12028 Background: The relativesof cancer patients are at risk for developing emotional distress following the death of their loved one. The aim of this study was to analyze whether sending a condolence letter offering a post-mortem consultation with the referent oncologist to the relatives of patients who have died of cancer improve their long term reported outcomes, such as anxiety, depression and complicated grief. Methods: In this multicenter, prospective, randomized, academic trial, bereaved relatives, of cancer patients who died in hospital, were randomized between receiving a condolence letter (CL) suggesting post-mortem consultation versus no CL. At 3 months and 6 months after enrolment, anxiety (HAD-A), depression (HAD-D) and grief (Texas Revised Inventory of Grief [TRIG]) were assessed using self-administered questionnaires. Results: Of the 426 randomized relatives, 118 agreed to take part in the study, of whom 102 (49 CL, 53 no CL) completed the questionnaire 3 months after the relatives’ death and 92 (43 CL, 49 no CL) at 6 months. There was no differences in socio-demographic characteristics or history of depression between the two groups. Palliative care was involved for (69% CL, vs 52% non-CL) of patients, with no statistical difference between the two groups. At 3 months post enrolment, both anxiety and depression were significantly lower in the CL group than the non-CL group (mean HADS-A score 7.3 vs 9.4, p=0.026; mean HADS-D score: 5.4 vs 8.1, p=0.009). In addition, receiving a condolence letter was associated with less grief at patient’s death (past TRIG subscale: 20.7 vs 25.8, p<0.001), and less current grief (present TRIG subscale score: 45.7 vs 52.0, p=0.025). At 6 months, the HADS-D score was significantly lower in the condolence letter arm (mean score 5.7 vs 8.3, p=0.025), as was grief at patient’s death (past TRIG subscale: 21.5 vs 25.0, p=0.035). Only 5% of CL had a post mortem consultation. Conclusions: Sending a letter of condolence to relatives of cancer patients who have died in hospital may reduce subsequent grief, depression and anxiety in loved ones. Encouraging this widespread post mortem contact such as correspondence may be a non-drug alternative to reduce post-mortem depression and improve the bereavement process for relatives of cancer patients. Clinical trial information: NCT02861625 .

This round table is the result of an observation. The observation being that controlled human infection clinical trials (also called "infectious challenge" trials or "Controlled Human Infection Models", "CHIM") recommended or even encouraged in the context of vaccine developments in particular, are not carried out in France. However, there are no formal prohibitions within regulations or ethical principles, which point to the prior assessment of risks and benefits for individuals and for society. The participants in this Round Table thus wished to examine, through the prism of their respective disciplines, the scientific and medical relevance of conducting such trials in France and, if possible, to imagine the conditions under which they would be carried out, thus resulting in recommendations on (1) the advisability of their conduct in France (2), the conditions under which they would be implemented in terms of logistics and regulations, and (3) their social acceptability. The recommendations on which the participants of the Round Table came to an agreement are presented as the analysis progresses.

La présente table ronde est issue d’un constat : les essais cliniques d’infection contrôlée chez l’humain appelés également essais de « challenge infectieux » ou « controlled human infection models » ou « CHIM » recommandés voire encouragés dans le cadre, notamment- de développements vaccinaux, ne sont pas pratiqués sur le territoire français. Or, il n’existe pas d’interdit formel au sein de la réglementation ou des principes éthiques, qui se réfèrent à l’évaluation préalable des risques et des bénéfices pour la personne et pour la société. Les participants à cette table ronde ont ainsi souhaité examiner, à travers le prisme de leurs disciplines respectives, la pertinence que présenterait la conduite de tels essais en France sur les plans scientifique et médical et, s’ils s’avéraient possible, imaginer les conditions de leur réalisation. Des recommandations ont ainsi été formulées sur (1) l’opportunité de leur conduite en France (2), les conditions de leur mise en œuvre sur les plans logistiques et réglementaires, et (3) leur acceptabilité sociale. Les recommandations auxquelles sont parvenues les participants à la Table Ronde sont présentées au fil de l’analyse.

