There is increasing interest in the use of adjuvant hormonal therapies, which are given after the resection or destruction of all gross disease, in early-stage prostate cancer, as a significant proportion of patients experience progression and/or die from the disease despite undergoing therapy with curative intent. Several retrospective studies suggest that adjuvant hormonal therapy may improve long-term outcome after radical surgery in men with positive lymph nodes, although this approach has yet to be studied in a prospective setting. No studies of adjuvant therapy for patients with extracapsular extension at surgery have been completed, but in an interim analysis of an open controlled trial, adjuvant flutamide significantly improved progression-free survival at 4 years. Three prospective studies in the radiotherapy setting have shown that adjuvant luteinizing hormone-releasing hormone (LH-RH) agonist therapy significantly improves progression-free and/or overall survival. Future studies need to define patient subgroups who will benefit most from adjuvant therapy. The side effects of the different therapeutic options also need to be compared. It is hoped that many of the outstanding questions concerning adjuvant hormonal therapy will be answered by the ongoing Bicalutamide Early Prostate Cancer Programme. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

As neoplasias mamárias em cadelas são afecções de significativa importância em medicina veterinária pela sua alta frequência, além de serem modelo para o estudo do câncer de mama na mulher. Nesse sentido, se faz necessária a realização de estudos continuados acerca da frequência de tumores e suas características clinicopatológicas. Constituem ainda um grupo heterogêneo de tumores quanto aos padrões histológicos e comportamento biológico, o que torna mais complexo e urgente a identificação de fatores de prognóstico e que possibilitem diagnosticar e tratar de forma mais eficaz animais portadores de tumor de mama. Nos últimos anos, tem se intensificado estudos dirigidos à identificação de marcadores moleculares envolvidos nos inúmeros eventos celulares que ocorrem durante a carcinogênese, como crescimento e diferenciação celular, proliferação, invasão e metástase. O receptor do fator de crescimento epidérmico humano tipo 2 (HER-2) é uma glicoproteína de membrana da família tirosina-quinase, codificada por um gene de mesmo nome, diretamente relacionada a mudanças significativas na proliferação celular e sobrevivência das células tumorais. Durante o processo de mutação desse gene ocorre hiperativação da cascata de sinalização intracelular, que resulta em rápido crescimento das células tumorais. Na mulher, a superexpressão de HER-2 está associada a neoplasias mamárias cujos parâmetros morfológicos sugerem malignidade e pior prognóstico, resultando em alta taxa de recidiva e de mortalidade no estágio inicial da doença, além de elevada incidência de metástases. Entretanto, na cadela, estudos que investigaram o papel do HER-2 nas neoplasias mamárias, com emprego da imunohistoquímica, não são consensuais até então, mantendo obscuro o significado da sobrexpressão de HER-2 nestas neoplasias. Com intuito de auxiliar na determinação de fatores prognósticos fidedignos para os tumores mamários nas cadelas, o presente trabalho teve como objetivos: determinar a prevalência de lesões mamárias diagnosticadas em cadelas no Laboratório de Patologia Veterinária da Universidade Federal de Uberlândia entre 2004 e 2014, bem como a relação entre aspectos epidemiológicos (idade e raça) e clínicopatológicos (ulceração, tamanho do tumor e comportamento biológico) na ocorrência dos tumores de mama; e verificar a expressão de HER-2 em carcinomas mamários de cadelas e sua relação com o tipo e grau histológico, idade das cadelas, metástase em linfonodos e à distância, tamanho tumoral e estadiamento clínico. / Mammary tumors in female dogs are important diseases in veterinary medicine due to their high frequency, besides being a model for the study of breast cancer in women. So, it is necessary to continuous studies on the frequency of tumors and their clinicopathological characteristics. They also constitute a heterogeneous group of tumors in correlation with histological patterns and biological behavior, which makes it more complex and urgent to identify prognostic factors and to make it possible to diagnose and treat animals with mammary tumors more effectively. In the last years, there have been intensified the number of studies about the identification of molecular markers involved in the innumerable cellular events that occur during carcinogenesis, such as cell growth and differentiation, proliferation, invasion and metastasis. HER-2 is a membrane glycoprotein of the tyrosine kinase family, encoded by a gene with the same name, directly related to significant changes in cell proliferation and survival of tumor cells. During mutation process of this gene, hyperactivation of intracellular signaling cascade results in a rapid growth of tumor cells. In women, HER-2 overexpression is associated with breast neoplasms whose morphological parameters suggest poor prognosis and malignancy, resulting in a high rate of recurrence and mortality in the early stage of the disease, as well as a high incidence of metastases. However, in the female dog, until now the