John Libbey Eurotext

Environnement, Risques & Santé


Epidemiological surveillance of cancer: Choosing a system for national surveillance Volume 2, issue 2, Mars 2003


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Institut de veille sanitaire, Département des maladies chroniques et traumatismes, 12, rue du Val d‘Osne, 94415 Saint‐Maurice Cedex <>. Institut de veille sanitaire, Département santé environnement, 12, rue du Val d‘Osne, 94415 Saint‐Maurice Cedex. Réseau Francim, Secrétariat de registre des cancers du Tarn, Chemin des Trois Tarn, 81000 Albi

The battle against cancer, a high public health priority in France, requires improvements in the epidemiologic surveillance system. The government included this project among the 70 measures included in the most recent plan against cancer, launched in March 2003. The current surveillance system of cancer incidence is based on registries that, except for the nationwide childhood cancer registry, cover only a limited portion of the country. The information demanded by government officials and society as a whole about the impact of given risks, especially environmental exposures, at any particular geographic location is thus unavailable. InVS has proposed a progressive set of changes in this system, based on the recommendations of a multidisciplinary working group established to implement a national epidemiologic surveillance system for thyroid cancer, the characteristics of which make it useful for testing the proposed national system. It will then be applied and progressively adapted to all of the types of cancer meriting national surveillance, in particular, those that may be associated with environmental exposures. Epidemiologists, medical researchers, and decision‐makers will jointly define these priorities. The system is based upon the development of a partnership for the routine surveillance of incident cases, based initially on hospital and health insurance reimbursement data, and subsequently on pathology and histology data. Reporting will occur locally and be coordinated by Cires (InVS regional relays). The national system thus proposed is a multisource system of anonymous, linked individual data, centralised at InVS. Its development requires: 1) the reinforcement of the cancer registries, which play a role in the validation and calibration of new tools in the department covered; 2) structuring and standardisation of pathology and histology data for health monitoring, and 3) the organization of their transmission on a national level. The goal is to have a single anonymous number for each patient that is generated by each source before it transfers coded data to InVS and can be traced back to the different sources, so that duplicates and recurrences can be identified. This national system should be constructed within the next 5 years.