Дисертації з теми "Dépistages des cancers"
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Rigal, Laurent. "Dépistages des cancers gynécologiques en médecine générale - Variabilité des pratiques de soins." Phd thesis, Université Paris Sud - Paris XI, 2014. http://tel.archives-ouvertes.fr/tel-00956912.
Pornet, 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.
To 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
Rondet, 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.
This 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
Dugord, Clara. "Déterminants et transmission des comportements de recours à la prévention sur longue période." Electronic Thesis or Diss., Université Paris sciences et lettres, 2023. http://www.theses.fr/2023UPSLD040.
This thesis examines women's demand for preventive care, particularly cancer screenings, over a long period using data from the French E3N-Générations cohorts. We show that preventive health seeking behaviors are stable over time, with a strong effect of habit. Secondly, women who are less educated and more distant from the healthcare system are more likely to remain outside the use of preventive health services and to stop their use prematurely. Lastly, social inequalities in the uptake of cancer screening persist across generations, as a result of the transmission of preventive health seeking behaviors. By targeting more strongly women who do not seek preventive care, health policies could induce a spillover effect on the next generation, helping to reduce social inequalities in health
Oldrini, Guillaume. "Dépistage en IRM mammaire." Thesis, Université de Lorraine, 2017. http://www.theses.fr/2017LORR0282/document.
Breast 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
Demoor, Goldschmidt Charlotte. "Effets iatrogènes à long terme de la radiothérapie dans l’enfance : prédiction de risque et dépistage." Thesis, Université Paris-Saclay (ComUE), 2019. http://www.theses.fr/2019SACLS533/document.
Background: Today, the five-year survival rate of children with cancer in France is over 80%, which corresponds to more than 50,000 adults cured of pediatric cancer, but the prevalence of long-term complications exceeds 60% after a 30-year follow-up. In this thesis, we focused on two distinct health problems: one serious and fatal, which is the risk of secondary breast cancer - the other morbid, affecting quality of life and multifactorial, which is the risk of a small height in adulthood. Methods: The approach was different, essentially descriptive with field analysis, followed by intervention with the implementation of a national screening program in a targeted population for secondary breast cancer - and analytical with the development of a risk prediction model for small height risk in adulthood. The population studied was mainly that of the French FCCSS cohort, which are adults cured of childhood solid cancer and treated before 2000, with which some centres have joined for the breast cancer part. Results: Few women cured of childhood cancer and whose treatment included radiotherapy were screened (21.2% and 15.4% with radiological examinations). A significant proportion of infiltrating carcinomas were aggressive with 29% of triple negative tumors. On an intervention level, the DeNaCaPST program began 18 months ago and faced the problem of follow-up and transition of these survivors.Concerning the risk of small adult size, we were able to specify that low doses of radiotherapy received by the pituitary gland were a significant risk factor that this risk increased with the dose, that a large field on the spine was also an important parameter. Being small and being young at diagnostic of childhood cancer were two additional risk factors. In addition, we discovered the impact of two chemotherapy molecules from the alkylant family: busulfan and lomustine. Conclusion: Secondary breast cancers are reminiscent of those occurring in women with a BRCA constitutional mutation (age of onset, cumulative incidence at 50 years, aggressiveness of cancers, bilaterality rate), which justified the development of a national program, inspired by that for women at high risk due to a genetic mutation so that "equal risk, equal screening". The necessary care network is gradually being set up, requiring several amendments to the program. Regarding the risk of small height in adulthood, further studies are needed to confirm our findings
Moshyk, Andriy. "Dépistage du cancer de la prostate analyse décisionnelle." Mémoire, Université de Sherbrooke, 2004. http://savoirs.usherbrooke.ca/handle/11143/3813.
Sévilla, Christine. "Evaluation économique des innovations biomédicales : l'exemple de la diffusion des tests génétiques en oncologie." Paris, EHESS, 2003. http://www.theses.fr/2003EHES0045.
The 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
Guedaoura, 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.
Marty, Maryse. "Cancer du col : dépistage et dysplasies : thèse audio-visuelle." Montpellier 1, 1992. http://www.theses.fr/1992MON11059.
Gocko, Xavier Pierre Antoine. "Dépistage organisé du cancer du sein et décision partagée." Thesis, Lyon, 2020. http://www.theses.fr/2020LYSES005.