extensive variability of results obtained from immunohistochemical protocols proposed for molecular classification, keeps the meaning of HER-2 overexpression in these neoplasms obscure. In order to assist determination of the reliable prognostic factors for canine breast neoplasms, the present study: determined the prevalence of breast lesions diagnosed in female dogs in Laboratory of Veterinary Pathology of the Federal University of Uberlândia between 2004 and 2014, as well as the correlation between epidemiological aspects (age and breed) and clinicopathological (ulceration, tumor size and biological behavior) in the occurrence of breast tumors; verified the HER-2 expression in female mammary carcinomas of dogs and their relationship with the type and histological grade, age of patient, metastasis in lymph nodes or distants, tumor size and clinical staging. / Tese (Doutorado)

Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2018-09-04T15:39:47Z No. of bitstreams: 1 homerogoncalvesjunior.pdf: 2526505 bytes, checksum: e3bc0f5bc2176febea8072cc318baab6 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2018-09-04T15:52:35Z (GMT) No. of bitstreams: 1 homerogoncalvesjunior.pdf: 2526505 bytes, checksum: e3bc0f5bc2176febea8072cc318baab6 (MD5) / Made available in DSpace on 2018-09-04T15:52:35Z (GMT). No. of bitstreams: 1 homerogoncalvesjunior.pdf: 2526505 bytes, checksum: e3bc0f5bc2176febea8072cc318baab6 (MD5) Previous issue date: 2018-07-06 / O tratamento do câncer de mama baseia-se na classificação dos casos, em termos de estadiamento e do perfil biomolecular. Os Tumores Triplo Negativos (TTN) representam um grupo especial de neoplasias mamárias que não expressam receptores hormonais e nem o antígeno Her2. São considerados agressivos e de pior evolução, e quando estudados em particular, apresentam muita heterogeneidade. Importa saber se a caracterização dos tumores como Triplo Negativos, é suficiente para delimitar o grupo em termos de prognóstico e terapêutica. Este estudo teve como objetivo comparar os aspectos clínico-epidemiológicos dos Tumores Triplo Negativos em relação aos Não Triplo Negativos, em coorte de mulheres com câncer de mama assistidas em centros oncológicos de referência de Juiz de Fora, Minas Gerais. A sobrevida global e a sobrevida livre de doença foram calculadas pelo método de Kaplan Meier, e as curvas de sobrevida foram avaliadas pelo teste de Log-Rank, nos subgrupos Triplo Negativos e Não Triplo Negativos (NTN). Os fatores prognósticos foram comparados pelo modelo de riscos proporcionais de Cox. Os Tumores Triplo Negativos apresentaram diferenças demográficas em relação aos NTN, com acúmulo de pacientes não brancas e de baixo nível sociocultural; e ainda com aspectos de maior gravidade ao diagnóstico. A evolução também foi pior, tanto em termos de sobrevida global quanto sobrevida livre de doença dentre os TTN. Na análise univariada, os fatores: idade, cor da pele, escolaridade, tamanho do tumor e grau tumoral, estado das axilas e estadiamento, bem como taxas elevadas dos marcadores P53 e Ki 67, se mostraram associados a sobrevida livre de doença nos Tumores Não Triplo Negativos. No cálculo da sobrevida global, essas variáveis se mantiveram, exceto a idade; e foi constatado maior risco para as mulheres oriundas do serviço público de saúde, bem como o surgimento de metástases no decurso do seguimento. Para os Triplo Negativos, a análise univariada mostrou influência do estado axilar e estadiamento na sobrevida livre de doença; e os mesmos fatores acrescidos do surgimento de metástases, para a sobrevida global. Na análise multivariada a escolaridade e o estado axilar representaram risco à sobrevida livre de doença para NTN, enquanto a cor da pele e o estadiamento para a sobrevida global. Quanto aos TTN, sua evolução se mostrou ligada a dois aspectos: o comprometimento axilar para sobrevida livre de doença e global; e também a multicentricidade para a sobrevida global. Os Tumores Triplo Negativos aparentam ter biologia bem diversa dos Não Triplo Negativos, na dependência dos componentes histológicos e moleculares que portam. A classificação molecular por imunoistoquímica se mostrou capaz de identificar os dois grupos tumorais e auxiliar na orientação terapêutica. / Current breast cancer treatment is based on the classification of tumor stage and molecular profile. Triple-negative breast cancer (TNBC) is a specific subset of tumors characterized by the absence of hormone and HER2 receptors. Despite being usually associated with a more aggressive clinical course, there is high heterogeneity within TNBC. Therefore, it has been questioned whether current classification of TNBC is adequate enough to assess its prognosis and make therapeutic decisions. This study thus aimed to investigate to which extent TNBC profile classification was able to efficiently distinguish this tumor subtype from other subtypes of breast cancer. It was performed on a cohort of women with breast cancer treated at referral centers in Juiz de Fora, Southeastern Brazil. Overall and disease-free survival and prognostic factors were assessed and compared for TNBC and non-TNBC. Survival functions were calculated using the Kaplan-Meier method, and the log-rank test was used to compare the survival curves. Prognostic factors were analyzed by the Cox proportional hazards model. TNBC presented