By Cancer Rose, 8th February 2026
Our collective was heard last June by the Court of Auditors (Cour des Comptes) as part of its evaluation of public policy on breast cancer screening, analysis of prevention, and breast cancer care.
https://www.ccomptes.fr/sites/default/files/2026-01/20260128-communique-Prevention-et-prise-en-charge-cancer-du-sein.pdf
Report and methodological appendix here:
https://www.ccomptes.fr/fr/publications/la-prevention-et-la-prise-en-charge-du-cancer-du-sein
This hearing lasted a good hour at the premises of the Court of Auditors, 13 Rue Cambon, 75001 Paris, led by three high-ranking government officials and required thorough preparation on my side, with the help of Mr. Autier, a renowned epidemiologist, to present a comprehensive PowerPoint presentation on all aspects of this healthcare system.
As shown on page 7 of the methodology document, many other parties were consulted, most of whom supported mammography screening, and those who questioned the program’s relevance had little influence.
We therefore wish to express our disagreement with the conclusions favoring increased mammography screening, which we do not share.
*Professor Autier:
1989: MPH in Epidemiology, Harvard School of Public Health
1991–1996: Jules Bordet Institute—initiator and director of the Breast Cancer Screening Programme in the Brussels Region
1996–2000: Deputy Director, European Institute of Oncology, Milan, Italy
2005–2010: Group Leader at IARC-CIRC, Lyon
2011–2022: Vice President, International Prevention Research Institute, Lyon
What conclusions does the Court of Auditors’ report draw?
From the very first chapter of the report and at the beginning of the press release, one can read:
“Organized breast cancer screening is an effective program that must be strengthened.
Organized breast cancer screening is a central pillar of prevention policy in a context where early diagnosis directly determines prognosis and the burden of treatment.
When detected at an early stage, breast cancer has very high survival rates, whereas late detection leads to more burdensome care and a significantly poorer prognosis.”
What is astonishing is the ability to align so many fallacious assertions in a single statement. Screening is not prevention. Early diagnosis is indeed valuable because if a cancer is detected early and at a small size, treatments will, of course, be less aggressive.
However, as we have endeavored to explain and demonstrate, believing that this could be understood by high-ranking officials who graduated from prestigious French universities, the question is phrased incorrectly.
Early detection is certainly laudable, but the real question is this: does screening manage to detect the most unfavorable cancers at an early stage and at a small size, or those that progress to advanced forms, which are the most aggressive and fastest-growing?
And the answer is NO—(https://link.springer.com/article/10.1007/s00508-025-02508-8)
These cancers are missed by screening and represent the major failure of mammographic detection, because they are either not visible on the images or develop so rapidly that they progress after a normal mammogram in a short period of time. They are known as interval cancers.Increased screening cannot resolve the underlying differences in cancer biology.
Here are some examples—
“Little”, but bad prognosis
Even if, by chance, they are detected during a screening mammogram, these aggressive forms, with inherently negative biological characteristics, have often already metastasized, even if these distant lesions are not yet visible.
The conclusion of the Court of Auditors’ report also states: “In terms of prevention, while organized screening can be given credit for earlier diagnosis, and therefore lower mortality and less intensive care, the low participation rate among the women eligible for screening is a cause of concern. »
Let us take a closer look at mortality data.
These are the figures we presented during our hearing:
When screening works, one should observe a faster and greater reduction in breast cancer mortality in countries (or regions) where programs were implemented early compared with those where screening was introduced later.
No data in France allows these two criteria to be assessed.
However, in countries with high-quality cancer registries, such as the Netherlands, the USA, and Norway, no reduction in advanced-stage breast cancers (stages 2–4) has been observed since the introduction of screening (Bleyer and Welch 2012; Lousdal, Kristiansen et al. 2016; Autier, Boniol et al. 2017).
A faster or greater reduction in breast cancer mortality has never been observed in countries or regions where screening was introduced earlier than elsewhere (Autier, Boniol et al. 2011; Autier, Koechlin et al. 2012; Harding, Pompei et al. 2015).
Since the 1990s, breast cancer mortality rates have fallen considerably in all high-income countries, including among unscreened women and even among women under 50, who are generally not screened. Almost all of this mortality reduction is due to effective treatments that became widespread in the early 1990s. (See references below)
Mortality data show that the reduction in France is similar to that in neighboring countries such as Germany or Italy (DIA 16).
