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Breast CancerE3NNCT03285230

The French E3N Prospective Cohort Study

An observational study of Breast Cancer and Colo-rectal Cancer, run by Institut National de la Santé Et de la Recherche Médicale, France at 1 site in France.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

The French E3N cohort was initiated in 1990 to investigate the risk factors associated with cancer and other major non-communicable diseases in women. The participants were insured through a national health system that primarily covered teachers, and were enrolled from 1990 after returning baseline self-administered… Read more about this study

Who is it for?
Ages 40 years and older, women onlyHealthy volunteers can take part
How many people
100,000 participants
Where
1 siteFrance
Study dates
15 Jun 1990to 31 Dec 2046
Phase
Observational
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 40 years and older
  • Women only
  • Healthy volunteers accepted
  • Adult, Older adult

Study population: The cohort comprised nearly 100 000 women with baseline ages ranging from 40 to 65 years, all insured through a French national health system (MGEN).

Who may be able to join

  • only women
  • born between 1925 and 1950
  • insured by the Mutuelle Générale de l'Education Nationale (MGEN)

Who cannot join

  • men

Trial locations and contacts

1 site in 1 country.

France1 site
  • Study site

    Villejuif, 94800

Other trials in France

About this study

Official title: The French E3N Prospective Cohort Study (Etude Epidémiologique auprès de Femmes de la Mutuelle Générale de l'Education Nationale)

The French E3N cohort was initiated in 1990 to investigate the risk factors associated with cancer and other major non-communicable diseases in women.

The participants were insured through a national health system that primarily covered teachers, and were enrolled from 1990 after returning baseline self-administered questionnaires and providing informed consent. The cohort comprised nearly 100 000 women with baseline ages ranging from 40 to 65 years.

Read more

Follow-up questionnaires were sent approximately every 2-3 years after the baseline and addressed general and lifestyle characteristics together with medical events (cancer, cardiovascular diseases, diabetes, depression, fractures and asthma, among others). The follow-up questionnaire response rate remained stable at approximately 80%.

A biological material bank was generated and included blood samples collected from 25 000 women and saliva samples from an additional 47 000 women.

Ageing among the E3N cohort provided the opportunity to investigate factors related to agerelated diseases and conditions as well as disease survival.

Read the detailed description

Who is in the cohort? In June 1990, a questionnaire was sent to 500 000 women who had been born between 1925 and 1950 and were insured by the Mutuelle Générale de l'Education Nationale (MGEN), a national health insurance plan that primarily covers teachers. The questionnaire was sent along with a leaflet explaining that an Inserm research team was launching a study of cancer risk factors and that participation would require filling in questionnaires every 2-3 years as well as the submission of a signed consent form providing permission to obtain information about each participant's vital status, address changes and medical expense reimbursements from the insurance plan. Nearly 100 000 women volunteered.

How often have they been followed-up? Until now, nine follow-up questionnaires have been sent every 2-3 years from the baseline. Approximately half of the answers were obtained after the first mailing. Two reminders were sent thereafter. The questionnaires were accompanied with newsletters that informed participants about the major results obtained to date. The participation rate remained high (77-92% according to the questionnaires) and the lost to follow-up rate was minimal because of the ability to trace non-respondents through their insurance plan files. The questionnaires were accurately filled in, with few missing or unacceptable answers.

What has been measured? To date, 11 self-administered questionnaires have been sent. The collected data are sociodemographic factors, anthropometric measurements, reproductive factors, hormonal treatments, health behaviour and lifestyle. Each follow-up questionnaire also recorded the participant's health status. The questionnaires are available at www.e3n.fr .

The questionnaires are anonymous and identified with an identification number and pin code that can be rapidly scanned to identify the respondents. The questionnaires are optically scanned and all answers are checked on screen. The scanned images are saved to allow data entry at a later time, including information regarding the addresses of medical doctors (18 000 to date) or drug names (pre-listed to avoid errors). The longitudinal data (repeats of identical questions for the purpose of updating information about topics such as menopause or smoking) are routinely homogenized. Several validation studies (e.g. dietary and anthropometrical data studies) have been performed and have revealed very satisfactory results.

Self-reported cases of cancer are validated and coded after reviewing the pathology reports obtained from medical practitioners, and nearly 90% of all cancer cases are histologically confirmed. Other diseases are also validated (e.g. diabetes, myocardial infarction, stroke, Parkinson disease) by requesting additional information about the participants (e.g. glycosylated haemoglobin levels, fracture-related circumstances, drug names) and sending questionnaires to medical doctors.

