Tesis sobre el tema "Cancer du sein – Dépistage"
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Gocko, Xavier Pierre Antoine. "Dépistage organisé du cancer du sein et décision partagée". Thesis, Lyon, 2020. http://www.theses.fr/2020LYSES005.
Texto completoContext. Participating in organized breast cancer screening is part of a shared decision-making process with an intelligible, fair and appropriate information delivered. This process is based on the knowledge, representations and values of women and professionals. The controversies surrounding this screening complicate the decision-making for women. In this context, the National Cancer Institute (INCa) launched online the first citizen consultation on this screening in October 2015.Aims. This work sought to feed the shared decision-making process within the framework of screening by studying the information given to women around the world and in France. He also sought to understand what the knowledge and values were underlying the decision of women. It dealt with the main subject of controversy: the discrepancies around overdiagnosis rates.Methods. Two systematic reviews were carried out: the first analyzed the various information tools in the world and the second the methodological differences leading to the overdiagnosis rates discrepancies. The INCa and “Cancer rose” websites were analyzed using the prism of International Patient Decision Aids Standards criteria. Citizen consultation was analyzed in a mixed and sequential study (qualitative / netnography and quantitative / multiple correspondence analysis) in order to understand the decisions to participate or not.Results conclusions. Appropriate information moves away from "pinkwashing" and takes into account the emotions of women. For professionals, overdiagnosis leads to regaining scientific doubt and managing it
Salicru, Bruno. "Un espoir pour les femmes, un projet pour l'Hérault : le dépistage des cancers du sein". Montpellier 1, 1988. http://www.theses.fr/1988MON11289.
Texto completoGuedaoura, Sonya. "Pratiques de dépistage du cancer des femmes non porteuses de mutations familiales des gènes BRCA1/2". Master's thesis, Université Laval, 2017. http://hdl.handle.net/20.500.11794/27686.
Texto completoThéberge, Isabelle. "Sensibilité et spécificité du dépistage du cancer du sein par mammographie : mesures directes et indirectes". Doctoral thesis, Université Laval, 2015. http://hdl.handle.net/20.500.11794/25981.
Texto completoDeville, Jeannick. "Intérêt et limites de l'échographie en pathologie mammaire actuellement : diagnostic, dépistage, surveillance des malades traités". Montpellier 1, 1990. http://www.theses.fr/1990MON11091.
Texto completoDelbany, Maya. "Acquisition IRM optimisée en vue du dépistage du cancer du sein". Thesis, Université de Lorraine, 2019. http://www.theses.fr/2019LORR0018/document.
Texto completoDiffusion-weighted imaging (DWI) is a promising tool to increase the specificity of MRI for breast cancer screening. However, the field of view covering the breasts makes the DWI at high resolution difficult and the images obtained have low signal-to-noise ratios (SNR). The current DWI techniques are limited by the spatial resolution, mainly a slice thickness greater than or equal to 3 mm. In this work, an isotropic DWI method was developed to obtain high resolution isotropic images (1x1x1 mm3) covering the entire breast. These images are obtained by combining: (i) a readout-segmented DW-EPI sequence (rs-EPI), with several segments of k-space and echo navigator providing high in-plane resolution, (ii) a super-resolution (SR) strategy, which consists of acquiring three datasets with thick slices (3 mm) and 1mm-shifts in the slice direction, (iii) and combining them into a 1x1x1 mm3 dataset using a dedicated reconstruction. Several SR reconstruction schemes were investigated, based on different regularizations. The proposed SR strategy was compared to native 1x1x1 mm3 acquisitions (i.e. with 1 mm slice thickness) on eight healthy subjects, and synthetics phantoms. To validate the SR method, we used several methods: Monte Carlo simulations, SNR measurements and sharpness metrics, the apparent diffusion coefficient (ADC) values in normal breast tissue and breast diffusion/resolution phantom were also compared. A new clinical research protocol is proposed to evaluate the effectiveness of the high resolution diffusion sequence on breast cancer screening. The aim of this protocol is to replace the contrast-enhanced perfusion by the diffusion sequence for screening
Delbany, Maya. "Acquisition IRM optimisée en vue du dépistage du cancer du sein". Electronic Thesis or Diss., Université de Lorraine, 2019. http://www.theses.fr/2019LORR0018.
Texto completoDiffusion-weighted imaging (DWI) is a promising tool to increase the specificity of MRI for breast cancer screening. However, the field of view covering the breasts makes the DWI at high resolution difficult and the images obtained have low signal-to-noise ratios (SNR). The current DWI techniques are limited by the spatial resolution, mainly a slice thickness greater than or equal to 3 mm. In this work, an isotropic DWI method was developed to obtain high resolution isotropic images (1x1x1 mm3) covering the entire breast. These images are obtained by combining: (i) a readout-segmented DW-EPI sequence (rs-EPI), with several segments of k-space and echo navigator providing high in-plane resolution, (ii) a super-resolution (SR) strategy, which consists of acquiring three datasets with thick slices (3 mm) and 1mm-shifts in the slice direction, (iii) and combining them into a 1x1x1 mm3 dataset using a dedicated reconstruction. Several SR reconstruction schemes were investigated, based on different regularizations. The proposed SR strategy was compared to native 1x1x1 mm3 acquisitions (i.e. with 1 mm slice thickness) on eight healthy subjects, and synthetics phantoms. To validate the SR method, we used several methods: Monte Carlo simulations, SNR measurements and sharpness metrics, the apparent diffusion coefficient (ADC) values in normal breast tissue and breast diffusion/resolution phantom were also compared. A new clinical research protocol is proposed to evaluate the effectiveness of the high resolution diffusion sequence on breast cancer screening. The aim of this protocol is to replace the contrast-enhanced perfusion by the diffusion sequence for screening
Rault-Gau, Françoise. "Etude de 159 cas de lésions infra-cliniques du sein opérées au centre François Baclesse de 1984 à 1987". Caen, 1990. http://www.theses.fr/1990CAEN3009.
Texto completoGuizard, Anne-Valérie. "Evaluation du dépistage mammographique du cancer du sein : analyse " coût-bénéfice " de la campagne héraultaise". Montpellier 1, 1993. http://www.theses.fr/1993MON11032.
Texto completoSévilla, Christine. "Evaluation économique des innovations biomédicales : l'exemple de la diffusion des tests génétiques en oncologie". Paris, EHESS, 2003. http://www.theses.fr/2003EHES0045.
