"It's feminist to inform women of the effects of mammography"

• In France, regular screening for breast cancer by mammography is organized for women aged 50 to 74.

• Covered by Health Insurance, he plans to have a mammogram every two years.

• A valuable screening tool, mammography is however a source of many questions for patients, to which Dr Cécile Bour answers in

  Mammo ou pas mammo

  , a book "to give women all the information they need on this examination", explains the radiologist at

  20 minutes

  .

"Should I have a mammogram before age 50?"

".

"Does Having a Mammo Increase Your Risk of Breast Cancer?"

".

“What is overdiagnosis?

".

If in France, the health system provides a regular breast cancer screening route for women aged 50 to 74, for many, it is not always easy to get a clear answer on the subject.

In

* (ed. Thierry Souccar), Dr. Cécile Bour, radiologist specializing in breast cancer, answers these questions that women ask themselves about mammography.

And on the occasion of Pink October, she delivers to 

 everything you need to know about the possible benefits and risks associated with this screening test.

In this book, you collect the questions of your patients, and many wonder about the figures for cancer: are there more or are we detecting it better?

We detect more because we detect it better.

Mathematically, the more we search, the more we find.

Medicine is able to detect smaller and smaller cancers, which increases the incidence.

But what few people know is that we make cancer cells every day.

Most of the time, our immunity overcomes these cells, which will not have time to attach themselves to an organ, and therefore will not develop into cancer.

But, more rarely, there is escape of the cancerous cell which will mutate, grow and give cancer.

The real question is how useful these findings are, since these higher detection rates unfortunately do not translate into fewer advanced breast cancers or fewer associated deaths.

There is increasing talk of triple negative breast cancer in young women.

Faced with these aggressive cancers, should we screen before age 50?

These are specific cancers, which are aggressive and rapid from the outset: they grow very quickly in the breast.

Screening misses them because intrinsically they are cancers with a high growth potential.

About 15% of breast cancers are triple negative, and young women under 40 are more likely to suffer from it.

We could decide to screen young women every six months, but that would not solve this problem because these are precisely cancers that escape anticipation.

This is where fundamental research can play an important role in identifying the factors favoring these cancers: lifestyle, pollution or endocrine disruptors are avenues to be explored.

Breast cancer screening is organized, as has been said, for women aged 50 to 74.

A mammogram every two years, is it the right approach?

This is what is planned in many countries.

This age group was determined because statistically, breast cancer peaks in frequency after menopause.

Then, we no longer screen in elderly women, to avoid treatment that could be more harmful than the disease itself.

As for the frequency of screening, if it is too close together, there is a risk of increasing the panel of “small cancers” which put little - if any - in danger to the lives of women.

Without improving the detection of serious rapid cancers, which sometimes develop in a few weeks.

Exactly, what risks can there be in having a mammogram concerning the rays received?

Mammography is X-rays. The more we multiply this type of examination, the more the effects of irradiation will accumulate.

When you take an x-ray - radiobiologists explain it - you are altering the DNA of the cells.

Most of the time, they repair themselves, but some people are "radiosusceptible" so their DNA does not repair well.

These DNA breaks accumulate with those caused by other radiographic examinations that can be taken.

Over time, this can induce a mutation in a cell which can lead to cancer.

Obviously, radiation induced cancer is rare: it is responsible for 1 to 10 deaths per 100,000 women having a mammogram every two years from the age of 50 with standard irradiation.

But beyond the statistics, a cancer caused by an excess of X-ray exams is one too many cancer!

Our dossier on Pink October

You also warn about the risks of overdiagnosis.

What is it and what are the consequences?

Screening aims to reduce the reservoir of aggressive cancers.

But in passing, he "takes in his nets" many "small cancers" low grade, which would not endanger the life or health of women.

This is the overdiagnosis.

However, once the diagnosis is made, it must be treated: overdiagnosis therefore leads to unnecessary overtreatment (mastectomies and radiotherapy), which can have consequences on health.

For example, radiation therapy can induce cell damage, toxic effects on the heart, and even secondary cancers.

When overdiagnosis is taken into account in the benefit / risk balance of screening, it no longer appears as positive.

Aren't you afraid of sounding like an “anti-mammo”?

What message do you want to convey through your book?

It is a question of proposing decision support tools. Women are very vigilant to protect their health, they ask a lot of questions about mammography and understand the answers when you want to give them! And today, many pass mammograms for which they receive an invitation from Medicare. But there are also many who do not go there because it is not compulsory.

The breast cancer screening program has been the subject of criticism in the scientific and medical community for many years. I wish, and this is the least of things, that women are informed so that they can, according to the data at their disposal, but also their experiences and their anxieties and convictions, decide in an enlightened manner whether to move on or not a mammogram.

I see a feminist issue: it is a form of violence to keep women in this lack of information, when it comes to engaging in screening, the benefit of which will ultimately be very low in the event of overdiagnosis, with heavy overtreatment which can cause early menopause or even withdrawal of a breast.

When you take any medicine, for example over-the-counter paracetamol, you have a leaflet about possible side effects, even those that occur in one in 100,000.

Why is this not the case for mammography?

* 

, by Dre Cécile Bour, Editions Thierry Souccar, in bookstores since August 26, 14.90 euros.

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