demographic differences compared to non-TNBC as it was more prevalent among nonwhite and less educated women. TNBC also presented at diagnosis with clinical parameters of advanced disease and had overall and disease-free survival significantly lower than non-TNBC. In univariate analysis the factors: age, color of the skin, education level, size and degree of tumor, axillary status and staging, as well as high rates of P53 e Ki 67 have been shown to be associated with disease-free survival in non-TNBC. These variables remained the same in the calculation of overall survival except for age; and it was also observed a greater risk for women from the public health service as well as the appearance of metastases during the follow-up. In multivariate analysis education level and axillary lymph node involvement presented a risk for disease-free survival while the color of skin and staging, for overall survival in non-TNBC. Regarding TNBC, its evolution was related to two aspects: axillary impairment for disease-free and global survival and multicentricity for overall survival. TNBC presents distinct biological properties compared to non-TNBC, which seems to be related to its specific histological and molecular components. The molecular classification by immunohistochemistry showed to be able to identify the two tumor groups and to support the therapeutic orientation.

Submitted by Ubirajara Cruz (ubirajara.cruz@gmail.com) on 2016-09-21T16:39:07Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) dissertacao_daniela_silva.pdf: 1064609 bytes, checksum: 8a6b89b15f9df72c182d7fe50c38554f (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2016-09-21T16:49:28Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) dissertacao_daniela_silva.pdf: 1064609 bytes, checksum: 8a6b89b15f9df72c182d7fe50c38554f (MD5) / Made available in DSpace on 2016-09-21T16:49:28Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) dissertacao_daniela_silva.pdf: 1064609 bytes, checksum: 8a6b89b15f9df72c182d7fe50c38554f (MD5) Previous issue date: 2014-02-28 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / O presente trabalho é constituído por estudos que visam avaliar potenciais marcadores prognósticos para tumores mamários caninos. Realizou-se um levantamento retrospectivo dos dados do Laboratório Regional de Diagnóstico da Faculdade de Veterinária da Universidade Federal de Pelotas (UFPel) acerca da casuística de dados clínico-patológicos de paciente com tumores mamários em diferentes períodos entre 2000-2012. A dissertação está apresentada na forma de dois artigos científicos. O primeiro artigo consiste da avalição do valor prognóstico do método de graduação de Elston e Ellis (1991). Foram avaliados 218 tumores. Verificou-se que a relação entre o tipo de tumor e tempo de sobrevida dos pacientes foi significativo (p<0,0001); que a maioria dos tumores pertenciam ao grau II (77/144-53.52%) e o grau tumoral influencia no tempo de sobrevida (p<0,0447). No segundo artigo estudou-se a possibilidade do uso da mensuração da densidade microvascular como fator prognóstico em tumores mamários caninos. Inicialmente dois métodos diferentes de mensuração de densidade vascular (campos aleatórios e hot-spot) foram avaliados e demonstrou-se que são equivalentes. Verificou-se que tanto a contagem de campos aleatórios ou contagem em áreas de intensa proliferação vascular apresentam resultados similares. Nos 218 neoplasmas avaliados não houve relação significativa entre o tipo histológico e o grau em relação a mensuração densidade microvascular, avaliadas pelos 2 métodos. Tumores de grau I apresentaram mais vasos que os de grau II e III. Conclui-se que no presente trabalho os carcinossarcomas foram os tumores mais prevalentes na casuística avaliada; que a associação do tipo e grau histológico tem valor prognóstico, enquanto que densidade microvascular não é um bom fator prognóstico para tumores mamários caninos. / This manuscript aims evaluate potential morphological prognostic factors to canine mammary tumors. Retrospective chart reviews of data from the Regional Diagnostic Laboratory were carried out to obtain the clinical and pathological features of the patients and mammary tumors in different periods from 2000 to 2012. The dissertation will be presented as two scientific manuscripts. The first manuscript aims the evaluation of the prognostic graduation method of Elston e Ellis (1991). A total of 218 tumors were evaluated. The relationship between tumor type and survival time were significant (p<0.0001). It was observed a preponderance of grade II (77/144-53.52%) tumors and also that the tumor grade can influence survival time (p<0.0447). The second manuscript evaluates the microvascular density as a prognostic factor in canine mammary tumors. Initially, two methods of mensuration (aleatory fields and hot spot) were evaluated and proved to be equivalent. In the 218 tumors evaluated no significant results were obtained in the comparison of histologic type or tumor grade with microvascular density evaluated by both methods. Grade I tumors presented more vessels than grade II or III tumors. It was possible to conclude that carcinosarcomas are the prevalent tumor type; association between tumor type and histologic grade could be used as prognostic factor. Microvascular density not consists in a good prognostic factor.

