The 2018 edition of the Pink October campaign ended a few days ago. It was an opportunity for all health organizations, as well as for the government, to recall the importance of mammography screening for breast cancer. The interest of this screening carried by the government and the National Cancer Institute (INCa) is seriously questioned by the scientific community. Thus, Professor Laurent Lantieri opened the debate on the relevance of this screening in an explicit tweet published on November 9th.
This candid position is based on a number of scientific publications challenging public screening policies. By the end of October, the Syndicat des Jeunes Doctors General (SNJMG) had denounced in a statement the inefficiency, if not danger, of this preventive approach to breast cancer. A Cochran review compiles no less than 7 trials involving 6,000 women aged 39 to 74, some of whom have gone through the mammography screening program and some who have not. The conclusions of this review are clear: screening would not reduce breast cancer mortality.
At present, it is impossible to say whether a cancer detected during a mammogram will evolve into an illness or even a death. In practice, for 2,000 women participating in mammography screening over a 10-year period, one death will be avoided. In return, because of the screening, 10 women who would not have been diagnosed if they had not performed a mammogram will be unnecessarily treated and will undergo sometimes heavy treatments (surgery, chemotherapy and radiotherapy), which may themselves lead to deaths. . Finally, of the 2,000 women who undergo mammography screening, more than 200 will have false positive results and will have to undergo multiple exams, which will sometimes cause them distress and anxiety.
Another publication, published in the very serious British Medical Journal , analyzes the Dutch impact of screening between 1989 and 2012. The conclusion is final, the authors claim that the Dutch program of mammography screening seems have little impact on the burden of advanced breast cancer, and would have only a marginal effect on mortality. Moreover, the authors argue that about one third of screen-detected cancers are neither more nor less than over diagnosis (non-evolving cancers that do not cause mortality). These data corroborate those of Cochrane and question the persistence of a systematic institutional screening model. The interest of mammography screening should therefore raise further fiery debates between advocates of evidence-based medicine and public authorities who do not seem to hear it that way.
In addition to mammography, it is important to remember that screening for breast cancer also begins with palpation, a palpation that must be performed by a doctor (general practitioner, gynecologist) or midwife once a year. 25 years old. This consultation can be an opportunity to learn the techniques of auto-palpation to be performed frequently between specialized consultations. If you ever notice a change in the breast (appearance of a ball, change in the shape or color of the areola, change in the nipple), consult your doctor (general practitioner or gynecologist) so that he can start the examinations as soon as possible.