Supplementary Figure 1: Representation of BRCA1 and BRCA2 major functional and risk domains (location of codons)

This study assesses individual factors that influence return to work (RTW) and in particular on the cancer survivors' ability to prepare his/her job resumption. A self-administered questionnaire was completed by 105 cancer survivors after at least 4 weeks after the time of their RTW. Various methods of returning to work were compared between occupational and medical characteristics with multivariate statistical tests. Regular contact by a cancer survivor with the company during sick leave is associated with RTW within 1 year of diagnosis (ORaj = 5.78). Optional pre-reinstatement visit with the occupational physician is associated with the absence of employee activity's change (ORaj = 2.30). The cancer survivors who during treatment period ask for an adaption of treatment are more likely to have a change in working conditions (ORaj = 14.5). The adaptation to recovery conditions appears to be associated with survivors' effort to RTW. It should be confirmed with new studies.

Aim: There is no consensual indication for surgical resection after diagnosis on per-cutaneous biopsy of borderline breast lesions (B3). We evaluate under-evaluation rate of per-cutaneous biopsy and predictive factors of under-evaluation. We analyze accuracy of reported decision-making tools. Methods: We conduct a prospective multicentric study including, atypic-ductal hyperplasia (ADH), atypic-lobular hyperplasia (ALH), atypic-cylindro-cubic metaplasia (FEA), papilloma, radial scars (RS) and phyllod tumors. When several B3 lesions were associated, the more severe lesion was used to classify the lesion. We determined breast cancers (BC) rate and histologic type. Among 478 patients, 518 B3 lesions were studied: 15.1% (78) FEA, 48.6% (252) ADH, 16.8% (n = 87) ALH, 5.4% (n = 28) RS, 12% (n = 62) papilloma, 0.8% (n = 4) phyllod tumors and 0,8% (n = 4) with a suspicious low grade DCIS. More than 1 lesion was identified in 31.9% (165) of cases. A surgical resection was performed for 86.3% (447/518) lesions. Significant factors of surgical resection were: residual micro-calcification after biopsy (OR: 2.7) and type of B3 lesion. Results: Overall BC rate was 15.3% (68/445) with 79.4% (54) in-situ carcinomas. According to B3 lesions, BC rates were 12.9% for FEA, 20% for ADH, 11.6% for ALH, 3.7% for RS, 8.8% for papilloma and 25% for suspicious in-situ carcinoma. A score has been calculated and patients were distributed in 3 groups. Patient's rates without BC were respectively: 100%, 80.4% and 80.6% (p = .029). Conclusion: In conclusion, it could be suggested to avoided complementary surgical resection in case of good radio-pathologic concordance and low probability of BC.

Inherited mutations in BRCA1 and BRCA2 genes increase the risk of development of cancer in organs especially in breast and ovary. Prevention and screening in BRCA mutation carriers are of high importance. Prophylactic surgeries are possible but are still insufficiently performed because they require surgical procedures in healthy patients. Guidelines for the management of BRCA mutations carriers must absolutely be part of the standard practice of all those involved in the management of these patients to increase the impact of the implementation of these preventive measures. There is no screening recommended for ovarian cancer. A risk-reducing bilateral salpingo-oophorectomy should be performed from age 35 to 40 years for BRCA1 mutation carriers and 40 to 45 years for BRCA2 mutation carriers. A screening for breast cancer should be performed annually from 30 years old by breast MRI and mammography. A risk-reducing bilateral mastectomy is recommended with nipple sparing mastectomy and immediate breast reconstruction from 30 years and before 40 years. A multidisciplinary care must be implemented for these patients with an important psychological support.

