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BMJ Open. 2019 Jun 18;9(6):e030013. doi: 10.1136/bmjopen-2019-030013.

ETIOSARC study : environmental aetiology of sarcomas from a French prospective multicentric population-based case-control study-study protocol.

Author information

Inserm U1219 - EPICENE team, Université de Bordeaux, BordeauxCedex, Aquitaine, France.
Inserm CIC 1401, Registre des cancers de la Gironde, Université de Bordeaux, BordeauxCedex, Aquitaine, France.
Registre des cancers du Haut-Rhin, Groupe Hospitalier de la Région de Mulhouse et Sud Alsace, Mulhouse, Grand Est, France.
Registre des cancers de Lille et de sa Région, Lille, France.
Pôle de Santé Publique, Service de Médecine du Travail et Pathologies professionnelles, CHU de Bordeaux, Bordeaux, Aquitaine, France.
Department of Medical Oncology, Centre Léon Berard, Université Claude Bernard Lyon 1, Lyon, Auvergne-Rhône-Alpes, France.
Department of Biopathology, Bergonie Institute, Bordeaux, Aquitaine, France.
Service d'anatomopathologie, CHRU Tours, Tours, France.
Inserm UI957, CHU Nantes, Nantes, Pays de la Loire, France.
Department of Medical Oncology, Institute Bergonie, Bordeaux, Aquitaine, France.
Medical Oncology Department, Institut Gustave Roussy, Villejuif, France.
Gironde Registry of Haematological Malignancies, Institute Bergonie, Bordeaux, Aquitaine, France.
Service d'Immunologie-Immunogénétique, Pôle de Biologie et Pathologie, CHU de Bordeaux, Bordeaux, Aquitaine, France.
Medical Oncology Department, Ctr Oscar Lambret, Lille, France.
Réseau de référence sarcome, Centre Léon Bérard, Lyon, Rhône-Alpes, France.
Clinical and Epidemiological Research Unit, Inserm CIC 1401, Institute Bergonie, Bordeaux, Aquitaine, France.



Sarcomas are rare tumours of connective tissue. The exact overall incidence of sarcomas is unknown due to diagnostic difficulties and the various histological subtypes (over 80 subtypes). However, the apparent increasing incidence of sarcomas suggests environmental causes such as pesticides. Except for some specific factors (ie, ionising radiation, vinyl chloride, dioxin and genetic predispositions) the scientific knowledge on the aetiology of sarcomas is sparse and inconsistent. France is a particularly appropriate country to set up a study investigating the causes of sarcoma occurrence due to the French organisation in treatment and care of sarcoma patients, which is highly structured and revolved around national expert networks. The main objective of the ETIOlogy of SARcomas (ETIOSARC) project is to study the role of lifestyle, environmental and occupational factors in the occurrence of sarcomas among adults from a multicentric population-based case-control study.


Cases will be all incident patients (older than 18 years) prospectively identified in 15 districts of France covered by a general population-based cancer registry and/or a reference centre in sarcoma's patient care over a 3-year period with an inclusion start date ranging from February 2019 to January 2020 and histologically confirmed by a second review of the diagnosis. Two controls will be individually matched by sex, age (5 years group) and districts of residence and randomly selected from electoral rolls. A standardised questionnaire will be administered by a trained interviewer in order to gather information about occupational and residential history, demographic and socioeconomic characteristics and lifestyle factors. At the end of the interview, a saliva sample will be systematically proposed. This study will permit to validate or identify already suspected risk factors for sarcomas such as phenoxyherbicides, chlorophenol and to generate new hypothesis to increase our understanding about the genetic and environmental contributions in the carcinogenicity process.


The present study is promoted by the French National Institute of Health and Medical Research (identification number C17-03). This study received National French Ethic committee (CPP Sud Méditerrannée I) approval (identification number 18-31) and French Data Protection Authority (CNIL) approval (identification number 918171). Results of this study will be published in international peer-reviewed journals. Technical appendix, statistical code and dataset will be available in the Dryad repository when collection data are completed.




aetiology; cancer; case–control study; environmental and occupational exposure; sarcoma

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