Context. 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
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.
Baud, Lydia. "Apport des tests immunologiques dans le dépistage du cancer colorectal." Caen, 2011. http://www.theses.fr/2011CAEN3049.
We compared, in general population settings, among 32,225 patients 50-74 years old, the performances of the Magstream (Fujirebio) immunochemical fecal occult blood test with those of the reference test for colorectal cancer screening in France, the gaiac test Hemoccult II (SKD). At the manufacturer cutoff (20 ng/ml hemoglobin (Hb)) and using two samples in parallel, the Magstream test was more sensitive (ratio of sensitivities RSN=2. 7[2. 4-3. 1]), but also less specific (ratio of false positives RFP=2. 3[2. 1-2. 5]) for the detection of advanced neoplasias than Hemoccult II. The gain in sensitivity was greater for high-risk adenomas (RSN=3. 3[2. 7-4. 0]) than for invasive cancers (RSN=1. 6[1. 3-2. 0]). The Magstream, at higher positivity cutoffs, was both more sensitive and more specific than the Hemoccult II. The relative ROC curves showed identical performances for the Magstream with either one or two samples (in parallel). This is in favor of the use of the Magstream with only one sample, for example at the 31 ng/ml Hb cutoff which led this test being as sensitive as the Hemoccult II for the detection of advanced neoplasias (RSN=1. 7[1. 5-2. 0]), without any loss in specificity, and with a similar positivity rate (2. 8% versus 2. 4%). Our literature review shows that the OC Sensor (Eiken) immunochemical test, also better than the Hemoccult II, could be slightly better than the Magstream. This should be confirmed by a direct comparison of these immunochemical tests, in order to select the best screening program
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.
La 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
Tazi, Mohammed Adnane. "Évaluation du dépistage de masse du cancer colorectal en Bourgogne." Dijon, 1998. http://www.theses.fr/1998DIJOMU12.
Papin-Lefebvre, Frédérique. "L’organisation du dépistage des cancers en France : éthique et droits des patients." Thesis, Paris 5, 2013. http://www.theses.fr/2013PA05D008.
According 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
Moniquet, Charlotte. "Le frottis cervico-vaginal de dépistage à l'usage du médecin généraliste." Montpellier 1, 1989. http://www.theses.fr/1989MON11006.
Heuzé-Vourc'h, Nathalie. "Etude de l'expression du gène hKLK3 codant le PSA (Prostate-Specific Antigen), marqueur du cancer de la prostate." Tours, 2001. http://www.theses.fr/2001TOUR4008.
Quéreux, Gaëlle. "Apport d'un réseau de soins dans la prévention du mélanome." Nantes, 2009. http://www.theses.fr/2009NANT47VS.
The incidence of melanoma has risen dramatically so prevention became a priority in Public Health. Primary prevention is based on programs to reduce sun exposure of the population. Early detection is also promoted. To campaign for melanoma prevention we created in 2001 a network called "Réseau Mélanome Ouest". We realised 3 prospective studies. The first one concerned the impact of an educational program on both children's knowledge and behaviour towards the sun, comparing the answers to a control group in which the children did not receive any education al program about sun protection. The program had a beneficial effect on the child's knowledge persisting at least few months but had no impact on his behaviour toward the sun. The second one evaluated the impact of a campaign to train 210 general practitioners about early detection of melanoma. 36 of the doctors stated that they had detectee melanomas since the training over a median period of 27 months (2 to 39 months). The Breslow index of the melanomas detected ranged from 0. 16 to 4 mm ( median of 0. 65mm). The third one consisted in a targeted screening to identify high risk melanoma subject and to propose them a skin screening. So we created a self-administrated questionnaire for people to en able them to assess their own melanoma risk factors. We tested the validity of this questionnaire in a large prospective study: the answers given by the subject were systematically checked by his or her general practitioner. Then we realised a case-control study based on this questionnaire to identify the strongest risk factor and find a combination of the risk factors to distinguish between melanoma patients and cases
Bouret, Nathalie. "La campagne de dépistage du cancer colo-rectal par le test hemocult en Aquitaine : le rôle du pharmacien." Bordeaux 2, 1994. http://www.theses.fr/1994BOR2P047.