Self-assessment of personal cancer risk may be a determining factor for lifestyle changes, risk factor control, or adherence to screening. We studied the characteristics of individuals who assessed their own risk of lung cancer (LC) as higher than that of the average population, and the impact of current smoking status in former and current smokers. The French nationwide observational survey, EDIFICE 6, was conducted online (June 26-July 28, 2017) on a core sample of 12 046 individuals (18-69y). Representativeness was ensured by quota sampling on age, sex, profession, and stratification by geographical area/type of urban district. In the whole population (N = 11 307), current smoking had the strongest correlation (OR = 7.89). Former smoking (quitting age ≥45y) and use of e-cigarettes were also strongly correlated. Current and former smokers represented 54% and 19%, respectively, of those who assessed their own risk of LC as higher than average (N = 3 544). In multivariate analysis, features associated with this perception were (1) among former smokers: ceased tobacco use ≥45y (OR = 2.56 [2.02-3.25]), male (OR = 1.60, [1.31-1.94]), manual work (OR = 1.42, [1.01-1.99]), and social vulnerability (OR = 1.37, [1.14-1.65]); (2) among current smokers: self-employed (OR = 1.82, [1.18-2.89]), and rating cancer prevention programs as ineffective (OR = 1.39, [1.19-1.63]). Current e-cigarette use and being close to someone with cancer or accompanying someone during cancer treatment were common features to former (OR = 1.98, [1.45-2.70], OR = 1.38, [1.15-1.65]) and current smokers (OR = 1.29, [1.05-1.59], OR = 1.20, [1.02-1.41]). Our results show that among individuals who assess their own risk of LC as higher than the average of the general population, current smokers belonged to the wealthiest socioprofessional categories and gave little importance to cancer prevention. Former smokers were more likely to be men, who ceased tobacco use ≥45y, and come from a modest social background. Additionally, both groups were more likely to have experienced cancer in someone close, and to be e-cigarette users.

Abstract Background Comprehensive cancer care uses complementary approaches alongside specific anticancer therapy. Using a dedicated questionnaire, the Calista 2 national survey sought to assess the importance of supportive care and activities among breast cancer (BC) patients, how often these services are made available, the uptake rate, and the proportion of unmet needs. Methods Of the 82 physicians who accepted to take part in the survey, 29 recruited 257 patients with BC of whom 210 answered the patient-reported questionnaire. Patients meeting the inclusion criteria were adult females already on specific therapy for early or advanced BC. The patient-reported questionnaires covered drug management of pain, fatigue, adverse events (AE), sleep disorders, social and psychological support, physical activities, and complementary and alternative medicines. Items were rated on a scale of 0 – 10. Questionnaires were collected between September 2016 and October 2017. Results After exclusion of non-valid patient questionnaires, 197 were analyzed. The mean age of these patients was 56.8 years (SD 12.6); 53% had early stage disease and 41% advanced stage disease. Patients perceived the management of AE and pain, and self-image improvement techniques as the three most important items (8.0, 7.5, 6.7, respectively), followed by physical activity (6.3) and the management of fatigue (6.0), while preservation of fertility (2.3), spiritual support (2.5), counselling with regards to employment (3.2), and art therapy (3.3) were the least important. Most facilities were available at the point of care. Physicians frequently suggested management AE and pain (83% and 73%, respectively), self-image improvement techniques (73%) and psychological support for the patient (70%). Management of fatigue was however far less frequently proposed (30%). Management of AE (75%) and pain (60%), and self-image improvement (50%) were the most widely used support techniques. Only 19% of patients who were offered support in the management of fatigue declared actually using it. The management of fatigue nevertheless represented one of the three main unmet needs (for 27% of patients), together with complementary medicines (37%) and relaxation (29%). Conclusion These key findings highlight the fact that support for the management of AE and pain, together with self-image improvement techniques, are important for patients, are available, suggested and used. Although management of fatigue is available, it is rarely suggested by physicians and is therefore seen by patients as an unmet need. Patients also expressed the need for complementary medicines and relaxation techniques; these are however less frequently available at the point of care and seldom proposed. Citation Format: Simon H, Viguier J, Naman H, Touboul C, Lhomel C, Ganem G, Eisinger F, Morère J-F. Patient care in breast cancer: Unmet and fulfilled needs [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-23.

