11:40, 13 October 2022, changed at 11:58, 13 October 2022
“I discovered while soaping 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 will not come out of this disease unscathed », declares the one who since 2019 has been chairman of the association “Vivre comme avant”, dedicated to supporting breast cancer patients. “When the diagnoses decreasedshe 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, to them, the most lethal. In 2018, it was responsible for more than 12,000 deaths. To better combat this scourge, the Directorate General 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 goal is to detect tumors that are not palpable before they are clinically expressed », explains doctor Kais Razzouk, surgeon at the Breast Kantis Institute in Nice.
Only one in two women undergo organized screening
But today the exam is still not very popular. In the period 2020-2021, the national participation in organized screening (which therefore falls 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 personnel in the fight against Covid, “The organized screening stopped between March and July 2020 », explains Corinne Balleyguier, head of the medical imaging department at 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, there are several factors that explain these figures. “In some regions, there is a lower participation in organized screenings because individual screenings are more important », states Corinne Balleyguier. Women under the age of 50 can, of their own free will or with a prescription from a doctor or gynecologist, go and be screened at an X-ray center whenever they wish. The diagnosis is less complete because there is none “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 who live in cities where “Women are often followed by gynecologists ». And where medical deserts are rarer.
Some women say “I’d rather not know”
The doctors also point out that not all women are informed in the same way about the importance of screening, and that the inequalities in access to care and to radiological centers are real. In addition, there is also the screening test’s bad image. “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, admits 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 specialists, the low participation in organized screening is linked above all to one “psychological brake ». ” Some women say to themselves “I’d rather not know, we’ll see when it happens” », laments Kais Razzouk, surgeon at the Kantys Breast Institute in Nice. ONE « ostrich politics » nourished by one fear of the outcome ». ” The first shock is learning you have cancer.” blows Annie Brousse. “We tell 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 the discomfort during the examination, performed by compressing the chest with the help of plates. On this point, Corinne Balleyguier wants to be reassuring. ” A correctly performed mammogram does not have to hurt, she assures. The radiologist must have sufficient equipment if he wants to be able to carry out screenings. » Communication with patients, important »has also developed according to Bruno Borens. “We get the women to 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 see the disease”
Today, for screening to become a reflex, the challenge is to ” to change women’s view of the disease ». ” When you have breast cancer, you don’t always have a heavy treatment », witnesses Annie Bush. The second emergency: « demystify the screening examination », insists Bruno Borens, who proposes the realization ” reports, videos » during the test. And to remember that breast cancer can be cured when detected in time “in more than 90% of cases”. “Detection of cancer at an early stage allows for subsequently being less invasive in terms of treatments, surgical and complementary”, completes his colleague Kais Razzouk.
Little by little, as screening sheds its disturbing connotation, things are changing. At the Nice Breast Institute, health professionals have created the “One day breast care” care program, which allows women who come for screening to have a mammogram and an ultrasound on the same day and to receive an initial diagnosis. ” The goal is to reduce the anxiety of waiting between the discovery of something suspicious and the results », explains Kais Razzouk.
To reach and raise awareness among populations with limited access to care and mammography centers, mobile teams also cross the Ile-de-France region aboard the “Rose October Truck” (appointments can be booked on Doctolib). Finally, the doctors also remind that every woman at her level can act thanks “the observation of her breasts »and learn self-palpation.
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pink october, it’s good because it’s a month when the world talks about breast cancer », smiles radiologist Bruno Borens. However, it is far from enough. ” You must always communicate », insists Corinne Balleyguier, who declares that ” it is 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. ” Every year, the number of deals increases during Pink October,” rejoices Bruno Borens. Before you conclude, more seriously: But this effect remains limited in time. »