Two large-scale studies * challenge the value of screening mammography in the fight against breast cancer. Dr. Cécile Bour, radiologist and member of the Cancer Rose ** collective, explains the importance of this scientific data for women. Interview.
Paris Match. A Dutch study, published in the prestigious “British Medical Journal”, reveals that in women whose screening mammogram reveals a cancerous lesion, one in two will be treated unnecessarily …
Dr. Cécile Bour. The authors of this study confirm the existence of an important overdiagnosis, up to 50% on stage 1 cancers (small lesions) and “in situ” cancers (non-invasive lesion). Very little evolutionary, it is especially these cancers that are detected by the screening without there being a decrease, globally, of the more advanced stage stage 2 to 4 cancers. In other words, mammography screening detects more and more cancers that have not evolved without affecting the rate of more serious cancers.
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Is the interest of screening not to treat less cancers detected early?
A woman with cancer in situ or stage 1 will not be treated as heavily as at stage 4. However, she will often have partial or complete ablation, and in all cases radiotherapy. Knowing that in case of recurrence, which is often the case of cancer in situ, she will undergo a radical treatment (removal of the entire breast) and radiation therapy. As the studies show, screening has not reduced the rate of ablations in France. Same thing in the United States. The goal of decreasing, through screening, the most advanced cancers that involve heavier treatments, is missed.
Mammographic screening often reveals lesions that one would have done better to ignore
Another recent publication joins that of the “British Medical Journal” in evaluating the rate of overtreatment of women at 50% …
Mammographic screening often reveals lesions that one would have done better to ignore. The challenge is not to treat women less heavily than for advanced stages, which is wrong in fact, but to leave them alone: when we are not sick, we do not need treatment. It took a long time before the concept of overdiagnosis was accepted by oncologists and screening promoters. Today, it is still minimized: INCa figures it at 20% and only touches on it in its information brochure for women .
The reduction in mortality is not attributable to screening, but to the improvement of treatments
The Dutch publication also reveals a low impact (between 0 and 5%) of the screening on the decrease of the mortality of the women …
It is the other missed objective of the screening of the breast cancer: to decrease the mortality of the women . The reduction that is observed is not attributable to screening, but to improvements in treatment. Another study, colossal, demonstrates it very well . It also shows a reduction in mortality for 14 other types of cancers that are not detected. In other words, we operate too much, without improving the life expectancy of women who suffer from serious cancers, and by decreasing the quality of life of those in which we have detected minor cancers, which we could ignore.
Note that you speak of healthy women who have no symptoms when the mammogram discovers a cancerous lesion …
Absolutely. It must be remembered that as soon as a symptom appears, consultation and examinations are necessary. The main signs that must alert are: a size, a deformed breast or bump, retraction of the nipple, unexplained redness, bloody discharge …
What about the risk of overdiagnosis and overtreatment when one is a “risky” woman: either because one carries a BRCA1 or BRCA2 gene, or because one has a personal or family history of cancer?
Women at risk ask questions and are distressed because they have few alternatives. Either they submit to a close surveillance that complicates their lives or they do not and live with a sword of Damocles above the head. Many use a mammectomy (removal of both breasts) at 30 years. It is a population apart. Our collective does not pronounce on this very complex subject which is beyond us. But we ask the following question: what is the logic of annual mammograms for young women who pose a risk to radiation with a technique that emits radiation? Today there is no consensus on the subject, everyone is in limbo. Some advocate ultrasound, others MRI, or the alternation of the one and the other. Still others will recommend genetic tests, but they do not brew all the genetic mutations that may exist …A study of “Prescrire” makes proposals for the conduct of high-risk women . I insist, the role of our collective is to sound the alarm on the risks of organized screening for women, in the general population, who have a medium risk, and who are without symptoms.