11616 Background: Advances in therapy and early detection, by population-based screening in particular, have significantly increased the number of patients cured from cancer. However, cancer patients’ chances of being cured varies strongly from one cancer to another. We studied the understanding of the concept of cure in the lay population and the factors associated with believing that cancer can be cured. Methods: The French nationwide observational survey, EDIFICE 6, was conducted online (June 26-July 28, 2017) on a core sample of 12 046 individuals (age, 18-69y). Representativeness was ensured by quota sampling on age, sex, profession, and stratification by geographical area/type of urban district. This analysis focused on understanding of the meaning of cure in breast (BC), cervical (CC), colorectal (CRC), lung (LC) and bladder (BLC) cancer for individuals with no history of cancer. Results: The majority of respondents believed that cure exists (BC 95%; CC 91%; CRC 89%; BLC 87%, LC 71%). Some agreed with the definition that cure is the disappearance of the disease (BC 42%; CC 38%; CRC 35%; BLC 33%, LC 25%), while others preferred the definition that cure is several years without disease (BC, CC 53%; CRC, BLS 54%; LC 46%). More men than women (P < 0.05) believed that cure exists for CRC, BLC and LC. Socially non-vulnerable individuals were more likely to believe in cure than their vulnerable counterparts (P < 0.05), as were individuals aged 50-69y (P < 0.05) versus those of 18-50y, and for all cancer types except LC. In multivariate analysis, the variable “clinical research enables progress” was correlated with believing that cure exists (BC, OR = 2.93; CC, OR = 1.86; CRC, OR = 2.22; LC, OR = 1.57, BLC, OR = 2.06), as was “progress is rapid” (BC, OR = 1.61; CC, OR = 1.66; CRC, OR = 1.7; LC, OR = 1.84; BLC OR = 1.68), and also social non-vulnerability. However, the variables “prevention”, respectively screening/treatments, “are important for cancer control” had a low impact on the belief in cure (OR~1). Conclusions: The lay population is relatively optimistic about the cure for cancer. Confidence in the existence of cure relies on medical progress. However, factors related to individual behavior, e.g., prevention and screening, did not affect the perception of cure.

Background The mean age at diagnosis of cervical cancer (CC) is 51 yrs old. Recommendations on cervical cancer screening has recently been implemented as a nationally organized program in France. Since 2018, women aged 25-65 yrs are now invited for a every 3 years pap smear test. It therefore appeared important to gain clearer insight into the characteristics of women who have had at least one Pap smear tests but have not returned after the recommended 3-year interval for a repeat test. Methods The French nationwide observational survey EDIFICE 6 was conducted online from 26 June to 28 July 2017 on 12 046 individuals (age, 18-69 yrs). Representativeness was ensured by quota sampling on age, gender, profession, and stratification by geographical area and type of urban district. Multivariate stepwise logistic regression analysis was conducted to identify factors likely to explain the non-uptake of subsequent CC screening. The present analysis included 4499 women (25-65 years) with no history of cancer. Results Of those who were in the target age range for CC screening, 15% (N = 671) did not return for the repeat examination within the recommended 3 years. Compared to those who were compliant with the recommendations, the population of non-compliant women was older (mean age 49.2 yrs vs 43.2 yrs). It was characterized by higher proportions of women living alone (single, widow or divorced, 40% vs 30%, P Conclusions Our findings highlight the need for novel awareness campaigns that specifically target the population which drops out CC screening (including, socially vulnerable women and smokers). Editorial acknowledgement Potentiel d’Action (France), funded by Roche. Legal entity responsible for the study Roche. Funding Roche. Disclosure T. de La Motte Rouge: Honoraria (self): Roche. F. Eisinger: Honoraria (self): Roche. S. Couraud: Honoraria (self): Roche. L. Greillier: Honoraria (self): Roche. C. Lhomel: Full / Part-time employment: Roche. M. Roupret: Honoraria (self): Roche. J. Morere: Honoraria (self): Roche. All other authors have declared no conflicts of interest. Scientific clarification and Linguistic correction