Texto completoThe localisation and the identification of two breast/ovarian cancer susceptibility genes, BRCA1 and BRCA2, have made it possible the introduction of genetic testing for predisposition to these cancers in new medical practices, intended for at risk persons identified on the basis of their idividual and familial characteristics. The objective of this work is to study the diffusion of this brand-new biomedical innovation and the difficulties it generates. After having presented the general factors of the diffusion of innovations identified by the economic theory, on the supply side and on the demand side, we present the problem posed by the genetic testing : we show how the diffusion of these tests poses some difficulties related to the general factors of diffusion or to problems more specific to activities of predictive medicine, but also how the resolution of some difficulties necessitates the adoption of a normative approach
Oldrini, Guillaume. "Dépistage en IRM mammaire". Thesis, Université de Lorraine, 2017. http://www.theses.fr/2017LORR0282/document.
Texto completoBreast MRI has a prominent place in breast imaging. Its wider use is limited in particular by its cost and the limited number of machines. We have worked on several aspects of this problem. In a first step, we changed the positioning from procubitus to decubitus. This showed that the decubitus allowed a better topographic correlation of the lesions with the ultrasound and was better tolerated by the patients. In a second step, we studied the factors of reduction of the acquisition time via the sequences with high temporal resolution and an abbreviated protocol. These changes should make it easier for patients to access MRI, reduce costs while maintaining the same sensitivity and specificity values as the standard protocol
Touré, Sounan Charles. "Facteurs associés à l'intention d'adhésion au programme québécois de dépistage du cancer du sein (PQDCS)". Master's thesis, Université Laval, 2010. http://hdl.handle.net/20.500.11794/22050.
Texto completoCrochard-Lacour, Anne. "Évaluation des programmes de dépistage du cancer du sein par mammographie en France". Lyon 1, 1994. http://www.theses.fr/1994LYO1T309.
Texto completoValdivieso, Joaquim. "Intérêt de la mammographie en médecine générale". Montpellier 1, 1997. http://www.theses.fr/1997MON11089.
Texto completoKadaoui, Nabila. "Pratiques et déterminants des pratiques des omnipraticiens québécois à l'égard du dépistage du cancer du sein chez les femmes hors PQDCS". Mémoire, Université de Sherbrooke, 2011. http://hdl.handle.net/11143/5573.
Texto completoGérard, André. "Le médecin généraliste et le dépistage du cancer du sein : résultats d'une enquête auprès de 200 généralistes du Bas-Rhin". Université Louis Pasteur (Strasbourg) (1971-2008), 1988. http://www.theses.fr/1988STR1M103.
Texto completoSeguret, Fabienne. "Le dépistage du cancer du sein dans l'Hérault : méthodes d'évaluation médico-économique et analyse des résultats après 18 mois de réalisation". Montpellier 1, 1992. http://www.theses.fr/1992MON11134.
Texto completoTchuente, Vanina. "Déterminants liés aux variations de la sensibilité, de la spécificité et du rapport de vraisemblance positif du dépistage par mammographie dans le cadre du Programme québécois de dépistage du cancer du sein". Master's thesis, Université Laval, 2019. http://hdl.handle.net/20.500.11794/33514.
Texto completoIn the Quebec Breast Cancer Screening Program (Programme québécois de dépistage du cancer du sein, PQDCS), women, radiologists and facilities characteristics may influence the screening performance. This study aim to identify those characteristics associated with sensitivity, specificity and accuracy (positive likelihood ratio) of screening mammography. This study consists of 3,727,724 mammograms performed on women aged between 50 and 69 in the PQDCS between January 2002 and September 2015. Data on the characteristics were obtained through three databases: the PQDCS information system, RAMQ and MedEcho. The associations of women, radiologists and facilities characteristics to sensitivity, specificity and accuracy was assessed by multivariable Poisson regression with robust error variance. Among the mammograms included, 368,079 were considered as abnormal and 17,867 lead to a diagnosis of invasive cancers (15,412 screen-detected cancers and 2,455 interval cancers). Overall, the sensitivity is 86.3 %, the specificity is 90.5 % and the accuracy is 9.1. Some characteristics are associated with an increase of the screening performance including woman’s age, being post-menopausal and having a high annual volume of mammograms for radiologists. Others are associated with a decrease of the performance, including having a history of breast puncture or biopsy, having an initial mammogram, having a high body mass index, taking a hormone replacement therapy, having a high breast density, being a female radiologist, using a digital mammogram in a screening facility. As the evaluation of the performance of the PQDCS is important, it is relevant to know the characteristics associated with it, in order to understand better the mechanisms by which the program could be improved.
Résumé en espagnol
Bouchard, Karine. "Comportements de santé et détresse psychologique des femmes s'engageant dans le processus d'un test génétique de prédisposition au cancer du sein BRCA1/2". Thesis, Université Laval, 2007. http://www.theses.ulaval.ca/2007/24262/24262.pdf.
Texto completoKiyang, Lawrence Ndoh Kiyang Lawrence Ndoh. "Intention des professionnels de la santé d'aider les femmes ciblées par le Programme Québécois de Dépistage du Cancer du sein à prendre une décision éclairée concernant leur participation au dépistage du cancer du sein". Thesis, Université Laval, 2012. http://www.theses.ulaval.ca/2012/29217/29217.pdf.
Texto completoThis descriptive study, based on the Theory of Planned Behaviour, evaluated health professionals’ intention to help women targeted by the Quebec Breast Cancer Screening Programme in making informed decisions about breast cancer screening with mammography. The 288 family physicians and 618 nurses who responded to our questionnaire had a strong intention to adopt this behaviour. The perception of behavioural control was the variable most strongly associated with intention, followed by attitude, and social norm. The main barriers to the adoption of the studied behaviour, as perceived by participants were lack of time and limited access to information. The intention of health professionals as well as the adoption of the studied behaviour could be reinforced by training activities on informed decision making and relevant decision support tools made available.
Kiyang, Lawrence Ndoh. "Intention des professionnels de la santé d'aider les femmes ciblées par le Programme Québécois de Dépistage du Cancer du sein à prendre une décision éclairée concernant leur participation au dépistage du cancer du sein". Master's thesis, Université Laval, 2012. http://hdl.handle.net/20.500.11794/23694.
Texto completoThis descriptive study, based on the Theory of Planned Behaviour, evaluated health professionals’ intention to help women targeted by the Quebec Breast Cancer Screening Programme in making informed decisions about breast cancer screening with mammography. The 288 family physicians and 618 nurses who responded to our questionnaire had a strong intention to adopt this behaviour. The perception of behavioural control was the variable most strongly associated with intention, followed by attitude, and social norm. The main barriers to the adoption of the studied behaviour, as perceived by participants were lack of time and limited access to information. The intention of health professionals as well as the adoption of the studied behaviour could be reinforced by training activities on informed decision making and relevant decision support tools made available.
