As Pink October approaches, breast cancer screening awareness month, the League Against Cancer looked into the obstacles that could push or force women not to participate in the screening program. screeningscreening organized. More than a million French women aged 50 to 74, the target of this national campaign, say they have never participated in it. Emmanuel Ricard, doordoor– spokesperson for the League Against Cancer, deciphers these results, and discusses the importance of having your breasts monitored regularly from the age of 50. Interview.
As Pink October approaches, we learn that the participation rate in the national breast cancer screening program has fallen sharply in recent years. Can you tell us more?
2,424,599 women completed a mammographymammography screening organized during the year 2022, which corresponds to a national participation rate of 44.9% (versus 50.6% in 2021). The lower participation observed in 2022 compared to 2021 is partly explained by the increased participation in 2021, a catch-up year due to the Covid-19 pandemic and confinements. Women are invited every 2 years to have a mammogram screening, the participation figures must therefore be looked at over a period of two successive years.
Over two years, is the participation rate less alarming?
Participation in 2021-2022 could begin a slight increase with a rate of 47.7% versus 46.6% over the 2020-2021 period for all age groups, all metropolitan regions and almost all departments. However, we are far from the 52.3% of the 2011-2012 period which we have not reached since. We are absorbing the consequences of the disruptions due to Covid-19, but the gradual decline in supply in senologysenology was already contributing to longer delays between two screenings and a drop in participation.
We know that the health crisis has had an impact, at least temporarily, on the screening of many diseases. How did this translate to breast cancer?
This is indeed also the case for breast cancer. Screening was stopped by the pandemic due to confinements and the mobilization of radiologists to deal with pneumological emergencies. Some people were able to do their screening the following year in addition to those who did so on the scheduled date, leading to additional activity for the regional cancer screening coordination centers and for radiologists. We have therefore been able to make up part of the participation deficit due to the closure during the pandemic, but we have not yet returned to the figures before the Covid years.
A survey commissioned by the League Against Cancer looked at the obstacles to screening mentioned by women aged 50 to 74, the main ones affected by the national program. What were you able to observe?
Brakes are actually very diverse. Among the main ones is the lack of understanding of what screening is since some women do not see the point, in the absence of symptoms, of this examination, or the need to do it by repeating mammograms every every two years whereas cancer is a disease that progresses over several years. But there are also other fears, such as that of being in pain, whether due to a bad personal experience or through “hearsay”. It is certain that the practice of mammography places the breast between two plates and clamps it, but this is the work of professionals and manipulators. radioradio to explain and support these actions to limit the inconvenience that may result.
Some obstacles mentioned by women reflect a lack of accessibility or information. Can you tell us about it?
The respondents actually mentioned the difficulties of accessing screening due to the distance of the structures, the cost of travel, the lengthening of appointment times, which lead to people giving up. They also reported a lack of time or a different prioritization, which may be understandable for some in a difficult economic context. There is also the question of the controversies which regularly arise about this screening, which are debates between professionals that are difficult for the population to understand.
Some of the respondents explained that they did not get screened for fear of having cancer. How to explain this contradiction?
Not wanting to consider the occurrence of cancer may be the consequence of a form of superstition: we do not want to call the disease. It is the fear of invoking the evil eye. This explanation is not reserved for certain cultures or religions. But this is not the only possible answer. For some people, life is already very complicated and considering illness when you are already in “trouble” is not possible. These people then adopt a fatalistic attitude. Supporting the mental overload, the additional tension that illness would bring, is not an option for them.
The distance results from a reduction in the number of radiologists on the one hand and a concentration of their distribution on the territory on the other hand, which results in less proximity to the centers of radiologyradiology for patients. One of the solutions is found in the strategies of “reaching out to the population”, either by developing facilities for appointments, which is what we are doing with Doctolib, or by developing mmmobile projects — devices and radiologists move to areas of less participation or remote areas, as we support in certain Normandy departments or in Loire-Atlantique –, or by facilitating travel possibilities. But sometimes it’s also about helping people get out of their neighborhood to locate structures, help them get there and show them that they won’t be alone if the mammogram is positive, that they will be able to find help. , psychological support.
Why is it important to get screened regularly from the age of 50?
80% of breast cancers occur after the age of 50, so this is the period when the greatest number of breast cancers can be detected. This is also the period when the menopausemenopause which makes the breasts less dense, and therefore where the doses of rays will be the most effective and in the smallest quantity. For this to be effective, mammograms must be repeated every two years because the cancer can take years to reveal itself. Screening must be seen as monitoring and not as a single and definitive result. Mammography can detect tumors that are much smaller than what can be detected by palpation. It is therefore a more effective examination than breast palpation, and complementary to it.
“Screening must be seen as monitoring and not as a single and definitive result”
We are observing an increase in cases of breast cancer among those under 50, who are not affected by the national program. In this case, is self-examination the only solution?
Screening is an action that must be effective and low risk. Repeated exposure to radiation will paradoxically increase the risk of cancer. We must therefore carry out radiological examinations in order to achieve the best detection but without increasing this risk, hence the choice of the population over 50 years old. Starting earlier multiplies the doses ofirradiationirradiation, and doing it in younger women with denser breasts reinforces the necessary doses. This should therefore only be done in women at increased risk, and not based on a single age criterion for the entire population. It is in this sense that research programs on the screening of younger women are being developed, such as the large European study MyPeBS which evaluates personalized screening of breast cancerbreast cancer.
France does not have the same culture of public health programs. It does not have an organization like the Scandinavian or British countries. We have a liberal system of medicine which favors curativecurative. It is also the culture of patients to value curative over preventative. One only has to look at the regular debates on the vaccinationvaccination. This culture will take time to establish but it is necessary for the challenge of the development of chronic diseases and the challenge of maintaining our social protection system.