This similarity shows that the level of healthcare for women with breast cancer is at least as good in France as elsewhere.[i]
The report of the Court also mentions the survival rate, claiming that screening would increase it to almost 90%.
In screening, the use of survival statistics should be avoided.
We also substantiated this point. First, survival is indeed high for cancers with a good prognosis, but not for highly malignant cancers—precisely those that screening misses, such as triple-negative cancers, whose 5-year survival is only around 20%.
Second, mammography screening preferentially and unnecessarily detects lesions that would never have caused death (so-called overdiagnosis). It is therefore entirely normal that survival artificially and misleadingly increases.
(See: https://cancer-rose.fr/en/2021/10/18/what-is-survival/)
The increase in survival is due to improved treatments and overdiagnosis. Women with overdiagnosed breast cancer do not die from it. Thus, the more women who are screened who would not have died from their cancer, the more we create the illusion that early detection works, because survival rates rise.
Accurate indicators of successful screening include a drastic and perceptible reduction in overall mortality, fewer severe cases, and fewer aggressive treatments. NONE of these three conditions has been met.
Don Quixotes…
Like Don Quixote fighting windmills, we have tirelessly persisted for 30 years in the absurd effort to destroy en masse breast lesions that would never have harmed anyone (overdiagnosis), thereby generating harmful overtreatment for women, all while congratulating ourselves for “doing something,” however futile.
Screening is a genuine case study example of focusing efforts on a process that has never been proven to work. To paraphrase Peter Drucker (1909–2005), author and management theorist: “There is nothing so useless as doing efficiently that which should not be done at all.”
First of all, we note the confusion—widely maintained, and deliberately so—between screening and prevention. Screening does not prevent cancer; it does not avoid it. A detected cancer by screening is already there!
So why this stubborn confusion between the words “screening” and “prevention” among doctors, institutions, and health authorities, endlessly repeated during the propagandistic and commercial October Pink campaign? Inattention? Not at all, it is rather a deliberate attempt, through the amalgamation of terms, to control minds and instill misleading notions, and what better way to do so than through the relentless repetition of an outrageous counter-truth?
The public is told exactly what it wants or needs to believe. It is a conspiracy of hope, as Canadian investigative journalist Renée Pellerin titled her book on mammography screening.
We would like to believe—and we try to make women believe—that screening prevents or avoids cancer, and this is just one of the many lies surrounding mammography screening.
The problem with overdiagnosis is that it can be identified in the population but not at the individual level.
More and more women are declared cured of a cancer that would never have made them ill or killed them.
But who are these women? We do not know. What we do know is that these overdiagnosed women would never have been ill without screening, and yet they will go through the cancer pathway—needlessly.
And meanwhile, we do not reduce the rate of real cancers, those that kill.
…to Cassandras
Who are these people who challenge screening and put forward completely counterintuitive notions? It is so much easier to believe that any cancer not found will inevitably cause death, that finding lots of small cancers will prevent large lethal ones, and that lives will be saved.
These troublemakers, these cursed Cassandras that no one wants to hear or believe, are very annoying; they prevent hope and belief, destroy faith in the religion of screening, and are labeled irresponsible, misogynistic, pessimistic, opponents of women’s causes, enemies of medical progress, and women killers.
Another argument has recently emerged: screening is social justice; it reduces inequalities—even if the equality achieved is that of the disaster of overmedicalization, leading to impoverishment, physical and psychological consequences of a cancer diagnosis that should never have occurred, and a deterioration in the quality of life of the women concerned. It is not a very enviable equality.
And then comes the inevitable question: “So what do we do instead?”
Instead, we could at least do no harm. Here, medicine itself induces an excess of disease. Yet primum non nocere is a cornerstone of medicine. Accepting uncertainty and the limitations of certain interventions, such as mammography screening, is inconceivable in a modern society that demands answers to everything. Better too much than too little—even if this pushes an entire female population towards a precipice they are not informed about.
This lack of information for women remains a major problem, one we frequently address on our website and seek to correct through decision-aid tools.
Here : https://oad.cancer-rose.fr/index.php?lng=en
And here in English version at the bottom of the page: https://cancer-rose.fr/2024/06/03/outil-daide-a-la-decision-cancer-rose/
Medicine, doctors, and health authorities should have the humility to recognize that screening will never defeat cancer. The solution does not lie in imaging but in genetics, fundamental research, environmental improvement, and lifestyle changes. That is where true prevention lies.