1535 Background: The efficacy and benefit/risk ratio of organized nationwide cancer screening programs rely on the age range of eligible average-risk populations. We studied the characteristics of off-target populations who underwent opportunistic screening for colorectal (CRC), breast (BC) or cervical (CC) cancer, ≤5y prior to the recommended age. Methods: The French nationwide observational survey, EDIFICE 6, was conducted online (June 26-July 28, 2017) on a core sample of 12 046 individuals (18-69y). Representativeness was ensured by quota sampling on age, sex, profession, and stratification by geographical area/type of urban district. Opportunistic screening for BC (in 533 women, age 45-49y), CRC (in 1331 individuals, age 45-49y) or CC (in 633 women, age 20-24y) was assessed in terms of smoking status (current, former/never smoker), marital status (single, living with a partner), type of residential area (urban, rural), having a close relative with cancer, social vulnerability (EPICES score), and self-reporting own cancer risk (higher, identical/lower than average). Results: In the off-target populations, screening rates were 78% for BC (N = 418, mammogram), 13% for CRC (N = 172, fecal test or colonoscopy) and 42% for CC (N = 264, cervical Pap smear test). Premature BC screening rates were significantly higher (P < 0.05) in non-vulnerable than in vulnerable individuals (84% vs 69%), and among those self-reporting their own BC risk as higher than average (84% vs 76% reporting own BC risk as identical/lower than average). Premature CC screening rates were correlated with: smoking status (66% in current smokers vs 35% in former/never smokers), and marital status (63% in those living with a partner vs 34% single). Lastly, factors correlated with premature CRC screening were: type of residential area (urban, 15% vs rural, 8%), and believing own risk of CRC to be higher than average (27% vs 8% of those who self-reported their own CRC risk as identical/lower than average). Conclusions: This analysis reveals several factors related to premature screening for BC, CRC and CC, provides clear insight into off-target cancer screening uptake profiles, and hints at new strategies to ensure the optimal risk/benefit ratio of screening practices.

La prise en charge du cancer, au-delà des traitements, intègre aujourd'hui des solutions en matière de soins/activités de support. L'enquête Calista 2 a cherché à identifier et analyser les attentes des patients dans ce domaine. L'enquête a été menée auprès d'un échantillon national représentatif de médecins oncologues médicaux et de spécialistes d'organes exerçant à l'hôpital ou en clinique privée et de patients en cours de traitement pour un cancer. Un auto-questionnaire destiné aux patients portait sur la prise en charge médicamenteuse de la douleur, des effets indésirables (EI), de la fatigue et des troubles du sommeil, le soutien psychologique et social, l'activité physique ainsi que les médecines complémentaires. Les questionnaires ont été recueillis entre septembre 2016 et octobre 2017. Cette analyse montre que la douleur et les EI sont pris en charge correctement, au contraire de la fatigue, du soutien psychologique pour les proches, qui sont disponibles mais non utilisés ; ou de l'accès aux médecines complémentaires et à des pratiques de relaxation, rarement disponibles.