Vachon, Julie. "Cancers d'intervalle chez les femmes symptomatiques et asymptomatiques suivant une mammographie de dépistage normale dans le cadre du programme québécois de dépistage du cancer du sein (PQDCS) entre 1998 et 2004". Thesis, Université Laval, 2010. http://www.theses.ulaval.ca/2010/27385/27385.pdf.
Texto completoOuedraogo, Samiratou. "Dépistage du cancer du sein : facteurs socio-économiques influençant la participation et rythme de suivi". Phd thesis, Université de Bourgogne, 2013. http://tel.archives-ouvertes.fr/tel-00967942.
Texto completoToure, Sounan Charles. "Facteurs associés à l'intention d'adhésion au programme québécois de dépistage du cancer du sein (PQDCS)". Thesis, Université Laval, 2010. http://www.theses.ulaval.ca/2010/26874/26874.pdf.
Texto completoPapin-Lefebvre, Frédérique. "L’organisation du dépistage des cancers en France : éthique et droits des patients". Thesis, Paris 5, 2013. http://www.theses.fr/2013PA05D008.
Texto completoAccording to WHO, organized screening is based on the voluntary participation of subjects who are recruited into the population through screening campaigns. In France, two are organized by the government: breast cancer screening and colorectal cancer screening. The aim of this thesis was to study by an ethical and forensic approach, the French organized programs for cancer screening.Ethical values of national screening programs are subject to European recommendations. In France, they are available in documents attached to the legal texts implementing screening programs. Some others texts more general, frame this practice in France.Detailed in a report published by INCa, the ethical analysis of organized screening program for breast cancer points the need to optimize patients’ information and to strengthen the position and role of the referring health professional, from the entry in the screening to the eventual output to the care.The study of GPs’ preferences in the organization of screening for colorectal cancer shows that issues related to patient information and procedures for collecting of consent, as well as patient monitoring, play a real impact on their adherence to the program, in terms of forensic risk
Breton, Philippe. ""Le sein normal" : à propos de 1000 mammographies de 40 à 70 ans issues d'un dépistage de masse systématique". Montpellier 1, 1995. http://www.theses.fr/1995MON11077.
Texto completoGuertin, Marie-Hélène. "La qualité des mammographies dans le programme québécois de dépistage du cancer du sein, 2004-2005". Doctoral thesis, Université Laval, 2016. http://hdl.handle.net/20.500.11794/27312.
Texto completoObjectives: The main objective of the present study is to evaluate mammography quality of mammograms in daily practice of the Quebec breast cancer screening program. This study also aimed at identifying factors associated with mammography quality among characteristics of patients and technologists who perform the mammograms. The last objective was to evaluate if clinical image quality is associated with the false-positive rate. Methods: A random sample of 1,278 mammograms was drawn from all 394 190 mammograms realized in the program in 2004 and 2005. The mammograms were evaluated based on the criteria used by the Canadian Association of Radiologists. These criteria include an overall evaluation (pass/fail) and a detailed evaluation of positioning, compression, sharpness, contrast, exposure level and artifacts. All sampled mammograms were evaluated by an expert radiologist familiar with the CAR criteria. A subsample of 197 mammograms was also evaluated by a second radiologist and a third one when results were discordant. Characteristics of women were obtained from the Quebec breast cancer screening program information system. Technologists’ characteristics were collected by mailed questionnaire developed specifically for the study purposes. To evaluate the association between women characteristics and mammography quality, Poisson regression models with robust estimation of variance were carried out in order to estimate proportion ratios. Technologists’ characteristics were analysed similarly but with positioning quality (higher/lower) as the outcome. Finally, mammography quality was analysed in association with the false-positive proportion using a similar model. All models were adjusted for potential confounders. Results: For the subsample evaluated by at least two radiologists, 49.7% of mammograms failed overall quality and positioning was suboptimal for 37.2% of mammograms. Inter-rater agreement between the two principal radiologists was generally low (Cohen’s kappa = 0.17 for overall quality and 0.18 for positioning). Increasing body mass index (kg/m2) was associated with lower mammography quality. For overall quality, women with a BMI≥30 had a failure proportion of 67.5% compared to 34.9% for women with a BMI< 25 (adjusted ratio = 2.1, 95%CI: 1.5 – 3.0). Technologists who, in addition to mandatory training, followed at least 15 hours of hands-on training in positioning performed higher positioning quality (adjusted ratio = 1.3, 95%CI = 1.1 - 1.5) compared to technologists with no such additional training. Technologists providing at least 15 hours of continued medical education (CME) also performed higher positioning quality (adjusted ratio = 1.3, 95%CI: 1.1 - 1.5) compared to those who provided less than 15 hours of CME. Finally, among mammography quality dimensions evaluated only presence of artifacts was significantly associated with an increase in the proportion of false-positives (adjusted ratio = 2.1, 95%CI: 1.3 – 3.3) compared to mammograms with few or no artifacts. Conclusion: This study is the first to evaluate mammography quality in daily practice of the Quebec breast cancer screening program. Our study also showed low inter-rater agreement for clinical image evaluation. This can have a major impact on screening centres since these evaluations are the main reasons for loss of accreditation. The proportion of mammograms with poor positioning was higher for women with high BMI. Our study results suggest that increasing hands-on training in positioning for technologists could help improve overall positioning quality in the Program. It would also be important to reassess the impact of clinical image quality on the false-positive rate in the context of digital imaging. A next step is also to evaluate if the observed variations in mammography quality are associated with screening sensitivity. The latter analyses are currently ongoing at the Institut national de santé publique du Québec.
Lagardère, Belloir Brigitte. "La papillomatose juvénile : à propos de treize observations". Bordeaux 2, 1995. http://www.theses.fr/1995BOR2M189.
Texto completoPornet, Carole. "Influence de l'environnement socioéconomique et de l'offre de soins sur la participation aux dépistages organisés des cancers du sein et du colon-rectum à l'aide d’un nouvel outil : the european deprivation index". Caen, 2013. http://www.theses.fr/2013CAEN3167.