Di, Fiore Frédéric. "Contribution au développement d'analyses moléculaires d'intérêt diagnostique ou pronostique dans le cancer colorectal." Rouen, 2008. http://www.theses.fr/2008ROUE01NR.
Guillaume, Elodie. "Organisation collective du dépistage des cancers et réduction des inégalités sociales de santé." Thesis, Normandie, 2017. http://www.theses.fr/2017NORMC413/document.
In accordance with the WHO's observation, there are differences in health between different population groups in France, as elsewhere, which result from the social conditions in which people are born, grow, live, work and age.In France, the reduction of social inequalities in health is a political priority, notably through successive cancer plans, with cancers being the main pathologies that provide inequalities. These plans have led to the introduction of organized screening for colorectal cancer and breast cancer, for which social and territorial inequalities of participation as well as non-adherence factors are well documented and constitute potential targets for interventions. This thesis aims to provide new knowledge and evidence to guide the policies and organization of cancer screening based on evidence, particularly for the reduction of social inequalities and territorial. She presents two studies. PRADO is an interventional study with a collective randomization unit (Grouped Islets for Statistical Information (IRIS)) multicentric, stratified on the urban / rural character and precariousness of IRIS and conducted in two parallel groups (Intervention vs Control), from 2011 to 2013 in Picardy. In the intervention arm, in addition to the usual modalities of organized screening for colorectal cancer, a screening assistant contacted by telephone those who did not carry out the screening test in the two previous round. The study showed that this intervention has increased participation and identified the conditions under which this type of intervention could reduce social inequalities. The second study evaluates the interest of a mobile radiography (the mammobile) in organized breast cancer screening. A retrospective analysis of the Orne device on five screening rounds shows that this device makes it possible to reduce the social and territorial inequalities of participation in screening. The principle of proportional universalism, the multilevel and intersectorial nature of intervention, the application of the principle of literacy and respect for informed choice appear as the foundations of a public health policy aimed at reducing social inequalities in the cancer field. The optimal mode of evaluation of these so-called complex interventions remains a major research issue
Berchi, Célia. "Approches économiques de l'organisation du dépistage du cancer colorectal en France." Caen, 2004. http://www.theses.fr/2004CAEN0618.
Delbany, Maya. "Acquisition IRM optimisée en vue du dépistage du cancer du sein." Thesis, Université de Lorraine, 2019. http://www.theses.fr/2019LORR0018/document.
Diffusion-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.
Diffusion-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
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.
Lasset, Christine. "Perspective de dépistages dans un centre de lutte contre le cancer : bilan de la consultation specialisée du centre Léon Bérard." Lyon 1, 1990. http://www.theses.fr/1990LYO1M033.
Théberge, 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.
Lepoittevin-Bergeot, Claudine. "Etude prospective de l'acceptabilité et de la faisabilité de la rectosigmoïdoscopie flexible comme examen de première intention dans le dépistage individuel du cancer colorectal." Caen, 1991. http://www.theses.fr/1991CAEN3107.
Milanese, Jean-Sébastien. "Développement d'un algorithme permettant la prédiction des métastases à partir de mutations germinales et celles du clone fondateur chez des patients atteints du cancer." Master's thesis, Université Laval, 2018. http://hdl.handle.net/20.500.11794/28327.
With the constant progress in neext generation sequencing, the quantity of data available for investigation becomes massive. In parallel, cancer detection methods and treatments remain very specific and barely accurate. Moreover, the patients survival rate are directly linked with tumoral progression and therefore, to cancer detection methods. Despite continual technological advances in recent years, the global cancer mortality rate keeps rising. The creation of new detection methods accessible to all cancer types becomes a necessity. As of now, there is no model available that using sequencing data to predict cancer traits (ex: recurrence, resistance, etc.). The following sections demonstrate the creation of such model using somatic and germline mutations to predict recurrence and its applicability across all cancer types (and even across different diseases). By using gene signatures specific to each cancer types, we were able to obtain an accuracy of 90% (and more) for the cohort where the cancer was recurrent. To our knowledge, this is the first attempt to develop a model that can predict the patient’s prognosis using genome sequencing data. This will affect future studies and improve personalized medicine as well as cancer detection methods.