Abstract Background Breast cancer (BC) screening has been part of a nationally organized program in France since 2004. Women aged 50-74 years are invited for a mammography every two years. After stabilization of up-take figures over the period 2008-2014, the latest data from the French health authorities confirm a declining trend which began in 2015-2016. This fall has been observed in all age groups, with the exception of women aged 70-74 years. It therefore appeared important to gain clearer insight into the characteristics of women who have had at least one screening examination but have not returned after the recommended two-year interval for a repeat mammography. Methodology The French nationwide observational survey EDIFICE 6 was conducted online from 26 June to 28 July 2017 on 12 046 individuals (age, 18-69 years). Representativeness was ensured by quota sampling on age, gender, profession, and stratification by geographical area and type of urban district. Multivariate stepwise logistic regression analysis was conducted to identify factors likely to explain the non-uptake of subsequent BC screening. The present analysis included 1954 women (50-69 years) with no history of cancer. Results Of those who were in the target age range for BC screening, 26% (N=380) did not return for the repeat examination within the recommended 2 years. Compared to those who were compliant with the recommendations, the population of non-compliant women was characterized by higher proportions of unmarried women (23% vs 19%, P<0.05), socially vulnerable individuals (53% vs 38%, P<0.05), and smokers (33% vs 20%, P<0.05). No differences were observed between compliant and non-compliant women in terms of mean age (59.3 SD 5.8, years) or socioprofessional categories. In multivariate analysis, the items associated with non-compliance included: current smoking (OR=1.81 [CI=1.40 – 2.34]), individuals who would not encourage someone close to enroll in a clinical trial (OR=1.55 [1.17-2.04]), considering that protection provided by a prevention program is ineffective (OR=1.48 [1.11-1.97]), and social vulnerability (OR=1.38 [1.09-1.74]). The most frequently cited reasons for non-uptake of subsequent screening were "I don't feel concerned" (45%), “individual negligence/not a priority” (29%), fear of the examination/results (25%), "I have not received a screening invitation" (18%), and self-examination (15%). Conclusion Indicators of non-uptake of repeat BC screening show various patterns: behavioral (currently smoking), social (vulnerability), and those related to information/education. In our analysis, this latter appeared concurrently with medical skepticism. The two main underlying reasons for not pursuing with breast cancer screening were "not feeling concerned" and "individual negligence". Our findings highlight the need for novel awareness campaigns that specifically target this population. Citation Format: Morère J-F, Eisinger F, Couraud S, Greillier L, Touboul C, Lhomel C, Rouprêt M, Viguier J, De la Motte Rouge T. Who drops out of breast cancer screening? Results from the EDIFICE 6 survey [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-02-05.

Les 40es Journées de la SFSPM se sont tenues à Avignon du 7 au 9 novembre 2018. Le thème abordé—Cancer du sein : optimisation du parcours de soins — a réuni plus de 1 200 participants sous les voûtes du Palais des Papes. La fluidité de chaque segment du parcours a été analysée en termes de risques de rupture de continuité des soins tant au sein du segment lui-même qu’en amont et en aval. Dans un parcours par essence pluridisciplinaire et plurimétiers, la nécessité d’une réflexion globale et d’une coordination active réalisées par des professionnels formés a été rappelée à chaque session. Chacun des intervenants a esquissé de potentiels indicateurs de qualité tenant compte à la fois de son implication dans son segment d’intervention, mais tenant compte aussi d’une vision plus globale de ce que devrait être le parcours au travers de la maladie et des soins. La parole a été très largement partagée entre soignants et associations de malades, entre paramédicaux et acteurs en sciences humaines et sociales, entre responsables de la santé publique HAS, ARS, CNAM–CPAM 84 et représentants des différents modes d’hospitalisation publique/privée et ESPIC. La session grand public a été l’occasion d’échanges fructueux et instructifs sur la perception des difficultés comme des satisfactions rencontrées que nous ont fait partager les malades, leurs proches et les représentantes des associations. Au total, un congrès de réflexion partagé par de nombreux acteurs qui cherchent tous à améliorer le parcours de soins des malades atteintes de cancer du sein. La publication le 21 janvier par l’INCa de dix indicateurs de qualité du parcours de soins pour les malades atteints de cancer du sein est une étape importante qu’attendaient tous les participants d’Avignon — SFSPM 2018.

