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Master Thesis

Pratique des médecins généralistes devant un frottis cervico-utérin anormal : état des lieux et évaluation de l'utilisation des recommandations INCa de décembre 2016 auprès des médecins généralistes des Bouches du Rhône

Abstract : Introduction: In France, cervical cancer is a major public health concern with 3000 new cases and around 1100 deaths per year. General practitioners have a central role in prevention and screenings of cervical cancers and pre-malignant lesions, especially by performing smear tests which are the leading detection assays. The aim of this study was to evaluate the management of abnormal smear results by general practitioners in comparison with the last recommendations published by INCa (French National Institute of Cancer) in December 2016. Material Methods: This transversal quantitative study is based on a survey made by 341 general practitioners located in Bouches-du-Rhône (South of France). Results: 118 surveys were collected between March and July 2018. The statistical results obtained showed that 48.3% of general practitioners perform smear tests by themselves, 16.1% of them give a prescription and 35.6% send their patient to a gynecologist. The study also reveals that general practitioners who perform most of smear tests are women under 45 years. For a diagnosis of ASC-US smear, a HPV test is suggested by 35.6% of family doctors for women under 30 years and by 33.9% for women over 30 years; For an abnormal cytology corresponding to LSIL, ASC-H or HSIL types, a colposcopy is immediately suggested by respectively 62.7%, 73.7% and 84.7% of interviewed practitioners. For AGC smears, the survey reveals that the procedure is not well-known and p16/Ki67 double immunostaining is almost never performed. 55.1% of practitioners were not aware of the last published recommendations. Among the 22.1% of practitioners who discovered these recommendations, mostly during a national conference of a dedicated DPC, 73.1% (n=19) of them reported that these recommendations facilitate the procedure. Conclusion: The knowledge of general practitioners regarding the last recommendations published by INCa in December 2016 is not optimal. The trend observed with medical demography curves will get the practitioners to perform and interpret more and more smear tests. The university reforms and the medical continuing education through evaluation of professional practices recently evolved but still have to be improved as they represent the main key for an optimized diagnosis of cervical cancer in general medicine. For this reason, a quality insurance is mandatory and the management of large organized cancer screenings represent a public health challenge.
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https://dumas.ccsd.cnrs.fr/dumas-02086287
Contributor : Faculté de Médecine Amu <>
Submitted on : Monday, April 1, 2019 - 11:47:48 AM
Last modification on : Monday, July 6, 2020 - 4:47:00 PM
Long-term archiving on: : Tuesday, July 2, 2019 - 1:26:06 PM

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Andréa Urbain. Pratique des médecins généralistes devant un frottis cervico-utérin anormal : état des lieux et évaluation de l'utilisation des recommandations INCa de décembre 2016 auprès des médecins généralistes des Bouches du Rhône. Sciences du Vivant [q-bio]. 2018. ⟨dumas-02086287⟩

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