NOVEMBER 5, 2021 BY CANCER ROSE
A Lancet study
Duggan C., Trapani D., Ilbawi A., Fidarova E., Laversanne M., Curigliano G. et al.
National health system characteristics, breast cancer stage at diagnosis, and breast cancer mortality: a population-based analysis
Concept of early clinical diagnosis
The authors make a distinction in their article between screening and early detection of breast cancer symptoms.
We therefore distinguish :
-Anticipated diagnosis = screening, which is based on repeated mammograms, as practiced in many countries.
- Early clinical diagnosis = the earliest possible detection of the first symptoms of breast cancer; this detection relies on the training and information of women and physicians and/or midwives (caregivers in general), on the one hand by raising their awareness (remembering to look for the symptom in the breast), and on the other hand by educating them on 'what' to look for.
- This concept of early clinical diagnosis contrasts with a late diagnosis due to the presence of symptoms of existing cancer that have been neglected for a long period due to a lack of information for women and a lack of training for caregivers.
The authors note that some countries do as well with early symptom detection as countries that use screening.
The Lancet article suggests that early diagnosis may work as well as screening.
Indeed, the WHO promotes early clinical diagnosis as an alternative to screening in countries that lack the resources for mass screening, which is not the case in France. We talked about it here: https://cancer-rose.fr/en/2021/09/04/screening-campaigns-a-move-toward-greater-caution/
Ukraine appears to have chosen this option, which is appropriate for developing countries that cannot afford routine mammography screening.
However, we can draw a pertinent question and a lesson from these findings for our countries where campaigns are in full swing, with mammographic screening, which no longer demonstrates its effectiveness and has drawbacks: What if early detection had a better benefit/risk ratio than routine mammographic screening?
Reducing breast cancer mortality with less overdiagnosis
The findings of the study, published in The Lancet Oncology, support the WHO recommendation, implying that early clinical diagnosis may be as effective as screening in avoiding advanced cancers and lowering mortality from breast cancer.
The benefit-risk balance of early diagnosis may be better than that of mass screening because it eliminates overdiagnosis and overtreatment caused by mammographic screening.
A serious alternative
As explained in detail on the website of Dr. Vincent Robert, statistician, this is an alternative to both screening and "doing nothing."
The idea, promoted by the WHO and confirmed by the Lancet study, is to offer this option to women to broaden their range of options and allow them to choose the path that appears to be most suitable for them, with full knowledge of the facts.