Texto completoTo reduce social inequalities in health, the High Council of Public Health recommends measure precisely compare between different regions or countries, and track changes over time. The mechanisms underlying social inequalities in participation in organized screening for breast and colorectal cancer are unknown. The objective was to analyze the environmental impact of socioeconomic status and healthcare supply on participation in organized screening for these cancers with an ecological deprivation index, the French version of EDI. This work presents the construction of this adaptable European transnational index. EDI is composed of census variables that best reflect the individual experience of relative deprivation. The study on the comparison of eight indices as to their assessment of deprivation at the individual level, showed that the performance of EDI were similar to those of the British indices. Using EDI, our studies have shown that in the most deprived areas, participation in screening for breast and colorectal cancer was reduced by 13% and 25% compared to the least deprived areas. No influence of the healthcare supply as measured by the presence or absence of general practitioners or certified radiologists were found. Social inequalities in screening could be reduced by combining individual interventions and geographical approaches targeted at populations at risk of low participation socially identified, emphasizing the superiority of organized screening on individual testing and advocating the involvement of general practitioners
Gangloff, Michel. "Le médecin généraliste et la campagne pilote de dépistage du cancer du sein mise en place par l'ADEMAS dans le Bas-Rhin : enquête auprès des praticiens". Strasbourg 1, 1995. http://www.theses.fr/1995STR1M021.
Texto completoSéguret, Fabienne. "Le Dépistage organisé du cancer du sein dans l' Hérault : évaluation des résultats des deux premiers tours et étude des facteurs de participation". Montpellier 1, 1999. http://www.theses.fr/1999MON1T020.
Texto completoHéry, Demont Clarisse. "Analyses spatio-temporelles de l'incidence et de la mortalité par cancer du sein : utilisation de données de registres". Paris 11, 2010. http://www.theses.fr/2010PA11T004.
Texto completoIn 2002, breast cancer was the most common cancer in women worldwide, with an overall incidence of 37. 5 per 100 000. Breast cancer is also the first cause of women cancer death in the majority of countries. In the years 1990s, many countries started a mammography screening policy, in parallel considerable improvement occurred in the breast cancer treatment. The first aim of this work was to describe temporal trends in incidence and mortality from breast cancer in a group of countries exposed to screening mammography and to improvement of treatment. The second objective was to describe the impact of screening only. We used data provided by cancer registries, published in the successive volumes of CIV (Cancer Incidence in Five Continents) then we conducted a literature review to identify articles that describe breast cancer trends by stage at diagnosis. Since year 1990s, breast cancer mortality decreased in all studied countries, except in Eastern Europe. Incidence of breast cancer has increased steadily in contradiction with the screening theory predictions. Twelve articles describing trends by breast cancer stage showed mixed results and no clearly decreased incidence of advanced breast cancer in the areas of screening. These results were based on a couple of registries only and couldn't be globalized. More investigations should be done to find more data for breast cancer by stage to appropriately evaluate mammography screening
Freitas, David de. "Sondes de détection gamma : optimisation pour la détection peropératoire dans le cancer du sein". Clermont-Ferrand 1, 2003. http://www.theses.fr/2003CLF1MM25.
Texto completoJalbert, Lisa-Marie. "Perceptions des bénéfices et des risques des tests génétiques de prédisposition au cancer du sein (BRCA1/2) par les femmes ayant recours à ces tests". Thesis, Université Laval, 2006. http://www.theses.ulaval.ca/2006/23805/23805.pdf.
Texto completoDevictor, Minvielle Bénédicte. "Utilisation des méthodes de surclassement dans le domaine de la santé publique : application au pronostic de cancer du sein". Aix-Marseille 2, 1993. http://www.theses.fr/1993AIX20653.
Texto completoLeblond, Débora. "Impact psychologique du test génétique de prédisposition aux cancers du sein et de l'ovaire chez les femmes atteintes d'un cancer du sein et initiant la recherche de mutation BRCA1/2 dans leur famille". Paris 5, 2011. http://www.theses.fr/2011PA05H110.
Texto completoObjectives This research’s objectives are to measure the cognitive, emotional, functional and behavioral impact of genetic screening for BRCA1/2, and its predictors, for women initiating the search for mutation in their family. A particular interest was paid to accuracy between subjective and objective risk, as well as on the place of the fear of recurrence (FRC) and the communication of an inconclusive result, for these consultants affected by breast cancer. Method The psychological impact of the test was measured by questionnaires after the first consultation (T1) and after the test result (T2). On 289 eligible patients, 243 sent back these questionnaires at T1 and 180 participated at both assessment time. Results Half of the women have inaccurate perception of their risk of predisposition at T1. Finally, the psychological impact of genetic testing is less beneficial than hypothesized, on the emotional and functional levels, and seems to be connected to the PRC or its associated factors. The impact of the inconclusive result differs significantly slightly from other results. It neither results in false reassurance nor modifies screening intentions, mainly predicted by geneticists’s recommendations. However, level of traitanxiety and ways of coping with cancer can modify the impact of test results. Conclusion If the psychological impact of genetic screening for BRCA1/2 remains acceptable, it is nevertheless advisable not to neglect its effect on consultants already affected by breast cancer, who have to face their risk of recurrence
Poujol, Julie. "Techniques d'acquisitions et reconstructions IRM rapides pour améliorer la détection du cancer du sein". Electronic Thesis or Diss., Université de Lorraine, 2017. http://www.theses.fr/2017LORR0143.
Texto completoBreast cancer is nowadays the first cause of female cancer and the first cause of female death by cancer. Breast MRI is only performed in second intention when other imaging modalities cannot lead to a confident diagnosis. In high risk women population, breast MRI is recommended as an annual screening tool because of its higher sensitivity to detect breast cancer. Breast MRI needs contrast agent injection to visualize enhancing lesions and the diagnosis is mostly based on morphological analysis of these lesions. Therefore, an acquisition with high spatial resolution is needed. Despite the use of conventional MRI acceleration techniques, the volume of data to be acquired remains quite large and the temporal resolution of the exam is around one minute. This low temporal resolution may be the cause of the low specificity of breast MRI exam. Breast MRI with higher temporal resolution will allow the use of pharmacokinetic models to access physiological parameters and lesion specifications. The main aim of this work is to develop a MRI sequence allowing a flexible use of the acquired data at the reconstruction stage. On the one hand, the images can be reconstructed with a conventional reconstruction like the protocol used in clinical routine. On the other hand, the new MRI sequence will also allow the reconstruction of images with a higher temporal resolution allowing the use of pharmacokinetic models. The development of this sequence was done by modifying the acquisition order in the Fourier domain. A random acquisition of the Fourier domain will allow the reconstruction of sub-sampled domains acquired faster. We paid attention to fat suppression efficiency with this new Fourier domain acquisition order. Tests were performed on phantom, female volunteers and patients. These tests showed that the random acquisition did not impact the quality of images (MRI signal and lesion morphology) obtained by conventional reconstruction thus allowing the conventional diagnosis. The reconstructions of the sub-sampled Fourier domains were made using Compressed Sensing reconstructions to remove sub-sampling artifacts. These reconstructions were developed and tested on digital phantoms reproducing breast MRI. The potential of this new MRI acquisition was tested on an artificial enhancing breast lesion developed especially for this purpose
Guedj, Thierry. "Le dépistage du cancer du sein au stade infraclinique : à propos de l'étude de 1000 bilans sénologiques pratiques à titre systématique au service de radiologie de la Clinique Ste Thérèse de Colmar". Université Louis Pasteur (Strasbourg) (1971-2008), 1989. http://www.theses.fr/1989STR1M175.
