Screening before age 50: not so simple!

I attended last Friday the 11th conference organized by women's committees in Paris on the thorny issue of the establishment in France of a routine screening before age 50. You can imagine the conference gave me a lot of information oh, Well I admit that after these few hours in the company of eminent doctors, teachers, psychologists and economists, my beliefs were slightly shaken.

In medicine the problem is a matter of benefit / risk balance. In other words, it is important to understand the risks to those involved and put them against the benefits that you are entitled to expect. Stakeholders have therefore succeeded to the desk, to expose us, not their views, but the objective data of our present knowledge. I know that this subject calls many of you and I prefer to give you an accurate preview of the conference rather than a vague summary that you can find on the net.

The facts

We all know, many young women affected by breast cancer and Dr. Marc Espie, center manager of breast disease at the hospital St. Louis, opened the session with a figure: according to the INVS, 8211 women were affected between 40 and 50 years in 2005 (823 before 35 years). The numbers are unfortunately old but it still gives us a clear picture of the problem. However according to epidemiologists cancer in young women is not increasing. The impression that we have and the doctors, would discover that a cancer in a woman under 50 has greater psychological impact, and we retain these cases.

He also recalled that 10 very specific criteria have been established by WHO in 1970 (revised in 2004 by the ANAES) to clearly establish the relevance of the introduction of screening for a disease (available here ). One can easily imagine that indeed we can not identify any needless to set the threshold of efficacy and safety for a given disease.

An economic problem?

In a second step, Jean Paul Moatti, professor of health economics in Marseille addressed the economic impact of early detection. For his very complicated for someone like me refractory to the numbers, I noticed something important: lowering the screening at age 40 would only cost 16,000 dollars per year per life-year gained. (47,000 dollars if tracks 40 to 75 years against 31 thousand dollars if we maintain the 50/75 age group). So the economics all that comes to mind would be a false problem.
The means at our disposal

Anne Tardivon radiologist at the Institut Curie gave us a quick inventory of screening tools available to us today: Clinical examination, mammography, ultrasound and MRI. Unfortunately each technique has its limitations and that mammography is the only really have demonstrated a significant reduction in mortality. But if it wins the race, it also has its disadvantages far from negligible. This technique radiant and sensitivity depends on breast density (important in the breasts of young women) from which an additional rate of false negatives (women who departed reassured when they have cancer) or false positive (women diagnosed when they have nothing). Anne Tardivon nevertheless recalled that all the young women did not have dense breasts!

There are significant opportunities and exciting technology being evaluated which I did thanks for the presentation here has exceeded my level of understanding and I might say something stupid. Just know that radiologists seeking to develop better tools and less dangerous, such as tomosynthesis, the angiomammographie the eslastographie ....


Screening in Europe

It is Bridget Séradour, radiologist and coordinator of the national group of screening for breast cancer, which made us an overview of the policy of our European friends.

In Sweden 60% of the county has set up a screening for women of age 40 with a free interval of 18 to 24 months between two mammosa. In Portugal, Spain, and Hungary 45 years old women are invited to the screening. In the Czech Republic, however, is an individual and not widespread screening is offered to women from 45 years. Finally in Belgium is no recommendation for young women.
Mammograms are - they risky?

The presentation of Dr Colin Radiologist Catherine Lyons was quite technical! However what I understand is that the studies are difficult to achieve as to be meaningful they should be practiced in millions of women. We also know that age has a major role: before age 40 for sure, there is a risk, but no studies have been done on the 40/50 range.

What is known is that the breast is a radio-sensitive organ and the greater it is subjected to radiation, the greater the risk of developing cancer. But everything is relative: Quebec nine studies were compiled and the conclusion is that from 100,000 women about 9-72 women have contracted cancer to radiation repeatedly. 9-72, the range is great! In fact Dr. Colin made ​​it clear that we were a bit in the fog: yes there is a risk but as to quantify it is beyond!

Sorry for this post so long for many of us but I know that it seemed natural to give you the essential information I could gather.

I would be curious to know what you think.

Posted in: Cancer