Additionally, a biological material bank was generated. Blood samples were initially collected from 1994-99. The participation rate among the invited participants was approximately 40%; this yielded approximately 25 000 blood samples that were each separated into 28 aliquots (e.g. plasma, serum, leukocytes, erythrocytes). Plastic straws were used to store each participant's samples in liquid nitrogen containers. The bio-repositories are located at the IARC (Lyon) and the EFS (Etablissement Français du Sang, Annemasse). Since 2004, approximately 10 case-control studies have been conducted (approximately 1 800 cases and 3 500 controls) with regard to the measurements of various biomarkers (e.g. fatty acids, calcium, vitamin D, vitamin B, cholesterol and C-reactive protein). A metabolomics study is currently ongoing.

From 2009-11, saliva samples (Oragene, DNA Genotek, Kanata, ON, Canada) were requested from 68 242 living women and were obtained from 47 000 women (participation rate, 69%). Salivary DNA has been extracted and has been used for genotyping in two case-control studies (approximately 2 500 cases and 850 controls) since December 2010.

The research team is currently planning to set up a tumour tissue bank and will begin with the collection of breast cancer tissues.

What has it found? The E3N cohort has produced a spectrum of results regarding the complex roles played by nutrition, hormonal factors, physical activity, anthropometric characteristics and other major lifestyle-related factors with respect to various diseases.

Medical subject headings
Breast Neoplasms, Colonic Neoplasms, Parkinson Disease, Asthma, Diabetes Mellitus, Inflammatory Bowel Diseases, Melanoma, Endometriosis

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Anthropometric measurements

    Height, weight, hip circumference and waist circumference

    Measured: From 1990 until now

  2. Educational level

    Measured: 1990

  3. Professional activity

    Insee categories

    Measured: 1992 and 2005

  4. Age at cessation of activity

    Measured: From 2005 until now

  5. Menstrual factors

    Age at menarche, length of menstrual cycle

    Measured: From 1990 to 2002

  6. Reproductive history

    Number of pregnancies, age at each pregnancy, durations and outcomes of pregnancies, breastfeeding, infertility

    Measured: From 1990 to 1992

  7. Menopause

    Age, type

    Measured: 1990, 1995, 1997, 2000, 2002, 2005

  8. Hormonal Treatments

    Menopausal Hormonal Treatments (MHT), oral contraceptives

    Measured: From 1992 to 2008

  9. Tobacco consumption

    Type, quantity, time of smoking

    Measured: From 1990 until now

  10. Alcohol consumption

    Type of alcohol, quantity

    Measured: 1993, 1997, 2005

  11. Physical activity

    Moderate and intense activity, sedentarity

    Measured: 1990,1997,2002, 2005, 2014

  12. Diet questionnaire

    Precise annual diet questionnaire

    Measured: 1993 and 2002

  13. Family history of diseases

    Cancer, diabetes and cardiovascular diseases

    Measured: 1990 to 2005

  14. Medication use

    linked with the drug reimbursement files from the health insurance

    Measured: From 1990 until now

  15. Medical and surgical history

    Measured: From 1990 until now

  16. Mental Health

    Centre for Epidemiologic Studies Depression Scale (CESD) and Depression

    Measured: From 1990 until now

  17. Health outcomes

    Measured: From 1990 until now

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted15 Sep 2017
  2. Study start15 Jun 1990
  3. Primary completion15 Nov 1991
  4. Study completion31 Dec 2046 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
100,000 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT03285230
Sponsor's protocol ID
C 95-01
Acronym
E3N
Status last verified
Jun 2026
First submitted
27 Jul 2017
Last updated
25 Jun 2026
Results posted
No
Data monitoring committee
Yes

Publications

  • Clavel-Chapelon F; E3N Study Group. Cohort Profile: The French E3N Cohort Study. Int J Epidemiol. 2015 Jun;44(3):801-9. doi: 10.1093/ije/dyu184. Epub 2014 Sep 10.

    PubMed 25212479
  • Danjou AMN, Coudon T, Praud D, Leveque E, Faure E, Salizzoni P, Le Romancer M, Severi G, Mancini FR, Leffondre K, Dossus L, Fervers B. Long-term airborne dioxin exposure and breast cancer risk in a case-control study nested within the French E3N prospective cohort. Environ Int. 2019 Mar;124:236-248. doi: 10.1016/j.envint.2019.01.001. Epub 2019 Jan 16.

    PubMed 30658268
  • Lajous M, Boutron-Ruault MC, Fabre A, Clavel-Chapelon F, Romieu I. Carbohydrate intake, glycemic index, glycemic load, and risk of postmenopausal breast cancer in a prospective study of French women. Am J Clin Nutr. 2008 May;87(5):1384-91. doi: 10.1093/ajcn/87.5.1384.

    PubMed 18469262
  • Fournier A, Cairat M, Severi G, Gunter MJ, Rinaldi S, Dossus L. Use of menopausal hormone therapy and ovarian cancer risk in a French cohort study. J Natl Cancer Inst. 2023 Jun 8;115(6):671-679. doi: 10.1093/jnci/djad035.