Rouhier, Marie-Laurence. "Dépistage des tumeurs colorectales : étude des tests de recherche de sang occulte dans les selles : à partir de données bibliographiques." Bordeaux 2, 1993. http://www.theses.fr/1993BOR23116.
Talavera, Anne-Marie Deville. "Le dépistage et la prévention du cancer du corps utérin, en particulier chez la femme ménopausée." Montpellier 1, 1988. http://www.theses.fr/1988MON11003.
Vabret, François. "Dépistage des hépatocarcinomes sur cirrhose : étude de quaranre et un cas hospitaliers, applications en médecine générale." Caen, 1990. http://www.theses.fr/1990CAEN3048.
Crochard-Lacour, Anne. "Évaluation des programmes de dépistage du cancer du sein par mammographie en France." Lyon 1, 1994. http://www.theses.fr/1994LYO1T309.
Guizard, 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.
Deby, Stanislas. "Développement d'un colposcope polarimétrique de Müller pour le dépistage du cancer du col utérin : premières mesures in-vivo." Thesis, Université Paris-Saclay (ComUE), 2017. http://www.theses.fr/2017SACLX021/document.
This thesis was devoted to the development and the implementation of a polarimetric imager of Müller installed on a standard colposcope in order to diagnose invivo precancerous lesions of the cervix.This work was based on the development carried out during the last ten years at the LPICM at the Ecole polytechnique of a new non-invasive medical imaging technology and a priori adapted to the early detection of cancer: polarimetric imaging
Benhamiche, Anne-Marie. "Épidémiologie descriptive des cancers digestifs : incidence, prévalence, tendances chronologiques." Dijon, 2000. http://www.theses.fr/2000DIJOMU05.
Fantini-Hauwel, Carole. "Approche cognito-émotionnelle des prédispositions génétiques aux cancers colorectaux." Aix-Marseille 1, 2006. http://www.theses.fr/2006AIX10103.
Céruse, Philippe. "Intérêt d'un nouveau marqueur tumoral sérique le Cyfra 21-1 dans les carcinomes des voies aéro-digestives supérieures." Lyon 1, 2003. http://www.theses.fr/2003LYO1T188.
Sobol, Hagay. "Prédisposition génétique au cancer : l'exemple du cancer médullaire de la thyroïde : localisation génique et proposition de dépistage des individus à risque." Lyon 1, 1990. http://www.theses.fr/1990LYO1T120.
Blanc-Jaques, Fabienne. "Dépistage du carcinome hépatocellulaire chez les cirrhotiques : étude prospective sur cinq ans." Montpellier 1, 1995. http://www.theses.fr/1995MON11184.
Lounis, Hafida. "Dépistage des événements génétiques impliqués dans le cancer épithélial de l'ovaire chez la femme." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0015/NQ43730.pdf.
Morlais, Fabrice. "Développements statistiques pour l'évaluation de techniques innovantes dans le dépistage du cancer broncho-pulmonaire." Caen, 2011. http://www.theses.fr/2011CAEN3052.
The main objective of this thesis is to propose new statistical methods for improving lung cancer screening tools. We compared the performance of lung cancer screening by chest radiograph and by low radiation chest CT scan. We quantified the cost associated with extra false positives generated by chest CT scan in order to detect one extra true positive compared with chest radiograph. In order to comprehensively account for available information on sputum cell samples, we proposed two statistical methods for evaluating cytological data. These methods consider that an individual is represented by the probability density of measurements conducted on his/her sputum cells. The first method compares the quantiles of probability density. The second method compares density curves through the development of a functional data analysis discrimination model. These two methods were tested on a case-control study composed of 22 sputum samples from subjects presenting with lung cancer and on 25 sputum samples from healthy subjects
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.
Employing 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
Mil, 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.
Background. 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
Boulard, Annick. "Stratégies de dépistage de masse des tumeurs colo-rectales : mise au point d'un modèle mathématique." Bordeaux 2, 1989. http://www.theses.fr/1989BOR23033.
Kadaoui, 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.
Tchuente, 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.
In 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
Angermann, Quentin. "'Détection temps réel assistée par ordinateur pour le dépistage précoce du cancer colorectal en vidéocoloscopie'." Thesis, Cergy-Pontoise, 2018. http://www.theses.fr/2018CERG0926/document.
