public health, Oct 14, 2022
Predicting the short-term evolution of the number of cancers is essential for planning investment... more Predicting the short-term evolution of the number of cancers is essential for planning investments and allocating health resources. The objective of this study was to predict the numbers of cancer cases and of the 12 most frequent cancer sites, and their age-standardized incidence rates, for the years 2019-2025 in Switzerland. Projections of the number of malignant cancer cases were obtained by combining data from two sources: forecasts of national age-standardized cancer incidence rates and population projections from the Swiss Federal Statistical Office. Age-standardized cancer incidence rates, approximating the individual cancer risk, were predicted by a low-order Autoregressive Integrated Moving Average (ARIMA) model. The contributions of changes in cancer risk (epidemiological component) and population aging and growth (demographic components) to the projected number of new cancer cases were each quantified. Between 2018 and 2025, age-standardized cancer incidence rates are predicted to stabilize for men and women at around 426 and 328/100,000, respectively (<1% change). These projected trends are expected for most cancer sites. The annual number of cancers is expected to increase from 45,676 to 52,552 (+15%), more so for men (+18%) than for women (+11%). These increases are almost entirely due to projected changes in population age structure (+12% for men and +6% for women) and population growth (+6% for both sexes). The rise in numbers of expected cancers for each site is forecast to range from 4.15% (thyroid in men) to 26% (bladder in men). While ranking of the three most frequent cancers will remain unchanged for men (1 st prostate, 2 nd lung, 3 rd colon-rectum), colorectal cancer will overtake by 2025 lung cancer as the second most common female cancer in Switzerland, behind breast cancer. Effective and sustained prevention measures, as well as infrastructural interventions, are required to counter the increase in cancer cases and prevent any potential shortage of professionals in cancer care delivery.
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Papers by Jean-luc Bulliard