Doing at all costs—a Danaides’ barrel
After three decades, the facts are clear:
Screening has major adverse effects without proven benefit; the benefit–risk balance is unfavorable.
Organized mass screening is not only useless but harmful, with adverse effects that are a measurable reality (false alarms, overdiagnosis, unnecessary irradiation). Screening does not save the most serious cancers, but can push a healthy woman into a patient’s pathway she would never have experienced otherwise.
This has heavy consequences: overtreatment linked to overdiagnosis is intolerable for women and costly in lives and healthcare resources.
The short- and long-term harmful effects of chemotherapy and radiotherapy are significant. They can cause cardiac, respiratory, and skin complications, as well as radiation-induced secondary cancers with poor prognosis and difficult treatment, and hematological malignancies.
Even if rare, they exist—and they affect 100% of the women concerned—generating additional oncological care costs.
Screening increases anxiety levels in the population, including across generations. It fuels illusions and continuous misinformation.
The citizen consultation on mammography screening—confiscated from women and shelved—therefore recommended, in its report (pages 6 and 133), “the cessation of organized screening” in both of its scenarios.
Mammography screening is a leaky barrel, a massive waste of human and material resources. It is also an obstacle to progress and fundamental research, and a barrier to better care for truly ill patients with progressive breast cancer. It is a squandering of resources for healthy populations at the expense of genuinely sick individuals.
There is now a project to lower the screening age, even though the benefit–risk balance is worse at younger ages. We will first move to 45, then very quickly—given the predictable futility of the measure—to 40, then 38, and why not start at 30?
Cancer will continue to thrive, incidence will inevitably rise, the problem of advanced cancers will remain entirely unresolved since they represent the failure of screening, and the costs borne by society will be colossal.
The Court of Auditors also points out the following shortcomings:
Delays: In some areas, waiting times for an appointment within organized screening exceed one year. We explained during our hearing that this is of no importance. Mammography screening concerns healthy women with no symptoms, and there is absolutely no urgency—none at all—to be screened exactly every two years.
One possible explanation for longer delays is overtreatment linked to overdiagnosis. Since screening leads, according to authors, to 30% to 52% over-detection of small or slow-growing cancerous lesions that would have remained asymptomatic throughout the patient’s life—and since all these lesions are treated “just in case”—the general increase in delays is a logical consequence, both for therapeutic management and for radiology practices whose schedules are clogged with annual follow-up mammograms after treatment.
Even if delays increase, there is no relevance in making mammography screening an “emergency.” It is simply not feasible due to overloaded radiology practices, surgical shortages, and delays in biopsy results. Moreover, invited women have no clinical symptoms and can therefore wait without any problem.
Radiologists: The Court of Auditors also blames radiologists, noting that a significant proportion of private radiology practices refuse to participate in organized screening, which is deemed less profitable. In short, the absence of radiologists is a blocked system.
We have a different analysis. The system of inviting women for screening is time-consuming for patients, radiographers, and radiologists alike. Forms must be completed and sent to departmental screening structures, which takes time. Second readings generate recalls due to pseudo-lesions deemed suspicious by the second reader, increasing false-positive rates.
Patients must return to the radiology practice where the initial mammogram was performed—often in a state of great anxiety—for additional images or ultrasound, further increasing the number of examinations and the time burden of the procedure, often for nothing at all. This is the very definition of a false alarm.
Personally, as a radiologist, I believe many of my colleagues recognize that mammography screening has run out of steam and failed to meet expectations. All that for this—it does not encourage continuation.
Digital lag: The Court of Auditors then cites a digital lag, with too many paper files circulating between radiology centers and reading centers. The Court supports the development of AI with human supervision, continuous evaluation, and clear integration into the existing system. Time will tell whether this is a good idea.
Explosion of expenditure: The Court observes that prevention is stagnating while healthcare spending is exploding. Over eight years, the cost of breast cancer care rose from €2.8 billion to €4.7 billion, an increase of 65%, while the number of patients increased by only 7%.
This is mainly due to innovative drugs and hospitalizations. The Court raises a crucial question: how can ever more expensive treatments continue to be funded if prevention and early diagnosis fail?
