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AbstractAbstract
[en] Context and issues: In the context of a significant and constant increase in exposure to ionizing radiation (IR) in medical imaging, an ever-increasing number of studies on radiation-induced risks in medical imaging are being published (Mathews, 2013; Pijpe, 2012, Colin, Foray, Di Leo, Sardanelli, 2017). However, health professionals in the field have different opinions about this issue, as do scientists (IRSN, 2006, 2012). While the risks of radiation-induced cancers associated with low doses of IR - especially in women under 50 who perform screening mammograms - may be considered a necessary evil by some radiologists, others are less of this opinion. Although the French National Health authority (HAS) (HAS, 2011) and the French National Cancer Institute (INCa) (2014b, 2017a) have provided recommendations to address this issue, healthcare practices do not seem to have changed sufficiently. This PhD thesis in social psychology of health aimed to investigate public health issues related to exposure to IR in screening mammograms by integrating the interactions between individuals, the social and cultural context, and the object studied (Apostolidis, Dany, 2012). The research work focused on understanding what guides radiologists' and women's decision-making processes in terms of performing breast-cancer screening or not, in the French context. Social representations theory (Moscovici, 1961) was used, as it constitutes a suitable theoretical basis to investigate the sociogenesis of knowledge when confronted with an unknown and abstract object, or radiation-induced risks in the present context (Apostolidis, Duveen, Kalampalikis, 2002, Jodelet, 1989). Research question: Linking practical field issues with theoretical perspectives, we aimed to investigate the social representations of mammograms, particularly regarding the IR dimension, and the perception of the risks associated with them, especially in women under 50 years of age. Methods: To study this question, four studies were conducted: A study of a corpus of 236 institutional documents, to gain a better understanding of both the national context, and public health institutions' points of view about breast cancer screening in France. A study of a corpus of 430 articles from the mainstream press, to identify common language elements regarding screening mammograms. A study of 1,300 women, representative of the French population, to investigate their representations of screening mammograms. A study of 292 radiologists, to explore their representations and perceptions of the risks associated with screening mammograms. Results: The results of the four studies helped highlight the social health norms linked to the decision to have a screening mammogram in women under 50 years of age in France. The majority of radiologists surveyed seemed to agree with the need for mammograms in young women, despite the fact that national recommendations call for caution. Data triangulation showed that radiologists' and women's representations of this examination are rooted in a social context of prevention. Data analysis also made it possible to understand the social representations network which encompasses the risks associated with screening mammograms. However, the radiation-induced risks seem to be absent from the objectification process of the sociogenesis of the women's network. This result raises the question of whether women are indeed well informed about IR-related risks when deciding to be screened or not (Gesbert, Mamzer, 2016, Rakowski, 1993). Conclusion: Individual screening for breast cancer seems to be part of a global context advocating early detection to help best define the cancer. Nevertheless, cancer prevention seems to take priority over providing women with exhaustive information about the ionizing radiation used in mammograms. The present work invites us to question health decision-making models and opens up new research perspectives for general practitioners and gynaecologists, who prescribe mammograms for women under 50 years of age. (author)
[fr]
Contexte et enjeux: Dans un contexte d'augmentation significative et durable de l'exposition aux rayonnements ionisants (RI) en imagerie medicale, un nombre croissant de travaux sur les risques radio-induits en medecine ont ete publies (Mathews, 2013; Pijpe, 2012; Colin, Foray, Di Leo, Sardanelli, 2017). Pourtant, cette question ne fait pas consensus, tant aupres des scientifiques que des professionnels de sante concernes (IRSN, 2006; 2012). En effet, les risques de cancers radio-induits associes aux faibles doses de RI, notamment chez les femmes de moins de 50 ans qui realisent des mammographies de depistage, sont tantot consideres comme essentiels dans la pratique de certains radiologues ou au contraire, tantot deconsideres. Bien que la HAS (HAS, 2011) et l'INCa (2014b, 2017a) aient mis en place des recommandations visant a border cette question, les pratiques semblent heterogenes. Ce travail de these en psychologie sociale de la sante vise a investiguer les enjeux de sante publique liee a l'exposition aux RI en mammographie de depistage, en integrant les interactions entre les individus, le contexte social et culturel, et l'objet etudie (Apostolidis, Dany, 2012). Il s'agit de comprendre ce qui guide les pratiques a la fois des radiologues et des femmes effectuant ou non le depistage, dans les specificites du contexte francais. La theorie des representations sociales (Moscovici, 1961) constitue en ce sens un ancrage solide pour apprehender la sociogenese des connaissances, face a l'objet meconnu et abstrait que sont les risques radio-induits (Apostolidis, Duveen, Kalampalikis, 2002; Jodelet, 1989). Problematique: Fondee sur l'articulation entre enjeux de terrain et perspectives theoriques, cette these vise a investiguer les representations sociales de la mammographie, notamment son caractere irradiant, ainsi que la perception des risques qui lui sont associes, dans le cas specifique des femmes de moins de 50 ans. Methodes: Pour etudier cette question, quatre operations methodologiques ont ete menees: etude d'un corpus de 236 documents institutionnels visant a apprehender, dans le contexte national, le point de vue des institutions de sante publiques au sujet du depistage du cancer du sein en France. etude d'un corpus de 430 articles issus de la presse grand public visant a recueillir les elements de langage transmis dans le sens commun a propos de la mammographie de depistage. etude aupres de 1300 femmes representatives de la population francaise visant a investiguer les representations de la mammographie de depistage. etude aupres de 292 radiologues afin d'interroger leurs representations et leurs perceptions des risques associes a la mammographie de depistage. Resultats principaux: Les resultats des differentes etudes permettent de mettre en evidence les normes sociales de sante favorisant les comportements de depistage chez les femmes de moins de 50 ans. De plus, la majorite des radiologues interroges semble en accord avec le fait de realiser des mammographies chez les femmes jeunes, bien que les recommandations nationales invitent a la prudence. La triangulation des donnees montre jusqu'a quel point le rapport a cet examen est ancre dans un contexte social fortement oriente vers la prevention. L'analyse des donnees a egalement permis d'apprehender le reseau des representations sociales dans lequel s'inscrivent les risques associes a la mammographie de depistage pour les radiologues. Cependant, les risques radio-induits semblent absent du processus d'objectivation de la sociogenese du reseau des femmes. Ce resultat questionne l'information faite aux femmes dans un contexte de decision medicale (Gesbert, Mamzer, 2016; Rakowski, 1993). Conclusion: Le depistage individuel du cancer du sein semble s'inscrire dans un contexte global partisan du depistage precoce, pour aider a circonscrire au mieux le cancer. Neanmoins, la prevention du cancer semble se faire au detriment d'une information exhaustive pour les femmes en ce qui concerne les rayonnements ionisants utilises en mammographie. Ce travail invite alors a se questionner sur les modeles de prise de decision en sante et il ouvre des perspectives de recherche autour des questions de depistage aupres des medecins generalistes et gynecologues, prescripteurs de la mammographie chez les femmes de moins de 50 ans. (auteur)Original Title
Analyse psychosociale de la radioprotection en mammographie de depistage. Perspectives pour l'IRSN
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14 Feb 2020; 362 p; [440 refs.]; Available from the INIS Liaison Officer for France, see the INIS website for current contact and E-mail addresses; These de Doctorat de l'Universite de Lyon, Discipline: Psychologie
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