Submitted in partial compliance with the requirements for the Master’s Degree in Technology: Chiropractic, Durban University of Technology, Durban, South Africa, 2017. / Background: The increasing cost and prevalence of chronic low back pain (LBP), has resulted in more resources being devoted to its treatment and management than ever before, despite only approximately 10% of acute cases progressing to chronicity. Determining prognostic factors for the short-term improvement of acute and chronic patients with LBP has become a research focus area to try and identify baseline factors that may affect a patients’ improvement with conservative treatment. Internationally studies have been conducted in developed countries however similar studies are lacking in developing settings like South Africa. It is unclear if the prognostic factors identified would be similar across populations. Thus, this study aimed to determine if pain, disability (social and physical), anxiety, depression, work fear-avoidance and locus of control, were associated with short-term prognosis, as determined by self-reported improvement using a Patients Global Impression of Change (PGIC) scale, in acute and chronic LBP patients attending the Durban University of Technology Chiropractic Day Clinic (DUT CDC). Method: Consecutive patients seeking treatment at the DUT CDC with a new episode of non-specific LBP, who met the study criteria, were approached for participation in the study. On agreeing to participate they were given the Bournemouth Questionnaire (BQ), a demographic questionnaire and a letter of information and consent (LOIC) at the initial consultation by student chiropractors. Those participants that were still attending treatment at the 4th/5th and tenth visit were required to complete the BQ and the PGIC. Results: A hundred participants were enrolled in the study, 65% had acute LBP and 52% were male. Only 20% of the initial group were still attending treatment at the 4th/5th follow-up. Baseline comparisons of those with acute and chronic pain revealed no significant difference in gender or age. Acute patients at the initial visit had higher levels of disability (social and physical), anxiety, depression and fear-avoidance beliefs than the chronic pain participants. At the 4th/5th treatment, the acute pain patients showed a significant decrease in pain (p=0.002) and disability (p=0.032), with all other measures decreasing from baseline measures. Similarly, chronic pain participants had a significant decrease in pain (p=0.038) but a significant increase in depression (p=0.015) scores, with all other prognostic factors being rated higher than at the initial consultation. The majority of participants (85%) in this study reported a clinical improvement in their LBP. In the acute pain sufferers, all but one participant reported improvement, thus identification of prognostic factors or this group was not possible. In the chronic pain participants, no factors were identified as prognostic for improvement, regardless of the low numbers still attending at the 4th/5th visit. Conclusions: Trends suggested that chronic pain sufferers were less likely to report decreases in the prognostic factors (except for pain), when compared to the acute pain participants. In the chronic LBP participants, no factors were associated with improved prognosis. The predictive value in determining which patients were less likely to improve was limited in the current study due to a small sample size. / M

Purpose: To evaluate the validity of the Gleason score after neoadjuvant hormonal treatment as predictor of diseasespecific mortality after radical prostatectomy. Patients and Methods: A total of 2,880 patients with a complete data set and a mean follow-up of 10.3 years were studied; 425 of them (15%) had a history of hormonal treatment prior to surgery. The cumulative incidence of deaths from prostate cancer was determined by univariate and multivariate competing risk analysis. Cox proportional hazard models for competing risks were used to study combined effects of the variables on prostate cancer-specific mortality. Results: A higher portion of specimens with a history of neoadjuvant hormonal treatment were assigned Gleason scores of 8–10 (28 vs. 17%, p < 0.0001). The mortality curves in the Gleason score strata <8 vs. 8–10 were at large congruent in patients with and without neoadjuvant hormonal treatment. In patients with neoadjuvant hormonal treatment, a Gleason score of 8–10 was an independent predictor of prostate cancer-specific mortality; the hazard ratio was, however, somewhat lower than in patients without neoadjuvant hormonal treatment. Conclusion: This study suggests that the prognostic value of the post-radical prostatectomy Gleason score is not meaningfully jeopardized by heterogeneous neoadjuvant hormonal treatment in a routine clinical setting.

