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Reduction of total mastectomies for breast cancer through organized screening - Myth or reality in France ?

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Reduction of total mastectomies for breast cancer through organized screening - Myth or reality in France ?

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Presentation « Reduction of total mastectomies for breast cancer through organized screening - Myth or reality in France ? » by Dr. Cécile Bour, Radiologist and president of Cancer Rose during the Conference of the French Society of Mammary Senology and Pathology (French Society of Mammary Senology and Pathology), November 2017, Lille.
Cancer Rose is a French non-profit organization of health professionals. Independent French medical doctors and a doctor in toxicology, have created the site www.cancer-rose.fr to inform you of the most recent and relevant data on breast cancer mass screening.
By decoding and popularizing the most recent research findings published in the most important international medical journals, analyzing the controversy and providing a social and feminine analysis, our objective is to inform women concerned by breast cancer mass screening in order to help them making their choice and to provide independent information resources to interested physicians.
Cancer Rose has no sponsorships, honoraria, monetary support or conflict of interest from any commercial sources.

Presentation « Reduction of total mastectomies for breast cancer through organized screening - Myth or reality in France ? » by Dr. Cécile Bour, Radiologist and president of Cancer Rose during the Conference of the French Society of Mammary Senology and Pathology (French Society of Mammary Senology and Pathology), November 2017, Lille.
Cancer Rose is a French non-profit organization of health professionals. Independent French medical doctors and a doctor in toxicology, have created the site www.cancer-rose.fr to inform you of the most recent and relevant data on breast cancer mass screening.
By decoding and popularizing the most recent research findings published in the most important international medical journals, analyzing the controversy and providing a social and feminine analysis, our objective is to inform women concerned by breast cancer mass screening in order to help them making their choice and to provide independent information resources to interested physicians.
Cancer Rose has no sponsorships, honoraria, monetary support or conflict of interest from any commercial sources.

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Reduction of total mastectomies for breast cancer through organized screening - Myth or reality in France ?

  1. 1. www.cancer-rose.fr Reduction of total mastectomies for breast cancer through organized screening Myth or reality in France ? Robert Vincent 1, Doubovetzky Jean 2, Lexa Annette 3, Nicot Philippe 4, Bour Cécile 5 1 Robert Schuman Hospitals, Medical Information Department (DIM), 9 rue Edward Steichen L-2540 Luxembourg 2 General practitioner, senior editor at the Medical Journal Prescrire, Albi, France 3 Doctor of Toxicology (Eurotox), Metz, France 4 General practitioner, expert at the HAS, Panazol, France 5 Liberal radiologist, President of the Organization Cancer Rose, Talange, France Speaker: Dr Bour Cécile, Radiologist, Talange, France
  2. 2. www.cancer-rose.fr Verify whether, in France, the generalization of organized breast cancer screening has been accompanied by a decrease in the most mutilating interventions, total mastectomies. One of the arguments advanced by its proponents would be a reduction in heavy treatments, made possible by diagnosing smaller lesions. This assumption has not been evaluated in France. OBJECTIVE OF STUDY
  3. 3. www.cancer-rose.fr METHODS The annual number of total mastectomies is estimated from the PMSI informations system on hospital stays listed in GHM root 09C04 "Total Mastectomies for Malignant Tumors". This number of hospital stays has been extracted, year by year, from the ScanSanté platform delivering PMSI data (www.scansante.fr) The study covered the period 2000-2016. Using data on the incidence of invasive breast cancer, available for 2000, 2005, 2010 and 2012 on the INVS site, the ratios of total mastectomies per 1,000 new cancers are calculated.
  4. 4. www.cancer-rose.fr
  5. 5. www.cancer-rose.fr RESULTS The annual number of total mastectomies increased over the study period from 17,403 in 2000 to 19,997 in 2016. This increase is statistically significant. In order to judge whether or not a treatment has de-escalated or not, it is necessary to look at whether, for the same number of prescriptions, more or fewer procedures are performed. The ratio number of total mastectomies per 1000 new cancers has remained stable: approximately 400 total mastectomies per 1000 cancers.
  6. 6. www.cancer-rose.fr The PMSI data is an exhaustive record of all interventions performed in France during hospitalization. Any decrease in total mastectomies should therefore be reflected in the data. Over the period 2000 - 2016, we are instead seeing an increase in the annual number of total mastectomies and a stable ratio of total mastectomies per 1,000 new cancers. Two hypotheses : -The small tumor size at the time of diagnosis would not be an essential determinant of the indications for total mastectomy (other factors would come into play, such as small breast size, or a retro-mamelonal lesion, or surgical habits). -The reduction in total mastectomies made possible by diagnoses of smaller lesions would be offset by an increase in total mastectomies due to over-diagnosis. (lesions that are not invasive carcinomas are surgically removed) DISCUSSION
  7. 7. www.cancer-rose.fr Real-life" studies: a necessary and complementary approach to clinical studies. The decline in total mastectomies for breast cancer attributable to organized screening is not confirmed by the PMSI data. Communication to women about screening should contain this information. Additional studies would be useful to clarify the causes, and in particular the role of over-diagnosis. CONCLUSION
  8. 8. www.cancer-rose.fr Cancer Rose is a French non-profit organization of health care professionals. Cancer Rose has no sponsorships, honoraria, monetary support or conflict of interest from any commercial sources. This study is published in : Revue Medecine , Volume 13, numéro 8, Octobre 2017 DOI: 10.1684/med.2017.233 Le dépistage organisé permet-il réellement d’alléger le traitement chirurgical des cancers du sein ?

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