Texto completoMil, Rémy de. "Efficience de programmes de santé publique visant à réduire les inégalités de participation au dépistage organisé des cancers". Thesis, Normandie, 2019. http://www.theses.fr/2019NORMC415/document.
Texto completoBackground. Increasing participation in organized cancers screening and reducing social and geographical inequalities in participation represent a major public health issue. Objectives. To determine the costeffectiveness of 2 interventions aiming at increasing participation and reducing inequalities in organized cancer screening in France Methods. We conducted a cost-effectiveness analysis from the payer's perspective: 1) of an invitation to a mobile mammography unit (MM) unit for breast cancer screening from retrospective data (n = 37461), 2) of a patient navigation program (PN) for colorectal cancer screening from a randomized controlled trial (n = 16250). Results. The incremental cost per additional screen compared with usual screening was: 1) € 611 [492-821] for the invitation to the MM (+ 3.8% [2.8-4.8], + € 23.21 [22.64-23.78] ), and 2) of € 1 212 [872-1 978] for PN (+ 3.3% [1.5-5.0], + 39.70 €). Effectiveness and cost-effectiveness were greater in deprived areas and in remote areas for MM, whereas they were less favorable in deprived areas for PN. Conclusion. MM and PN can reduce inequalities while being more efficient in remote areas and in deprived areas for MM, while, to achieve this, PN should target deprived people, even if being not the most efficient strategy. Research needs to be pursued to determine the optimal conditions for MM integration in organized breast cancer screening, and to improve the effectiveness and cost-effectiveness of PN, which can not be recommended as experimented for now
Larouche, Geneviève. "Le dépistage par mammographie chez les femmes ayant été testées pour les gènes BRCA1/2 : évaluation des méthodes de rapport et comparaison des taux d'utilisation après et avant le test génétique". Doctoral thesis, Université Laval, 2016. http://hdl.handle.net/20.500.11794/27327.
Texto completoThis thesis aims to assess the effect of BRCA1/2 genetic testing on screening practices according to test results. Three studies were carried out. The participants in these studies were tested for genetic susceptibility to breast and ovarian cancer in the INHERIT BRCAs (Interdisciplinary Health Research Team on BReast CAncer susceptibility) research program, conducted between 1998 and 2004. Self-reported and administrative data from the Quebec Health Insurance Board database (“Régie de l'assurance maladie du Québec” (RAMQ)) for these participants were used. The results from the first two studies were used to support methodological choices in the main study. Since women who were tested for BRCA1/2 tend to overestimate their use of mammography, administrative data are preferable than self-reported information to assess their use of breast cancer screening. RAMQ data are thus considered as a better means of assessing mammography screening following genetic testing BRCA1/2, since specific procedure codes covering all mammography exams, whether done in a private clinic or hospital, can be tracked. Analyses of RAMQ data carried out in the main study suggest that BRCA1/2 mutation carriers and women with an inconclusive test result had more screening mammography after, than prior to, genetic testing. Conversely, non-carriers did not have more breast screening exams. In conclusion, this thesis has allowed a better understanding of the long-term use of mammography after BRCA1/2 genetic testing. It specifically showed that young female non-carriers, contrary to what was expected, do not change their use of mammography after genetic testing. These women could therefore benefit from interventions to improve their cancer screening to their specific level of risk for breast and ovarian cancer. Cancer screening methods that are better adapted to cancer risk would contribute to optimizing utilisation of health resources. Indeed, a stratification risk approach to breast cancer and personalized screening measures should lead to changes in the current recommendations for breast cancer screening. The adherence of women and physicians to these new approaches will then need to be further evaluated.
Zomahoun, Hervé Tchala Vignon. "Effets des caractéristiques des femmes et des technologues sur la qualité du positionnement en mammographie de dépistage, Programme québécois de dépistage du cancer du sein 2004-2005 : analyses préliminaires". Thesis, Université Laval, 2010. http://www.theses.ulaval.ca/2010/27779/27779.pdf.
Texto completoPoujol, Julie. "Techniques d'acquisitions et reconstructions IRM rapides pour améliorer la détection du cancer du sein". Thesis, Université de Lorraine, 2017. http://www.theses.fr/2017LORR0143/document.
Texto completoBreast cancer is nowadays the first cause of female cancer and the first cause of female death by cancer. Breast MRI is only performed in second intention when other imaging modalities cannot lead to a confident diagnosis. In high risk women population, breast MRI is recommended as an annual screening tool because of its higher sensitivity to detect breast cancer. Breast MRI needs contrast agent injection to visualize enhancing lesions and the diagnosis is mostly based on morphological analysis of these lesions. Therefore, an acquisition with high spatial resolution is needed. Despite the use of conventional MRI acceleration techniques, the volume of data to be acquired remains quite large and the temporal resolution of the exam is around one minute. This low temporal resolution may be the cause of the low specificity of breast MRI exam. Breast MRI with higher temporal resolution will allow the use of pharmacokinetic models to access physiological parameters and lesion specifications. The main aim of this work is to develop a MRI sequence allowing a flexible use of the acquired data at the reconstruction stage. On the one hand, the images can be reconstructed with a conventional reconstruction like the protocol used in clinical routine. On the other hand, the new MRI sequence will also allow the reconstruction of images with a higher temporal resolution allowing the use of pharmacokinetic models. The development of this sequence was done by modifying the acquisition order in the Fourier domain. A random acquisition of the Fourier domain will allow the reconstruction of sub-sampled domains acquired faster. We paid attention to fat suppression efficiency with this new Fourier domain acquisition order. Tests were performed on phantom, female volunteers and patients. These tests showed that the random acquisition did not impact the quality of images (MRI signal and lesion morphology) obtained by conventional reconstruction thus allowing the conventional diagnosis. The reconstructions of the sub-sampled Fourier domains were made using Compressed Sensing reconstructions to remove sub-sampling artifacts. These reconstructions were developed and tested on digital phantoms reproducing breast MRI. The potential of this new MRI acquisition was tested on an artificial enhancing breast lesion developed especially for this purpose
Di, Giacomo Daniela. "Développement de méthodes moléculaires pour la détection et l'interprétation de mutations : applications aux cancers du colon et aux prédispositions génétiques aux cancers du sein et de l'ovaire". Rouen, 2013. http://www.theses.fr/2013ROUENR02.