Patients and methods: Malignant supratentorial glioma (anaplastic astrocytoma, oligoastrocytoma, oligodendroglioma and glioblastoma incl. gliosarcoma), age 16-70y, KPS 50-100. Postoperative randomization to chemotherapy with either BCNU (B) (80 mg/m2 x 3 every 6 weeks) alone or additional VM 26 (V) (50 mg/m2 x 3 every 6 weeks) starting concomitant with radiotherapy. Central histopathological review was required. Primary endpoints were survival time (ST) and progression free survival (PFS) . In addition confirmative analysis of prognostic factors and their interaction with therapy was performed. Results: Eligible: 501 of 522 randomized pts: 82% WHO grade IV gliomas, 18% grade III gliomas. 57% male, mean KPS 74, mean age 50.9 years. The high incidence of lung toxicity – with a cumulative risk of 19% during the first year - was alarming. Survival was not significantly different ( median 50.3 (B) versus 52.4 (V) (weeks), but an increase in long term survivors was observed (18 months: 29% B, 34% V, 5 years 5% B, 12% V) and PFS showed a significant difference with a median of 31.4 (B) versus 34.3 (V) weeks. Qualitative interaction between KPS and therapy (p < 0.01) was demonstrated: pts with a KPS ≥ 70 benefited from additional VM26, those with reduced KPS < 70 did better with BCNU-monotherapy. Conclusion: Adding VM26 to BCNU is effective in the chemotherapy of malignant gliomas. Because of the demonstrated interaction with therapy performance status, not tumor grade is the crucial factor to determine application and aggressiveness of chemotherapy. With risk adapted therapy a significant proportion of patients even with glioblastoma survive for years in good general condition. BCNU should be replaced by an equipotent alkylans to avoid the unacceptable high rate of lung toxicity.

Background: Factors predicting survival in men with lymph node-positive prostate cancer are still poorly defined. Patients and Methods: 193 prostate cancer patients with histopathologically proven lymph node involvement with a median follow-up of 7.3 years were studied. 94% of patients received immediate hormonal therapy. Kaplan-Meier curves were calculated to evaluate overall survival rates and compared with the log-rank test. Cumulative disease-specific and competing mortality rates were calculated by competing risk analysis and compared with the Pepe-Mori test. Cox proportional hazard models were used to determine the independent significance of predictors of all-cause mortality. Results: Age (70 years or older vs. younger), Gleason score (8–10 vs. 7 or lower) and the number of involved nodes (3 or more vs. 1–2) were identified as independent predictors of all-cause mortality. When patients with 0–1 of these risk factors were compared with those with 2–3 risk factors, all-cause (rates after 10 years 21% vs. 71%, p < 0.0001), disease-specific (12 vs. 37%, p = 0.009) and competing mortality (9 vs. 33%, p = 0.02) differed significantly. Conclusions: Some of the excess mortality in patients with poor-risk lymph node-positive prostate cancer may be attributed to increased competing mortality, possibly caused by an interaction between comorbid diseases and hormonally treated persistent or progressive prostate cancer. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

There is increasing interest in the use of adjuvant hormonal therapies, which are given after the resection or destruction of all gross disease, in early-stage prostate cancer, as a significant proportion of patients experience progression and/or die from the disease despite undergoing therapy with curative intent. Several retrospective studies suggest that adjuvant hormonal therapy may improve long-term outcome after radical surgery in men with positive lymph nodes, although this approach has yet to be studied in a prospective setting. No studies of adjuvant therapy for patients with extracapsular extension at surgery have been completed, but in an interim analysis of an open controlled trial, adjuvant flutamide significantly improved progression-free survival at 4 years. Three prospective studies in the radiotherapy setting have shown that adjuvant luteinizing hormone-releasing hormone (LH-RH) agonist therapy significantly improves progression-free and/or overall survival. Future studies need to define patient subgroups who will benefit most from adjuvant therapy. The side effects of the different therapeutic options also need to be compared. It is hoped that many of the outstanding questions concerning adjuvant hormonal therapy will be answered by the ongoing Bicalutamide Early Prostate Cancer Programme. