Saturday , October 1 2022

Demoranding – Why is breast cancer discussed?



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The October 2018 edition of the October 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 mammographic screening for breast cancer. The interest of this review by the government and the National Cancer Institute (INCa) is seriously questioned by the scientific community. Thus, Professor Laurent Lantieri launched the debate on the relevance of this screening in an explicit tweet published on November 9th.

This sincere position is based on a series of scientific publications that trigger public screening policies. By the end of October, Syndicat des Jeunes general practitioner (SNJMG) denounced in a statement the ineffectiveness, if not the danger, of this preventive approach to breast cancer. A review Cochrane compiles not less than 7 studies involving 6,000 women aged 39 to 74 years, some of whom were screened by mammography and others who did not. The conclusions of this review are clear: screening would not reduce breast cancer mortality.

overdiagnosis

It is now impossible to tell if a cancer detected during a mammogram will evolve into a disease or even death. In practice, for 2,000 women participating in mammography screening for a period of 10 years, avoid death. Instead, because of the screening, 10 women who would not have been diagnosed if they did not perform a mammogram would be treated unnecessarily and sometimes undergo heavy treatments (surgery, chemotherapy and radiotherapy) that could lead to deaths. . Finally, out of the 2,000 women undergoing mammography screening, over 200 will have false positive results and will need to do more exams, sometimes causing them suffering and anxiety.

Another publication, published in very serious British Medical Journal, the Dutch-scale screening of the impact of screening between 1989 and 2012. The conclusion is inappropriate, the authors argue that the Dutch mammography screening program appears to have little impact on the burden of advanced cancers and would only have an effect marginally on mortality. Furthermore, the authors claim that about one-third of the cases of cancer detected by screening are neither more nor less than overdiagnosis (non-evolutionary cancers that do not cause mortality). These data confirm that of the magazine Cochrane and to question the persistence of a systematic institutional screening model. The interest of the mammography exam should therefore trigger new heated debates between evidence-based medicine advocates and public authorities who do not seem to hear that way.

In addition to mammography, it is important to remember that screening for breast cancer also has first palpation, a palpation that has to be performed by a doctor (general practitioner, gynecologist) or midwife once a year initially. 25 years. This consultation may be an opportunity to learn self-tapping techniques that are frequently carried out between specialist consultations. If you ever notice a change in the breast (the appearance of a ball, changing the shape or color of the areola, changing the nipple), consult your doctor (general practitioner or gynecologist) to start the battery. examinations as soon as possible.

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