Texto completoLa prima parte di questo lavoro di tesi riguarda la ricerca sensibile di mutazioni nei geni KRAS e BRAF in tumori primari di pazienti affetti da cancro del colon metastatico. Il trattamento in prima linea di questi pazienti, seguiti nel reparto di Oncologia dell'Ospedale S. Salvatore di L'Aquila, è basato su una triplice chemioterapia combinata con un trattamento anti-angiogenico (anti-VGFR; Bevacizumab). Per il genotipaggio del DNA tumorale abbiamo utilizzato la metodica SNaPshot, seguendo il protocollo messo a punto a Rouen, nei laboratori di Genetica somatica dei tumori. Questa metodica, infatti, permette di rilevare mutazioni anche in campioni contenenti una bassa percentuale di cellule tumorali. Su una serie di 59 pazienti, 31 (53%) sono risultati wild-type e 28 (47%) mutati KRAS (codoni 12 e 13). In questa serie di pazienti non sono state rilevate mutazioni nel gene BRAF. Per quanto riguarda l'evoluzione clinica, nel corso del protocollo terapeutico utilizzato, non è stata trovata nessuna differenza significativa tra il gruppo KRAS wild-type e KRAS mutato. Tuttavia, per questi pazienti trattati con triplice chemioterapia più Bevacizumab, la mutazione c. 35G>A (Gly12Asp), sul gene KRAS, trovata in 15 pazienti (25%), è stata associata significativamente ad una prognosi sfavorevole di sopravvivenza globale. La seconda parte di questa tesi è incentrata sull'interpretazione di varianti di sequenza di significato sconosciuto (VUS), trovate in famiglie con predisposizione genetica al tumore del seno e dell'ovaio, con un interesse particolare sull'effetto che queste varianti di sequenza hanno sullo splicing dell'RNA messaggero. Questo lavoro è stato realizzato in gran parte nell'Unità INSERM U1079, della facoltà di Medicina e Farmacia dell'Università di Rouen, utilizzando sistematicamente un test funzionale di splicing basato sulla trasfezione transitoria di minigeni che portano il cambio di sequenza. In una prima fase, il test, che si avvale di routine dell'utilizzo del minigene pCAS-2 messo a punto nell'Unità INSERM U1079, è stato utilizzato per studiare delle serie importanti di VUS trovate nella rete dei laboratori di diagnostica molecolare francesi o nei laboratori di diagnostica molecolare di L'Aquila e di Roma. Il progetto è stato focalizzato successivamente su un esone particolare del gene BRCA2, l'esone 7, selezionato come modello di regolazione esonica di splicing. Il lavoro descritto in questa tesi si incentra su un totale di 32 varianti di sequenza di questo esone analizzate nel minigene pCAS-2, nonché una gran parte anche nel minigene pcDNA-Dup, sviluppato nei laboratori INSERM U1079, che permette di individuare le variazioni di attività "enhancer di splicing" associate con i cambi di sequenza. Queste 32 varianti sono state anche classificate in due gruppi, in base al loro effetto sulla regolazione esonica di splicing: 11 aumentano, con livelli differenti, l'esclusione dell'esone 7 di BRCA2; 22 non aumentano l'esclusione. Questa importante serie di varianti di sequenza con effetti accertati sulla regolazione dello splicing ci ha permesso di validare un nuovo metodo per prevedere mutazioni esoniche di splicing (Ke et al. , 2011). Gli autori di questo metodo hanno condotto un'analisi sperimentale high-throughput sugli effetti di tutti i possibili 4096 esameri, inseriti in esoni modello, in diverse posizioni e assegnando a ciascun esamero uno "score" di inclusione/esclusione dell'esone. Noi abbiamo utilizzato questi scores per sviluppare una strategia di predizione dell'effetto delle varianti di sequenza studiate sperimentalmente nell'esone 7 di BRCA2. E' da notare come le predizioni del nuovo metodo basato sugli scores di esameri definiti da Ke et al. , 2011, sono risultate perfettamente concordanti con i risultati ottenuti, fatta eccezione per due VUS situate nella stessa posizione nucleotidica, per le quali non è stato osservato l'effetto previsto sullo splicing. I contributi maggiori di questa sezione della tesi sono stati la cartografia dettagliata degli elementi di regolazione esonici di splicing nell'esone 7 di BRCA2 e la validazione di una metodica di predizione dell'effetto che varianti di sequenza hanno su questa regolazione. Abbiamo dimostrato che questa nuova metodica di predizione è più affidabile dei metodi precedenti e proponiamo che questa possa essere incorporata attraverso programmi informatici adeguati nell'analisi di routine delle numerose varianti di sequenza osservate nelle attività di sequenziamento di nuova generazione. Questo lavoro contribuisce all'interpretazione delle VUS trovate in geni predisponenti al cancro in quanto dimostra che le variazioni di sequenza dell'esone, spesso hanno un impatto sulla maturazione dell'RNA messaggero, non solo per le modificazioni dei siti di splicing, ma anche per l'alterazione degli elementi esonici di regolazione. Gli effetti di queste alterazioni sono molto spesso parziali, il che rende difficile definire la loro eventuale patogenicità. Si propone di rafforzare studi multicentrici in modo da poter combinare i dati provenienti da diverse fonti, tra cui la struttura familiare, la segregazione di VUS, i dati clinici e le caratteristiche del tumore per definire un consenso per l'interpretazione di questi difetti parziali splicing
La première partie de ce travail de thèse porte sur la détection sensible des mutations des gènes KRAS et BRAF dans les tumeurs primaires de patients atteints de cancer du colon métastasique. Le traitement de première ligne de ces patients, suivis dans le service d'Oncologie de l'Hôpital universitaire San Salvatore de L'Aquila, est basé sur une triple chimiothérapie combinée avec un traitement anti-angiogénique (anti-VGFR ; Bevacizumab). Nous avons utilisé pour le génotypage de l'ADN tumoral la méthode SNaPshot, d'après le protocole mis au point à Rouen, dans le laboratoire de Génétique Somatique des Tumeurs, car cette méthode permet de détecter des mutations même dans des échantillons contenant une faible proportion de cellules tumorales. Sur une série de 59 patients, 31 (53%) ont été trouvés sauvages et 28 (47%) ont été trouvés mutés dans KRAS (codons 12 et 13). Aucune mutation BRAF n'a été trouvée dans cette série. Aucune différence significative parmi les groupes KRAS sauvage et KRAS muté n'a été trouvée dans l'évolution clinique, au cours du protocole thérapeutique utilisé. Cependant, pour ces patients traités par triple chimiothérapie plus Bevacizumab, la mutation c. 35G>A (Glyl2Asp), trouvée dans 15 patients (25%), était associée significativement à un mauvais pronostic de survie globale. La deuxième partie de cette thèse a porté sur l'interprétation des variations de séquence de signification inconnue (VSI), trouvées dans des familles avec prédisposition génétique aux cancers du sein et de l'ovaire, avec un intérêt particulier pour l'effet de ces variations de séquence sur l'épissage de l'ARN messager. Ce travail a été réalisé en grande partie dans l'Unité Inserm U1079, à la Faculté de Médecine et Pharmacie de l'Université de Rouen, en utilisant systématiquement les tests fonctionnels crépissage basés sur la transfection