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Le cancer du sein est actuellement dans les pays occidentaux le premier cancer chez la femme, en termes d’incidence et de mortalité (taux standardisés de 101,5 et 17.7 pour 100 000 personnes années en 2005 respectivement). De très nombreux facteurs de risque et facteurs pronostiques sont déjà connus et étudiés, plusieurs axes de recherche sont développés sur toutes les étapes de la maladie, mais l’influence des facteurs socio-économiques et géographiques, aux niveaux individuel et environnemental n’avait pas encore été étudiée en France sur le cancer du sein.L’objectif général de ce travail était d’explorer cette influence par différents moyens afin d’en tirer des connaissances et une application pratique dans la prévention du cancer du sein, qu’elle soit primaire, secondaire ou tertiaire.Dans notre première étude nous avons montré que les femmes d’un niveau socio-éducatif faible étaient moins à même d’avoir bénéficié d’au moins une mammographie dans les 6 ans ou d’au moins un suivi gynécologique dans les 3 ans précédant leur diagnostic de cancer du sein. Egalement elles ont un stade de diagnostic plus avancé que les femmes de niveau socio-éducatif plus élevé. Ces variables sont ensuite retrouvées comme facteurs pronostiques péjoratifs de la survie. Dans notre seconde étude nous avons montré que l’accès à un chirurgien spécialisé dans les interventions du cancer du sein, gage d’une meilleure survie, était influencé par le niveau socio-économique du lieu de résidence de la patiente, ainsi que par son éloignement géographique par rapport aux centres de traitement de référence du cancer, où travaillent les chirurgiens spécialisés. Dans notre troisième étude nous avons montré qu’à l’inverse de nombre de cancers, l’incidence du cancer du sein était plus élevée dans les zones socio-économiquement plus favorisées, et ce quelle que soit la classe d’âge de la patiente, phénomène pour lequel nous n’avons pas vraiment d’explication, surtout pour les femmes les plus jeunes. Enfin dans notre quatrième étude actuellement en cours, nous avons pour objectif d’étudier au niveau individuel, conjointement avec le nouvel indice de défavorisation européen adapté à la France, en quoi le degré de richesse économique et sociale et la proximité des services médicaux des patientes atteintes de cancer du sein joue sur le stade de la tumeur, l’accès et les modalités de traitement, et la survie. / In developed countries, breast cancer is currently the leading cancer in women in terms of incidence and mortality (standardized rate of 101.5 and 17.7 per 100,000 person-years in 2005, respectively). Many risk factors and prognostic factors have been studied and are well known. Research is under way with regard to every step in the development of breast cancer, but the impact of socio-economic and geographic factors, at the individual and environmental level with regard to the disease have never been studied in France.The general aim of this work was to explore the impact of these factors in different ways to build on our knowledge and to develop practical applications in the primary, secondary or tertiary prevention of breast cancer.In our first study, we showed that women with a low socio-educational level were less likely to have benefited from at least one mammography within the 6 years or at least one gynaecological consultation within the 3 years before the diagnosis of breast cancer. These women also had a more advanced tumour at diagnosis than did women with a higher socio-educational level. These variables also came to light as predictors of a poor prognosis in terms of survival. In our second study, we showed that access to a surgeon specialised in breast cancer surgery, which is associated with better survival, was influenced by the socio-economic level of the patient’s place of residence, as well as the distance between the patient’s home and reference centres for cancer treatment, where the specialised surgeons work. In our third study, we showed that in contrast to many cancers, the incidence of breast cancer was highest in the most socio-economically privileged areas, and this whatever the age of the patient. We have no explanation for this phenomenon, particularly with regard to the youngest age group of women. Finally, the aim of our fourth study, which is currently on-going, is to study at the individual level, using the new European deprivation index adapted to France, to what extent economic wealth and social standing, as well as the proximity of medical services for patients with breast cancer have an impact on tumour stage, access to treatment, treatment techniques and survival.