A woman in eight develops breast cancer during her life, according to public health figures, France. While almost 62,000 new cases are diagnosed every year nationwide, the Government proposes to reduce organized breast cancer detection, recommended for women aged 50 to 74 years.
Currently, a mammogram should be repeated every two years between 50 and 74 years. It is also recommended from the age of 25 to have a palpation by a doctor, a gynecologist or a midwife every year.
80% of breast cancers occur after 50 years
But the question of detection arises on this day of fighting cancer, while more and more studies inform an increase in the number of cancers (the breast, but not only) in a younger patient. “There is a real question about how to better prevent and better detect these types of cancer that occur in younger women,” said Anne-Vincent Salomon a few days ago, director of the Women’s Institute of the Curie Institute in Paris, in France Inter.
However, cancer specialists are not favorable to the idea of reducing the age of detection at the age of 50, unlike what one might think. “It is not obvious”, Corine Balleyguier, radiologist and head of the Department of Medical Imaginaries of the Gustave-Roussy Institute, specialized in the fight against cancer.
First simply because the age groups before 50 are not the ones with the highest risk of developing breast cancer, according to the incidence rate of the age groups. According to her, the incidence rate goes from a single to double between 40 and 60 years because “there is a peak or a real risk acceleration” at that time of life: this figure is 6 cases for 1000 women in women of 50 years, compared to 3 cases per 1000 among the 40 years.
“We all have in their entourage of young women who have had cancers, so I understand that it particularly marks, especially because their number has increased … but in general 80% of breast cancers arrive after 50 years, because of what That those who are triggered before does not represent the majority, “says the radiologist, for whom to advance in age is not” necessarily a good idea. “
Mammography not recommended at an early age
Therefore, she does not recommend mammography for young women. “It is not necessarily a good exam for young women who have dense breasts. This density of the mammary gland makes the images less legible. What is more, are x, so we do not offer it at 20 years, to Age.
So why don’t we control ultrasound, magnetic resonance and mammograms for all? “First, we are not sure to have enough machines for all, but it is not necessarily the first problem,” says Corine Balleyguier. The risk also lies in the possibility of discovering false positives.
Ultrasound control, for example, is not ideal when you have no precise idea of what you are looking for. “Today there is no quality control, so ultrasound are not equal to each other and will depend a lot on the time that ultrasound has spent on the chest.”
Then, “with this type of exams, we will necessarily find a lot of small nodules, the images at first sight when these are absolutely soft and normal nodules,” explains the specialist. “What are called false positives, among which we will have to solve it, which can lead to biopsies for nothing.”
“This type of invasive gesture always represents a risk, even minimal, a cost, stress for patients, and can scare or discourage women to do their detection exams later, at the age at which it is really necessary.”
The custom detection track
Instead of reasoning in terms of age arbitrarily, the specialist in cancer detection, therefore, proposes to think in terms of personalized risk factors. “It does not depend only on the age factor. We can completely imagine a 70 -year -old woman who has no particular risk compared to a 35 or 40 -year -old woman,” develops the head of the medical imagination department.
“Not everyone is equal to the risk of developing cancer: we must take into account the family history, lifestyle, weight, food, alcohol consumption and tobacco, the level of density of the breasts.”
According to her, it would be worth “being interested in risk factors and focusing more energy on women who need it most”, even if he recognizes that the question of the detection of women from 40 to 45 years is discussed. According to her, the question is “very debated” within the medical community. In 2022, the new recommendations of the European Commission proposed to expand the detection of the disease from 45 to 74 years.
“The idea is not aberrant because it is true that the risk is not so different for women between 45 and 50 years. So, if there was something we could move, that could be.”
Very low detection rate
Corine Balleyguier remains skeptical, however, in the effectiveness of such a measure, in the sense that women who are chosen for detection organized in France are only 46% to carry out the recommended detection. A figure that tends to fall, according to public health.
Meanwhile, personalized detection programs are born worldwide, even in France. On European scale, the My PBS study (My Personal Breast Screaning) coordinated by Dr. Suzette Deloge invites 20,000 French women to test a personalized approach so that the detection takes into account the individual risk. In the Gustave-Roussy Institute, there are also prevention routes for patients specifically at risk, such as those with BRCA1 and 2 genes, such as the “Interception” program.
Finally, the Corine Balleyguier radiologist believes that if we are beginning to think about reducing the age of the beginning of breast cancer detection, we must also think about expanding age beyond the 74 years that are currently recommended. “Women live more and more and the risk of capturing breast cancer does not stop at 74 years. Although they are often less aggressive cancers, this risk tends to be the element with the ‘age”, he suggests the specialist.
Source: BFM TV
