Manon Britel will defend her thesis
on Friday 14th February 2020 at 2:00 pm
at Lyon 2 University, Quai du Rhône Campus
86 Rue Pasteur
Professor Laurent Auzoult, Dijon University, Reporter
Professor Christine Binquet, CHU de Dijon, Examiner
Professor Michel Bourguignon, Paris Saclay University (UVSQ) - IRSN, Examiner
Professor Bruno Quintard, Bordeaux University, Examiner
Professor Marie Préau, Lumière Lyon 2 University, Thesis supervisor
Professor Aurélie Untas, Paris Descartes University, Reporter
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 ; Colin et al, 2017). However, health professionals in the field have different opinions about this issue (IRSN, 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 Cancer Institute (INCa 2014b) 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 decisionmaking 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).
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.
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.
The results 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 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).
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 decisionmaking models and opens up new research perspectives for general practitioners and gynaecologists, who prescribe mammograms for women under 50 years of age.