transitoire de minigènes, portant les changements de séquence. Dans une première phase, le test de routine basé sur le minigène pCAS-2, développé dans l'Unité Inserm U1079, a été utilisé pour étudier des séries importantes de VSI trouvés dans les laboratoires de diagnostic moléculaire du réseau BRCA français ou dans les laboratoires de diagnostic moléculaire de L'Aquila et de Rome. Le projet a été ensuite focalisé sur un exon particulier du gène BRCA2, l'exon 7, choisi comme modèle de régulation exonique de l'épissage. Les travaux décrits dans cette thèse portent sur un total de 32 changements de séquence de cet exon, testés dans le minigène pCAS-2 et en grande partie également dans le minigène pcDNA-Dup, développé dans le laboratoire Inserm U1079, qui permet de détecter les variations d'activité « enhancer d'épissage » associées avec les changements de séquence. Ces 32 changements ont été ainsi classés en deux groupes, selon leur effet sur la régulation exonique de l'épissage : 11 augmentent, avec des degrés différents, l'exclusion de l'exon 7 de BRCA2, et 22 n'augmentent pas l'exclusion. Cette série importante de variations de séquence avec effets établis sur la régulation de l'épissage nous a permis de valider une nouvelle méthode pour la prédiction des mutations exoniques d'épissage (Ke et al. , 2011). Ces auteurs ont réalisé une analyse expérimentale à haut débit de l'effet de tous les 4096 hexamères possibles, insérés dans des exons modèles, à plusieurs positions et ont attribué à chaque hexamère un « score » d'inclusion/exclusion d'exon. Nous avons utilisé ces scores pour développer une stratégie prédictive de l'effet des variations de séquence étudiées expérimentalement dans l'exon 7 de BRCA2. De façon remarquable, le prédictions de la nouvelle méthode basée sur les scores d'hexamères définis par Ke et al. , 2011 ont été parfaitement concordantes avec les résultats obtenus, à l'exception de deux VSI, situés à la même position nucléotidique, pour lesquels un effet prévu sur l'épissage n'a pas été observé. Les contributions majeures de cette partie du travail de thèse sont la cartographie détaillée des éléments de régulation exonique de l'épissage dans l'exon 7 de BRCA2 et la validation d'une méthode de prédiction de l'effet de changements de séquence sur cette régulation. Nous avons montré que cette nouvelle méthode de prédiction est plus fiable que les méthodes précédentes et nous proposons qu'elle soit intégrée, sous la forme de programmes informatiques appropriés, dans l'analyse de routine des nombreuses variations de séquence observées dans les activités de séquençage de nouvelle génération. Ce travail contribue à l'interprétation des VSI trouvés dans les gènes de prédisposition aux cancers, car il montre que les variations exoniques de séquence ont souvent un impact sur la maturation de l'ARN messager, non seulement par la modification des sites d'épissage, mais aussi par l'altération d'éléments de régulation exonique. Les effets de ces altérations sont le plus souvent partiels, ce qui complique la définition de leur pathogénicité éventuelle. Nous proposons le renforcement d'études multicentriques permettant de combiner les données provenant de plusieurs sources, notamment la structure familiale, la ségrégation du VSI, les données cliniques et les caractéristiques tumorales, afin de définir un consensus pour l'interprétation de ces défauts partiels de l'épissage
Verdonck, Magali. "FTIR imaging: a potential new tool to characterize cancer cells and tumor infiltrating lymphocytes in human breast cancer". Doctoral thesis, Universite Libre de Bruxelles, 2015. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209047.
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Le cancer du sein est le carcinome le plus fréquent chez la femme. C’est une maladie très hétérogène du point de vue histologique, de la réponse thérapeutique et de l’évolution clinique. Une détection rapide et précise de la maladie est cruciale, un diagnostic du cancer du sein dès les premiers stades de la maladie permet une meilleure prise en charge du patient et est directement associé à un meilleur pronostic. Néanmoins la classification actuelle des cancers du sein ne permet souvent pas de caractériser la maladie de manière précise, ce qui donne lieu à la mise en place de traitements moins ciblés et une évolution clinique peu favorable. Pour remédier à cela, des efforts conséquents sont réalisés en recherche, dans le but de mettre au point des méthodes capables d’identifier et de caractériser les cellules tumorales. De plus il est actuellement reconnu que le micro-environnement tumoral (composé des cellules non-tumorales) influence fortement la progression du cancer. Récemment de nombreuses études ont montré que la présence de lymphocytes au niveau des tumeurs mammaires (TILs) était corrélée à un meilleur facteur pronostic et prédictif. Bien que l’évaluation des TILs soit de grande importance dans le cadre des immunothérapies, cet élément n’est actuellement pas pris en compte dans les analyses de routine. Par ailleurs, l’imagerie infrarouge par transformée de Fourier (FTIR) a démontré son utilité dans l’étude de plusieurs cancers humains. La spectroscopie infrarouge (IR) couplée à la microscopie fourni des images composées de multiples spectres qui reflètent la composition biochimique et les modifications dans les échantillons biologiques. De ce fait l’imagerie infrarouge procure des informations utiles pour améliorer l’identification et la caractérisation du cancer du sein. L’objectif général de cette thèse est d’améliorer le diagnostic du cancer du sein par imagerie FTIR pour mieux identifier et caractériser les cellules cancéreuses et le micro-environnement tumoral des tumeurs mammaires. Dans un premier temps nous avons effectué une étude de faisabilité afin d’évaluer l’impact du protocole de fixation des tissus sur les spectres IR. Bien que les spectres soient indéniablement influencés par cette altération biochimique, nos résultats indiquent que des types cellulaires proches sont influencés de manière similaire et peuvent donc être discriminés sur base de leurs caractéristiques spectrales. Nous avons ensuite démontré la capacité de l’imagerie IR de distinguer un environnement tumoral d’un environnement normal sur base des particularités spectrales des cellules tumorales et de la matrice extracellulaire. Une attention particulière a ensuite été portée afin d’identifier des signatures spectrales de cellules immunitaires du sang et au sein d’organes lymphoïdes secondaires, tels que les amygdales. Nos résultats ont révélé que l’imagerie IR permet d'identifier une signature spectrale particulière, que nous avons associée à une stimulation lymphocytaire. Finalement nous avons mis en évidence l’utilité de l’imagerie IR en tant qu’outil complémentaire pour identifier et caractériser les TILs dans les échantillons tumoraux mammaires. De manière générale, nos résultats suggèrent que l’imagerie IR fournit des informations intéressantes et fiables pour améliorer la caractérisation et l’évaluation du micro-environnement immunitaire dans les tumeurs mammaires.
