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Prévention du col de l'utérus : étude dans un département français, la Côte-d'Or

Abstract : Two complementary prevention tools exist for cervical cancer : HPV vaccination (Human Papillomavirus) and screening using Pap smear. Despite these effective tools, this cancer is responsible for 1,000 deaths each year in France, mostly in women who are not in accordance with the national recommendations regarding screening. Our first article, using data from the registry of gynecological cancers of Côte-d'Or, aimed to identify factors associated with mortality from cervical cancer. A significant association between non adequate follow up by screening and death was found. Association with socio-economic vulnerability and cancers was also noticed.The purpose of our second article was 1) to assess HPV vaccine coverage in a representative population of girls, aged 14 and above, attending school in Côte-d'Or and 2) to identify correlates of vaccines initiation and completion. A cross-sectional study was carried out between October 2010 and May 2011 in 948 girls. Vaccine initiation rates were 42.1% among 14-year-old girls and 57.3% among the oldest, insufficient to achieve optimal vaccination efficacy. Parental concerns about the acceptability of HPV vaccination were found and barriers to vaccination initiation and completion were complex. Girls had poor and confuse knowledge about sexually transmitted diseases in general and HPV in particular.Our third article deals with cervical and colorectal cancers screening in a population of women living in Côte-d'Or and up to date for breast cancer screening. In France, cervical cancer screening is an individual initiative, unlike screenings for breast and colorectal cancers, which are organized at a national level. Overall, 1856 women aged 50 to 65 returned a self-reported questionnaire delivered by post. The objective was to determine participation rates and factors associated with participation in both colorectal and cervical cancer screenings. Respectively 78.3% and 56.6% women were up to date for the two screenings with disparities regarding socioeconomic status and health care facilities access.Additional questions have to be explored on these two complementary modes of prevention. Follow up of cohorts of vaccinated girls will allow assessing the impact of vaccination on the incidence of cervical cancers, HPV epidemiology and the protection afforded against other HPV positive cancers. It is also important to define how vaccinated girls should be screened. HPV tests in this context are promising.
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Aurélie Bertaut. Prévention du col de l'utérus : étude dans un département français, la Côte-d'Or. Médecine humaine et pathologie. Université Bourgogne Franche-Comté, 2017. Français. ⟨NNT : 2017UBFCI001⟩. ⟨tel-02084886⟩



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