We would reframe the question: would it not be more relevant to continue funding drugs that work well against breast cancer while stopping the relentless expansion of screening—thus avoiding costly overdiagnosis and overtreatment—and redirecting financial resources towards true prevention and fundamental research to understand the complex mechanisms of cancer progression?
A national cancer registry: Finally, a good idea. Currently, only partial registries exist. Incidence figures are extrapolated from data collected in 14 metropolitan registries covering only 19 departments, about 24% of the population. These extrapolations ignore regional differences that make populations poorly comparable.
The report announces the creation of a national database within the National Health Data System (SNDS), shared by Health Insurance and Public Health France, allowing national centralization and linkage of all screening and follow-up data. Eventually, these data may be integrated into the national cancer registry run by INCa.
Inequality in surgical care: Being operated on in a high-volume center improves survival for women with breast cancer. In France, minimum activity thresholds have long been set far below European recommendations. The Court therefore advocates concentrating surgical procedures in so-called expert centers—though it remains to be seen whether these centers can handle the volume.
Post-cancer: Financially, out-of-pocket costs average over €1,500 after the acute phase, especially for supportive care. French Parliament passed a law improving coverage for care and devices related to breast cancer, including full reimbursement for prosthesis renewal, medical tattooing, and adapted underwear, and regulating extra billing for reconstruction. For now, in the absence of implementing decrees, nothing is happening, and the law has raised several issues.
Conclusion
The conclusion can be summarized in an image I generated with AI, because human intelligence, even among senior government officials, is decidedly too prone to cognitive bias.
References
Autier, P. and M. Boniol (2011). « Caution needed for country-specific cancer survival. » The Lancet 377(9760): 99-101.
Autier, P., M. Boniol, A. Gavin and L. J. Vatten (2011). « Breast cancer mortality in neighbouring European countries with different levels of screening but similar access to treatment: trend analysis of WHO mortality database. » BMJ 343: d4411.
Autier, P., M. Boniol, C. Héry, E. Masuyer and J. Ferlay (2007). « Cancer survival statistics should be viewed with caution. » The Lancet Oncology 8(12): 1050-1052.
Autier, P., M. Boniol, A. Koechlin, C. Pizot and M. Boniol (2017). « Effectiveness of and overdiagnosis from mammography screening in the Netherlands: population based study. » Bmj 359: j5224.
Autier, P., A. Koechlin, M. Smans, L. Vatten and M. Boniol (2012). « Mammography screening and breast cancer mortality in Sweden. » J Natl Cancer Inst 104(14): 1080-1093.
Barratt, A., K. J. Jorgensen and P. Autier (2018). « Reform of the National Screening Mammography Program in France. » JAMA Intern Med 178(2): 177-178.
Biller-Andorno, N. and P. Juni (2014). « Abolishing mammography screening programs? A view from the Swiss Medical Board. » N Engl J Med 370(21): 1965-1967.
Bleyer, A. and H. G. Welch (2012). « Effect of three decades of screening mammography on breast-cancer incidence. » N Engl J Med 367(21): 1998-2005.
Cho, H., A. B. Mariotto, L. M. Schwartz, J. Luo and S. Woloshin (2014). « When do changes in cancer survival mean progress? The insight from population incidence and mortality. » J Natl Cancer Inst Monogr 2014(49): 187- 197.
Gøtzsche, P. C. and O. Olsen (2000). « Is screening for breast cancer with mammography justifiable? » Lancet 355(9198): 129-134.
Harding, C., F. Pompei, D. Burmistrov, H. G. Welch, R. Abebe and R. Wilson (2015). « Breast Cancer Screening, Incidence, and Mortality Across US Counties. » JAMA Intern Med.
Junod, B., P. H. Zahl, R. M. Kaplan, J. Olsen and S. Greenland (2011). « An investigation of the apparent breast cancer epidemic in France: screening and incidence trends in birth cohorts. » BMC Cancer 11: 401.
Lousdal, M. L., I. S. Kristiansen, B. Moller and H. Stovring (2016). « Effect of organised mammography screening on stage-specific incidence in Norway: population study. » Br J Cancer.
The independent UK panel on breast cancer screening (2012). The Benefits and Harms of Breast Cancer Screening: An Independent Review.
Vainio, H. and F. Bianchini, Eds. (2002). IARC Handbooks of cancer prevention. Volume 7. Breast cancer screening. Lyon, IARC Press.
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