Doctorat en Sciences agronomiques et ingénierie biologique
info:eu-repo/semantics/nonPublished
Seigneurin, Arnaud. "Evaluation du dépistage du cancer du sein par mammographie : estimation du surdiagnostic, de la participation des femmes après un résultat faux positifs et de l'incidence des cancers de l'intervalle". Phd thesis, Université de Grenoble, 2011. http://tel.archives-ouvertes.fr/tel-00637175.
Texto completoRondet, Claire. "Déterminants socio-territoriaux de l'absence ou du retard de participation aux dépistages des cancers féminins. Impact de l'origine migratoire et du lien social. Une étude en population générale à partir des données de la cohorte SIRS". Thesis, Paris 6, 2016. http://www.theses.fr/2016PA066573/document.
Texto completoThis study inscribes itself in the general scheme of better knowing the social determinants of delayed or no lifetime participation of gynecological cancer screening. Social determinants here refer to the sociodemographic and psychosocial dimensions which can have an impact on this participation. We particularly looked at the impact of migration origin and social contact of women. Based on the data collected by the SIRS cohort study in 2010, this work leads to confirm the existence of an important social gradient with regard to the participation of women but leads to demonstrate that women of immigrant origin are in an intermediary position between French women born from two French parents and foreign women regarding the delayed or no lifetime participation on cancer screening. We also have showed the importance of social contact in this participation
Rideau, Alexis. "Rôle de la protéine sécrétée OLFM4 dans la carcinogénèse colorectale et mammaire : importance du contexte cellulaire". Thesis, Angers, 2017. http://www.theses.fr/2017ANGE0071.
Texto completoThrough their high frequencies and the lack of early diagnosis, breast and colorectal cancer remain poor prognosis’ diseases. Therefor, the identification of early markers appears as crucial. The proteomic approach isone of the potential tools to identify these biomarkers as it enables the study of tumour cell lines or tissues amples. Indeed, proteins enriched from a shotgun proteomic approach can be identified and quantified by mass spectrometry. In a previous study, we have analysed the proteome of colorectal tumour at different stages and defined Olfactomedine-4 (OLFM4) as a potential biomarker. While OLFM4 expression is increased at primary tumoral site only in non-invasive stages, we have observed that OLFM4 isover expressed in the blood of patients regardless of the cancer stage. The same analysis was made on breast cancer patients. Although OLFM4 has been described as a stem cell marker, its functions remain unclear. In this study, we found that OLFM4 confers cancer stem cell properties. It acts as a regulator of proliferation in low adhesion conditions, migration, mammosphere formation and tumor growth. These abilities could be dependent of Sonic Hedgehog signalling pathway, especially of transcriptional factor GLI1, and regulation of adhesion proteins like E-cadherin. According to the cellular background, all these features highlight a close relationship between a potential biomarker and its involvement in the acquisition of an aggressive phenotype
Liberalotto, Nora Alejandra. "L'engagement des médecins généralistes à l’égard du dépistage des cancers féminins : un révélateur de leurs positionnements face aux transformations de leur contexte d’exercice". Paris, EHESS, 2012. http://www.theses.fr/2012EHES0014.
Texto completoEmploying an approach based on concepts and methods of symbolic interactionism, this thesis studies the general practitioners’ (GPs) commitment in the screening for breast and cervical cancers and seeks, in particular, to understand the implications, terms as well as reasons and beliefs that underlie their commitment. This research is based on a qualitative sociological approach, from which a corpus of various materials has been put together and analyzed. Data was generated through semi-structured interviews with GPs from various French regions. Methodologically, these interviews have been central, but not exclusive. In addition, other sources such as statistics, general and medical journals and official reports and legislation have been consulted. The analysis of this data allowed us to understand that the ways in which practitioners conceptualize and develop their interventions in these screening processes vary considerably, depending on various structural and subjective elements; some of which are likely to evolve throughout the physicians’ careers. Such diversity of attitudes resulting thereof seems contingent on the particular context of the French health care system, which gives GPs a considerable scope of individual autonomy to decide the content of their actions. Due to the fact that, since a few decades, this scope of autonomy tends to decrease, this study of the heterogeneity of GPs’ notions and practices towards women’s cancer screening appears to be significant of the ways in which GPs cope with the main issues that characterize their area of practice and challenge their autonomy as practitioners
Ayme, Aurélie. "Prédispositions génétiques au cancer du sein et de l'ovaire dans la population suisse entre 1996 et 2009 : bilan de l'activité oncogénétique et du dépistage de mutations constitutionnelles dans les gènes BRCA1/BRCA2". Thesis, Aix-Marseille, 2013. http://www.theses.fr/2013AIXM5081.
Texto completoGenetic predispositions are responsible for 5 to 10 % of all breast and ovarian cancers. The main breast/ovarian cancer predisposing genes are BRCA1 and BRCA2. For some years, the screening of pathogenic mutations in BRCA1/BRCA2 genes is provided in a clinical setting. At the Hôpitaux Universitaires de Genève (HUG, Geneva, Switzerland), a consultation in predictive oncology has been set up since 1994 for individuals concerned by the evaluation of their familial cancer risk and the probability to carry a genetic predisposition to cancer. Until 2009, the single national laboratory for BRCA1/BRCA2 testing was established in the HUG. The objectives of this work were to evaluate different aspects of the consultation process for breast/ovarian cancer predisposition syndromes provided in our Unit and to review all BRCA1/BRCA2 complete screenings (n=1’163) performed between 1996 and 2009. Results of the present study will certainly influence future activity in predictive oncology, particularly regarding the role of the genetic counselor
Also, Alio Ramatou. "Influence de la densité mammaire, du traitement hormonal substitutif et de l'indice de masse corporelle sur la sensibilité et la spécificité de la mammographie de dépistage : Programme Québécois de Dépistage du Cancer du Sein (PQDCS) 2000-2005". Thesis, Université Laval, 2011. http://www.theses.ulaval.ca/2011/28624/28624.pdf.
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