    PubMed 36809347
  • Paoletti X, Clavel-Chapelon F. Induced and spontaneous abortion and breast cancer risk: results from the E3N cohort study. Int J Cancer. 2003 Aug 20;106(2):270-6. doi: 10.1002/ijc.11203.

    PubMed 12800205
  • Clavel-Chapelon F; E3N-EPIC Group. Differential effects of reproductive factors on the risk of pre- and postmenopausal breast cancer. Results from a large cohort of French women. Br J Cancer. 2002 Mar 4;86(5):723-7. doi: 10.1038/sj.bjc.6600124.

    PubMed 11875733
  • Fournier A, Berrino F, Riboli E, Avenel V, Clavel-Chapelon F. Breast cancer risk in relation to different types of hormone replacement therapy in the E3N-EPIC cohort. Int J Cancer. 2005 Apr 10;114(3):448-54. doi: 10.1002/ijc.20710.

    PubMed 15551359
  • Fournier A, Fabre A, Mesrine S, Boutron-Ruault MC, Berrino F, Clavel-Chapelon F. Use of different postmenopausal hormone therapies and risk of histology- and hormone receptor-defined invasive breast cancer. J Clin Oncol. 2008 Mar 10;26(8):1260-8. doi: 10.1200/JCO.2007.13.4338.

    PubMed 18323549
  • Dusser P, Nguyen Y, Perrin C, Frenoy P, Mariette X, Boutron-Ruault MC, Severi G, Salliot C, Seror R. Birth length and perinatal exposures and rheumatoid arthritis risk in the E3N cohort. RMD Open. 2026 Apr 9;12(2):e006415. doi: 10.1136/rmdopen-2025-006415.

    PubMed 41956708
  • Dusser P, Nguyen Y, Perrin C, Frenoy P, Mariette X, Boutron-Ruault MC, Varraso R, Severi G, Salliot C, Seror R. Early-life animal and farming exposures and the risk of rheumatoid arthritis: findings from the E3N French cohort study. RMD Open. 2025 Dec 7;11(4):e005954. doi: 10.1136/rmdopen-2025-005954.

    PubMed 41360603
  • Auguste A, Jansana A, Freisling H, Ferrari P, Laouali N, Severi G, Kvaskoff M. Impact of Hypertension on Cancer Stage at Diagnosis Among French Women: The E3N Prospective Cohort. Cancer Med. 2025 Aug;14(15):e71021. doi: 10.1002/cam4.71021.

    PubMed 40719276
  • Klu YE, Amazouz H, Canonico M, Guenel P, Kvaskoff M, Severi G, Radoi L, Auguste A. Association Between Hormonal Factors and Risk of Lung and Upper Aerodigestive Tract Cancer in French Women: The E3N Prospective Cohort Study. Cancer Rep (Hoboken). 2025 Jun;8(6):e70223. doi: 10.1002/cnr2.70223.

    PubMed 40490966
  • Koemel NA, Shah S, Senior AM, Severi G, Mancini FR, Gill TP, Simpson SJ, Raubenheimer D, Boutron-Ruault MC, Laouali N, Skilton MR. Macronutrient composition of plant-based diets and breast cancer risk: the E3N prospective cohort study. Eur J Nutr. 2024 Aug;63(5):1771-1781. doi: 10.1007/s00394-024-03379-x. Epub 2024 Apr 18.

    PubMed 38635026
  • Shah S, Mahamat-Saleh Y, Ait-Hadad W, Koemel NA, Varraso R, Boutron-Ruault MC, Laouali N. Long-term adherence to healthful and unhealthful plant-based diets and breast cancer risk overall and by hormone receptor and histologic subtypes among postmenopausal females. Am J Clin Nutr. 2023 Mar;117(3):467-476. doi: 10.1016/j.ajcnut.2022.11.019.

    PubMed 36872016
  • Shah S, Mahamat-Saleh Y, Hajji-Louati M, Correia E, Oulhote Y, Boutron-Ruault MC, Laouali N. Palaeolithic diet score and risk of breast cancer among postmenopausal women overall and by hormone receptor and histologic subtypes. Eur J Clin Nutr. 2023 May;77(5):596-602. doi: 10.1038/s41430-023-01267-x. Epub 2023 Feb 1.

    PubMed 36726032

Questions about this trial

What is this clinical trial studying?

An observational study of Breast Cancer and Colo-rectal Cancer, run by Institut National de la Santé Et de la Recherche Médicale, France at 1 site in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 25 Jun 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Anthropometric measurements (time frame: From 1990 until now). The study lists 17 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT03285230, which also lists 21 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 25 Jun 2026.

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The French E3N Prospective Cohort Study (NCT03285230) | AzTrials