Breast cancer: an update on screening

Thirty percent of breast cancers diagnosed in France occur before the age of 50, but organized screening promoted by the health authorities starts at age 50 , at the rate of a mammogram every two years. Meanwhile, each is prescribed - or not - individually this examination of the breast by his doctor or his gynecologist, without double reading that catches up to 10% of cancers gone unnoticed, or 100% reimbursement by the Social Security. The mammogram is an X-ray of the two breasts performed standing, shirtless, on a device specially designed for this purpose. It is a quick and easy test that can detect, even before the appearance of symptoms, small abnormalities in the breasts.

Why are the authorities not lowering the age of organized screening? Partly because of previous studies that showed no mortality gains (but these studies used much less effective techniques than today, and the differences between mammograms were probably too great). And because of the cost, of course. In terms of public health, the bill would be rather salty. In addition, at age 40, the proportion of women with breast cancer is still lower, the "profitability" of screening would drop dramatically. Opponents of early organized screening also wonder whether it is reasonable to impose a 40- to 50-year review on all women, even though the number of those actually affected would be much smaller? Two specialists here, and not least, go up to the plate. Twenty-five women a day die of breast cancer, and ten of them would probably have been cured if they had been diagnosed in time. Among them, young women undergo more aggressive cancers. The debate is open.

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Breast cancer screening: the opinion of Professor Marc Espié

Professor Marc Espié

Director of the Center for Breast Diseases, Saint-Louis Hospital, Paris.

In the United States, the American Cancer Society recommends individual screening every 40 years. Trials in some Scandinavian countries show the value of mammograms at least every eighteen months, because the cancers of the young woman evolve more quickly. Personally, I would opt for a reference mammogram from the age of 40 and, depending on the risk factors, to perform it every eighteen months up to the age of 50, then to continue screening as part of screening. organized. Ultrasound can come in addition, it is very useful in case of dense breasts and can correct false negatives (cancers that are not seen in mammography). MRI is needed for many family history of breast cancer . It's a test that shows a lot of abnormalities, but sometimes too much, and then leads to biopsies for nothing. This is why it is recommended for screening only when there is a very high risk of developing breast cancer.

"Should we imagine a regular screening even younger, from 35 years? I do not think so, mammography generates X-rays with some toxicity; to multiply excessive irradiation would instead generate a number of breast cancers. The younger you start, the greater the risk * . This is also why it is inadvisable to do these examinations during pregnancy , unless absolutely necessary. "

* The risk specifically related to mammography and irradiation of breasts by radiation is 1 to 5 deaths per 100 000 women, with a mammogram every two years from 50 years. If we start at age 40, this risk increases from 10 to 20 per 100,000. (Source: International Agency for Research on Cancer, 2002.)

Breast cancer screening: the opinion of Professor David Khayat

Professor David Khayat

Head of the oncology department at La Pitié-Salpêtrière Hospital, Paris .

Breast cancer is not just a disease of "old", it is a disease that affects all women , including between 40 and 50 years. Rather than screening organized for all at the national level from the age of 40, I defend the idea of ​​a specific prevention for each according to its risk factors. If you have never had children , if your first pregnancy was late, if you have never breastfed, if your mother or sister had breast cancer, etc. ; so yes, you need special prevention. In the United States, there are risk scales for women who want to enter prevention trials.

With a government will, experts in France could establish scales to the French that would guide the best women, through the occupational health for example or by receiving the information of awareness by the Health Insurance. The women concerned could practice - according to their specific risks and the density of their breast - either a mammogram or a mammogram plus an ultrasound, or an MRI, much more reliable before age 50 (at this time, the mammogram "lets in" two cancers out of ten, and can be falsely reassuring).

In addition, MRI has the advantage of not being dangerous at all, since it sends electromagnetic radiation. Some specialists, including me, recommend a first mammogram at 35, after the first maternity. The advantage would already be to detect some rare cancers, but also to sensitize women to breast monitoring. They would know the path of the radiologist, would know what a mammogram is and would be in the idea of ​​a necessary surveillance of the breasts - a bit like women have admitted the idea of ​​smear every year or every two years. "

Breast cancer: is there a rejuvenation of affected women?

This is certainly the feeling of many oncologists, but no study has demonstrated scientifically. Is it due to the fact that women are now so sensitized that the first alert, they run to mammography?

Perhaps, says oncologist David Khayat: "Ten years ago, they said," I'm too young, there's no reason I have breast cancer . " Their diagnosis was delayed by three or four years. But thanks to the poster with this young and beautiful icon of organized screening , many women have finally received the message, they were diagnosed earlier and better cured, with less severe cancers than at the time. "

It should be known that twenty years ago, most of the cancers examined by senologists reached 5 cm; today, we are less than 2 cm. And 90% of these cancers taken in time are cured.

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