e13555 Background: Many factors affect decisions regarding cancer screening. Risk perception depends on individual behavior but also on emotional, social and cultural issues. We studied individuals self-reporting a higher-than-average risk of cancer, and sought to distinguish between actual risk and possible misconceptions. Methods: The French nationwide observational survey, EDIFICE 6, was conducted online (26 June-28 July 2017) on a core sample of 12 046 individuals (age, 18-69 years). Representativeness was ensured by quota sampling on age, gender, profession, and stratification by geographical area/type of urban district. Multivariate stepwise logistic regression analysis was used to identify pointers of higher-than-average self-risk-assessment for breast (BC), cervical (CC), colorectal (CRC) and lung cancer (LC). Results: In all, 11 307 individuals (5776 women) were questioned about self-perceived higher-than-average risk. Thirty eight (N = 2220; BC) and 25% (N = 1476; CC) of women assessed their own risk as higher than average; 25% (N = 2806; CRC) and 31% (N = 3544; LC) of the total population self-assessed their individual risk as higher than average. Features associated with this perception were: for BC, accompanying someone close during cancer treatment (OR = 1.34, 95% CI = [1.14-1.57]), current smoker (OR = 1.28, [1.12-1.45]) and alcohol consumption (OR = 1.15, [1.02-1.28]). For CC: manual work (OR = 1.57, [1.12-2.18]), social vulnerability (OR = 1.31, [1.15-1.49]). For CRC: male (OR = 1.58, [1.44-1.73]), social vulnerability (OR = 1.37, [1.25-1.51]). For LC: current smoker (OR = 7.89, [7.13-8.74]), ceased tobacco ≥age 45 (OR = 2.65, [2.21-3.18]), current e-cigarette use (OR = 1.82, [1.55-2.15]). Being close to someone with cancer was a common feature of individuals assessing their own risk as higher than average: BC (OR = 1.71, [1.45-2.02]), CC (OR = 1.40, [1.23-1.59]) and CRC (OR = 1.51, [1.38-1.65]). Conclusions: Genuinely at-risk individuals identify with well-known risk factors e.g., tobacco for LC. Being close to a person with cancer raises awareness but can lead to needless overestimation of risk. Socioeconomic features observed hint at inadequate knowledge of cancer or difficulties in healthcare access.

2533 Background: Clinical research is a major aspect of drug development and requires patient participation. Family and friends are known to play a role in medical decision-making, the extent of which depends on factors such as timing (onset or end of the disease), type of disease, the legal situation (e.g., patients under guardianship, or minor), and cultural aspects. The role of the close circle in inciting patients to enroll in clinical trials therefore warrants further study. Methods: The French nationwide observational survey, EDIFICE 6, was conducted online from 26 June-28 July 2017 on a core sample of 12 046 individuals (age, 18-69 years). Representativeness was ensured by quota sampling on age, gender, profession, and stratification by geographical area and type of urban district. Multivariate stepwise logistic regression analysis was conducted to identify factors likely to incite close relatives of cancer patients to urge them to enroll in a clinical trial. The present analysis included 11 307 individuals with no history of cancer and focused on the question

Le souci de bienfaisance est le second souci des médecins (après ne pas nuire). Néanmoins, la possibilité de « sauver des vies » n’est pas une justification pour toutes les interventions mais un préalable. En ce qui concerne les informations de nature génétique, les personnes doivent accéder librement et volontairement aux consultations cliniques et doivent, par la suite, avoir la maîtrise de leurs décisions. En contrepoint, le respect absolu, non négociable et aveugle de l’autonomie pourrait aboutir au concept de médecine « self-service » dont un exemple caricatural, mais réel, est celui d’une personne profondément affectée par une histoire familiale de cancer du sein et dont les analyses ont éliminé la possibilité pour elle d’être porteuse d’une mutation. Cette personne peut néanmoins demander avec insistance (exiger ?) une chirurgie prophylactique dès lors que l’on ne peut l’assurer d’une absence de risque de cancer du sein, et ce, malgré l’assurance de l’absence de mutation. Les médecins ne peuvent seuls résoudre ces contradictions et certaines ambiguïtés. Ils ne peuvent pas non plus s’appuyer uniquement sur des outils scientifiques et techniques. L’adjonction d’autres plans d’analyse permettra sans doute d’améliorer la qualité des décisions sans en altérer l’efficacité.

We studied cancer screening over time and social vulnerability via surveys of representative populations.