This manuscript presents the work carried out for the development of a new tool dedicated to real-time computer-assisted detection for the detection of colorectal polyps in videocoloscopy, in the context of early detection of colorectal cancer. This cancer remains today associated with a high mortality rate when detected too late. A such tool could help to improve medical care.First of all, an analysis of the state of the art makes it possible to highlight the limitations of current methods. It is then possible to determine the scientific and technical positioning to adopt in order to create an innovative tool dedicated to this detection task.A first phase dedicated to the analysis of still frames confirms or invalidates the possible scientific choices and thus develops an approach in accordance with the constraints imposed by clinical use (processing time, performance in particular). This first method is able to detect polyps in less than 40 milliseconds per image, which is compatible with real time, with good performance (F1 Score of 47.55%).Logically, we are interested in the detection of polyps in videos, which allows to get closer to real exams. In particular, several optimizations (such as temporal coherence) are proposed to benefit from video. The tool is then able to alert the doctor about the presence of polyps in 97.6% of cases (on a set of 36 videos) in real time with only an average processing time of 23 milliseconds per frame.In the end, this tool, which can alert the doctor of the presence of colorectal polyps in real time during the examination, could therefore be part of the clinical routine of videocoloscopy. Future clinical trials will identify possible limitations to be overcome
Le, Bonniec Alice. "Les déterminants psychosociaux de la participation au dépistage du cancer colorectal : enjeux de l’arrivée du nouveau test immunologique." Thesis, Montpellier 3, 2018. http://www.theses.fr/2018MON30014/document.
IntroductionColorectal cancer is the second leading cause of cancer deaths in France (HAS, 2013) but also the third most common cancer (INCa, 2014). An organized screening programme has been put in place since 2008, but participation rates remain low: 33.5% in France (Santé Publique France, 2018). According to the literature, the main barriers to participation in screening are the lack of confidence in the health care system (Clavarino et al, 2004) ; embarrassment, discomfort and dissatisfaction accompanying testing procedures (Varela et al, 2010); or lack of time. Finally, the lack of general practitioners’ recommendations is one of the most significant obstacles (Walsh et al, 2010, Powell et al, 2009). The Hemoccult II test, used as part of organized screening until March 2015, was replaced by a new immunological test, considered more sensitive, more specific and more reliable by the medical community (INCa, 2014).Objectives and methodFaced with the low screening rates and main obstacles identified in the literature, this thesis aims at analyzing the determinants of screening participation, with both patient and general practitioner points of view. Moreover, it appears necessary to evaluate issues with the arrival of the new immunological test.This doctoral work is based on the technique of triangulation (theoretical, methodological and data triangulation). More precisely, two validated and recognized theoretical frameworks in health and social psychology were employed, namely the Theory of Social Representations (Moscovici, 1984), and the Theory of Planned Behaviour (Ajzen et al, 1991), allowing the adoption of a comprehensive approach as well as a predictive approach to studying screening participation. Three studies have been set up:- A qualitative study through semi-structured interviews, conducted with 17 general practitioners, aimed at understanding their social representations of colorectal cancer screening and how it can be anchored in their practice of recommendation;- A qualitative study by focus groups, conducted with 29 participants from the general population. The objective was to apprehend their social representations of colorectal cancer screening as well as the obstacles and facilitators to screening participation.- A quantitative study by questionnaire, including 160 participants from the general population, endeavours to identify the key predictors of colorectal cancer screening intention and behaviour.Main resultsThe analysis of interviews revealed an inconsistency between the role general practitioners think they should play with patients in prevention and screening, and the reality of their practice which leaves them insufficient time to devote to it. The focus group analysis revealed that the main barriers to participation in screening are: the lack of accessibility of the test (needing to consult the general practitioner in order to obtain the screening kit), a low concern for prevention, but also the fact that colorectal cancer refers to a body part that is deemed taboo, and considered “dirty”. Finally, the analysis of questionnaires allowed the identification of several variables influencing intention and behaviour of screening, namely: previous screening behaviour, frequency of screening, denial, social proximity, social norms and perceived behavioural control. Analysis particularly emphasized the value of perceived behavioural control, which can directly influence behaviour without going through intention.ConclusionResults reveal the relevance of combining a comprehensive approach with a predictive approach. Our perspectives suggest the implementation of interventions aimed at improving the perceived level of control of the general population faced with this screening