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Screening of breast cancer : tribulations of a radiologist in France, autobiographical presentation

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Screening of breast cancer : tribulations of a radiologist in France, autobiographical presentation

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Presentation « Screening of breast cancer : tribulations of a radiologist in France , autobiographical presentation» by Cécile Bour, MD, Radiologist and president of organization Cancer Rose. Drawings made by Dr. Cécile Bour.
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 « Screening of breast cancer : tribulations of a radiologist in France , autobiographical presentation» by Cécile Bour, MD, Radiologist and president of organization Cancer Rose. Drawings made by Dr. Cécile Bour.
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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Screening of breast cancer : tribulations of a radiologist in France, autobiographical presentation

  1. 1. www.cancer-rose.fr Tribulations of a Radiologist in the « Screening-land »
  2. 2. As a radiologist having participated for twenty years in organized breast cancer screening in Moselle region, France, I ended up wondering how it was possible to get entire crowds to run around with a pink ribbon on a T-shirt, under the illusion of a "cause": the fight against breast cancer. How do explain that despite the hype of pink incentive marketing, supposed to halt the progression of breast cancer, the incidence of this disease has just exploded since the beginning of screening? Pink October Pink October
  3. 3. www.cancer-rose.fr Two obligations of medical practice flouted: inform the patient, and do no harm. • Delivering "clear, fair, appropriate information" (article 33 of the public health law in France). The information on the risk-benefit balance of screening is difficult to find for the patient and even for the professional. ■"primum non nocere", there are adverse effects that our screening practices may inflict on the woman being screened. ■It appeared to me that these two principles were not guaranteed to the patient. « I inform you that is in your head, the problem »
  4. 4. www.cancer-rose.fr ■ From the onset of screening, a technical system was adopted, namely mammography, which over time proved to be an imperfect tool, unable to give a binary result. We then had to adapt this tool to each woman screened, taking into account the highly subjective and variable nature of the organ that is the breast. ■ Finally, we now perform individualized screening under the illusion of performing mass screening without providing women with the benefit-risk balance of mammography screening. It’s pink, it’s ugly, and it doesn't fit with anything …and not sure it will save your life It’s yellow, it’s ugly, and it doesn't fit with anything But it can save your life
  5. 5. www.cancer-rose.fr ■ From these observations, in May 2015, I communicated my doubts in an interview with our regional newspaper, the Republican Lorrain.
  6. 6. www.cancer-rose.fr ■ The virulence of the response from local screening officials, led me to believe that the controversy was beyond the medical debate, and that the protest was disturbing other interests besides those of women's health and well-being. ■"Irresponsible, cruel and prideful to torment women by sowing confusion in their minds", were reproached to me. Pride and cruelty lie in depriving women of the information to which they are entitled, considering them as poor little infantile beings ...
  7. 7. www.cancer-rose.fr ■ The paternalistic vision of the medical profession locks women into these unhealthy stereotypes, reducing them to "buy-and-run" women for a "cause" that is thriving. ■ The promoters of this "cause" of which we, radiologists, are taking part, are the same people who unilaterally inform, in defiance of the notion of conflict of interest that currently plagues the breast cancer screening campaign. « But why are we all running like that? » « Well, to catch up with cancer ! »
  8. 8. www.cancer-rose.fr ■ For all these reasons we have created, together with a group of colleagues worried about the deviations (three general practitioners, an anatomo- pathologist and myself, met within Formindep, French organization for independent medical training), an information site on breast cancer screening, whose aim is to provide the most loyal, objective and complete information, containing articles on all aspects of screening, as well as a downloadable information brochure, available at www.cancer-rose.fr.
  9. 9. www.cancer-rose.fr The problem of double mammography reading Serious scientific studies… Are always made in double blind…
  10. 10. www.cancer-rose.fr
  11. 11. www.cancer-rose.fr ■ A mammogram cannot be read, it is an image that has to be interpreted. Yes, but this is without considering two major pitfalls: ■ The difficulty of "reading" a mammogram objectively, ■ And the state of mind of the "reader".
  12. 12. www.cancer-rose.fr ■ The texture of the breast is composed of voids, solids, organizing themselves in a random way. This thread- like structure, more or less dense, compact or airy, changes from one woman to another, from one cycle to another in the same woman, from one year to another; according to hormonal treatments, physiological modifications, weight variations. ■It will be a question of detecting in this capricious texture the image that reflects a real lesion. But the smaller a lesion is, the less characteristic it is. And the less characteristic it is, the more we examine it. The more we examine it, the more we wonder, the more we doubt, and the more we tend to "cover up" by classifying the file as "suspect", as a precaution. Why is this an interpretation?
  13. 13. www.cancer-rose.fr Human factor ■ Humans are also capricious, changeable. There are three kinds of radiologists: the relaxed-serene, the pragmatic- focused, the anxious-stressed. ■ Depending on the radiologist's experience (suspected but unconfirmed cancers, "missed" cases, patients needlessly alarmed), he or she may go from a relaxed-serene attitude to an anxious-stressed state or the opposite. ■ The performance is therefore uneven depending on the temperament and state of mind of the reader.
  14. 14. www.cancer-rose.fr In Screening-land the examiner is the law and order authority and cancer is the offender. ■ Either you are a relaxed and serene person, you are confident and won't call out to others. Your results in the fight against crime will not be very good. ■ But you will have given a dubious individual the chance to not evolve pejoratively and to prove his benevolence. According to our analogy, you take the risk of letting a real cancer go free.
  15. 15. www.cancer-rose.fr Either you are one of the focused pragmatists, you apply the strict criteria of radiological semiology that you have been taught, and you miss the atypical but real cancer.
  16. 16. www.cancer-rose.fr ■ Or you are an incorrigible anxious and stressed person, and you are not discriminating enough. You arrest all criminals, but also based on "appearance profiling"! Your crime rate will tend towards zero, but you will have eliminated genuine innocents, who would never have endangered the lives of others. ■ To continue the comparison, you will classify too many images in a positive light, which will result in multiple biopsies, sometimes useless. MEDICAL RESPONSABILITY
  17. 17. www.cancer-rose.fr ■ The pressure to discover ever smaller lesions pushes the screener towards an abusive diagnosis, with the double reading increasing this phenomenon. …the more you find The more you search …
  18. 18. www.cancer-rose.fr ■ So those are the hazards of screening that gradually made me give up on the second reading. ■ Because for each individual woman it means 100% in every situation. One hundred percent in the case of a false negative or false alarm, or over-diagnosis, one hundred percent invasion of her breast if a biopsy is decided upon...
  19. 19. www.cancer-rose.fr ■ Nocebo effect: causes the disease by anticipating the disease in a favorable emotional context ■ Healthy women who are over-diagnosed and treated ■ Chronic stress caused by the terror of cancer ■ Anxiety causing tests and anxious waiting ■ Ohysical and psychological impact of the treatments
  20. 20. www.cancer-rose.fr ■ Equality in the nonsense? ■ Or do we think together about the information to be given, and the relevance of screening to the community? Men claim the right to their screening testography !
  21. 21. 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.

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