11:40 a.m., October 13, 2022, modified at 11:58 a.m., October 13, 2022
“I discovered while soaping up in the shower that I had a lump in my right breast, I was 38 years old. » Since then, Annie Brousse, 65, has had two recurrences and two mastectomies. Breast cancer is a subject she knows well. “We do not emerge unscathed from this disease », declares the one who, since 2019, has been president of the association “Vivre comme avant”, dedicated to supporting breast cancer patients. “When the diagnoses fellshe explains, it was a bit like having the sword of Damocles over my head. »
Today, according to Santé Publique France, breast cancer accounts for a third of all new cases of cancer in women. He is also, for them, the deadliest. In 2018, it was responsible for more than 12,000 deaths. To better combat this scourge, the General Directorate of Health (DGS) launched a screening program in 1994, which was generalized in 2004 to the entire territory. While the risk of developing breast cancer increases with age, all women between the ages of 50 and 74 are invited to take a free mammography screening test every two years. “The objective is to discover tumors that are not palpable, before they are expressed clinically », explains Doctor Kais Razzouk, surgeon at the Breast Kantis Institute in Nice.
Only one in two women undergoes organized screening
Yet today, the exam is still too little popular. Over the period 2020-2021, the national rate of participation in organized screening (therefore falling under the national screening program) was 46.6% (42.6% in 2020, 50.6% in 2021) according to Santé Publique France. Due to the pandemic and the mobilization of health professionals in the fight against Covid, “Organized screening stopped between March and July 2020 », explains Corinne Balleyguier, head of the medical imaging department of the Gustave Roussy cancer center (94). But the low participation in the medical examination is not new. According to the public establishment, it is effective ” for 10 years »“ for all age groups and all regions “.
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In France, several factors explain these figures. “In some regions, there is a lower participation in organized screenings because individual screenings are more important », indicates Corinne Balleyguier. Indeed, women under the age of 50 can, of their own free will or on the prescription of a doctor or gynecologist, go and be screened at a radiology center whenever they wish. The diagnosis is less complete because there is no “only one reading of the results » by the medical team instead of two as for the organized screening, but the patients can leave the same day with the results. This screening technique mainly benefits, according to the radiologist, people living in cities, where “women are often followed by gynecologists ». And where medical deserts are rarer.
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Some women say “I’d rather not know”
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The doctors also point out that not all women are informed in the same way about the importance of screening, and that inequalities in access to care and to radiology centers are real. In addition, the poor image of the screening test is also in question. “There are mixed messagesnotes Corinne Balleyguier, how the test can cause [à cause des radiations liées à la mammographie ndlr] radiation-induced cancers. » A risk that exists, concedes Bruno Borens, breast radiologist at the Nice Santa Maria Breast Institute, but which is ” very rare » according to him.
“Fear of the result”
But for all the specialists, the low participation in organized screening is above all linked to a “psychological brake ». ” Some women say to themselves “I’d rather not know, we’ll see when it happens” », regrets Kais Razzouk, surgeon at the Kantys Breast Institute in Nice. A « ostrich policy » nourished by a fear of the result ». ” The first shock is to learn that you have cancer,” blows Annie Brousse. “We say to ourselves, ‘I’m fine, I have no symptoms’, and now we’ve been diagnosed with a potentially fatal disease. ».
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This fear sometimes goes hand in hand with that of suffering during the examination, carried out by compression of the chest using plates. On this point, Corinne Balleyguier wants to be reassuring. ” A properly done mammogram doesn’t have to hurt, she assures. The radiologist must have adequate equipment if he wants to be able to carry out screenings. » Communication with patients, essential »has also evolved according to Bruno Borens. “We make the women talk during the exam, we ask them how they feel, we ask them to tell us when it hurts », he declares.
“Changing the way women look at the disease”
Today, for screening to become a reflex, the challenge is to ” changing women’s view of the disease ». ” When you have breast cancer, you don’t always have heavy treatment », testifies Annie Bush. The other emergency: « demystify the screening examination », insists Bruno Borens, who suggests the realization ” reports, videos » on the course of the test. And to remember that, when detected in time, breast cancer can be cured “in more than 90% of cases”. “Discovering cancer at an early stage offers the possibility of being less invasive in terms of treatments, surgical and complementary, afterwards”, completes his colleague Kais Razzouk.
Little by little, so that screening gets rid of its distressing connotation, things are changing. At the Nice Breast Institute, health professionals have set up the “One day breast care” care program, which allows women coming for screening to have a mammogram and an ultrasound on the same day, and to have a first diagnosis. ” The aim is to reduce the anxiety of waiting between the detection of something suspicious and the results », explains Kais Razzouk.
To reach and raise awareness among populations with limited access to care and mammography centres, mobile teams also criss-cross the Ile-de-France region aboard the “Rose October Truck” (appointments can be made on Doctolib). Finally, the doctors also recall that each woman, at her level, can act thanks to “the observation of her breasts »and learning self-palpation.
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Pink October, it’s good because it’s a month when the world is talking about breast cancer », smiles radiologist Bruno Borens. However, it is far from enough. ” You always have to communicate », insists Corinne Balleyguier, who declares that ” it’s not when things are going well that we think about screening ». For the youngest, less affected by the risk of cancer, doctors recommend ” a gynecological follow-up from the age of twenty-five ». For older women, dare to overcome their fears. The pink month has a positive impact. ” Each year, the number of appointments increases during Pink October,” rejoices Bruno Borens. Before concluding, more seriously: But this effect remains limited in time. »