information sur le dépistage du cancer du sein
Cancer Rose est un collectif de professionnels de la santé, rassemblés en association. Cancer Rose fonctionne sans publicité, sans conflit d’intérêt, sans subvention. Merci de soutenir notre action sur HelloAsso.
Cancer Rose is a French non-profit organization of health care professionals. Cancer Rose performs its activity without advertising, conflict of interest, subsidies. Thank you to support our activity on HelloAsso.
Cancer Rose est un collectif de professionnels de la santé, rassemblés en association. Cancer Rose fonctionne sans publicité, sans conflit d’intérêt, sans subvention. Merci de soutenir notre action sur HelloAsso.
Cancer Rose is a French non-profit organization of health care professionals. Cancer Rose performs its activity without advertising, conflict of interest, subsidies. Thank you to support our activity on HelloAsso.
Cancer Rose est un collectif de professionnels de la santé, rassemblés en association. Cancer Rose fonctionne sans publicité, sans conflit d’intérêt, sans subvention. Merci de soutenir notre action sur HelloAsso.
Cancer Rose is a French non-profit organization of health care professionals. Cancer Rose performs its activity without advertising, conflict of interest, subsidies. Thank you to support our activity on HelloAsso.
Cancer Rose est un collectif de professionnels de la santé, rassemblés en association. Cancer Rose fonctionne sans publicité, sans conflit d’intérêt, sans subvention. Merci de soutenir notre action sur HelloAsso.
Cancer Rose is a French non-profit organization of health care professionals. Cancer Rose performs its activity without advertising, conflict of interest, subsidies. Thank you to support our activity on HelloAsso.
Cancer Rose est un collectif de professionnels de la santé, rassemblés en association. Cancer Rose fonctionne sans publicité, sans conflit d’intérêt, sans subvention. Merci de soutenir notre action sur HelloAsso.
Cancer Rose is a French non-profit organization of health care professionals. Cancer Rose performs its activity without advertising, conflict of interest, subsidies. Thank you to support our activity on HelloAsso.
Cancer Rose est un collectif de professionnels de la santé, rassemblés en association. Cancer Rose fonctionne sans publicité, sans conflit d’intérêt, sans subvention. Merci de soutenir notre action sur HelloAsso.
Cancer Rose is a French non-profit organization of health care professionals. Cancer Rose performs its activity without advertising, conflict of interest, subsidies. Thank you to support our activity on HelloAsso.
In the journal “Pratiques”, Dr Marc Gourmelon reviews the history of breast cancer screening in France, from the launch of organized screening campaign, through citizen consultation, until the current situation with the new 2021/2025 cancer plan endorsed by President Macron, in a climate of deafness of authorities to citizen demands and despite the failure of this screening. All of this is against women's right to fair information on the risk-benefit balance of this screening.
Marc Gourmelon, Medical doctor, member of the Cancer Rose collective
Mammography (breast X-ray) is a radiological examination for diagnosis of any abnormalities detected in breast. It became common practice in the late 1960s with the arrival of the first mammograph in 1965. [1] [2]
Two randomized screening experiments are believed to have proven the effectiveness of mammography on mortality reduction.
These are the New York HIP trial (1963) and the study of two counties in Sweden (1985, 1997).
The published results were identical: a 30% reduction in mortality in the screened group compared to the control group in women over 50 years of age. This resulted in great enthusiasm leading several countries (United States, Sweden, Finland, United Kingdom, the Netherlands and others) to the decision to launch systematic screening campaigns by mammography.
In France, systematic breast cancer screening by mammography was first launched in ten pilot departments in 1989.
Thanks to this screening, it is believed that women would no longer have to die of breast cancer and the disease would be defeated on the basis of an a priori intuitive concept: the smaller or "in time" a cancer is caught, the less serious it is and the quicker it can be removed, thus the more advanced forms of cancer will be averted for women.
Starting in the 1990s, an increasing number of doctors began offering this imaging technique to detect breast cancer, and many studies were carried out in parallel on the subject.
A report from the French National Agency for Health Accreditation and Evaluation (ANAES) dated March 1999 assesses relevance in general population. It recommends the breast cancer screening for all women between 50 and 69 years of age, to be performed every two years. [3]
Based on this recommendation, the cancer plan 2003-2007 in its measure 21, notes: "Fulfilling the commitment to generalize organized breast cancer screening by the end of 2003".[4] Organized screening of breast cancer by mammography, under the impetus of President Chirac, will then be generalized in France in 2004.
However, voices of national and international scientists have been raised, as early as 1987, urging caution, but inaudible in the climate of general euphoria. [5]
In 2001, the independent Nordic collective Cochrane published a meta-analysis, updated several times [6], which questions benefits of this screening.
Nevertheless, the French High Authority for Health (HAS), which evaluated this study in early 2002, refused to question the relevance of organized breast cancer screening. [7]
Despite the accumulation of studies and evaluations in recent years, today the organized screening of breast cancer by mammography is still recommended by the health authorities ( French High Health Authority, National Cancer Institute) on the basis of 2004 guidelines.
The objective is even to intensify it, because the participation targets for eligible women (50 to 74 years old) set at 70 or 80% have still not been reached.
In fact, participation in the organized breast cancer screening program represents only slightly more than 50% of women.
At the same time, the number of mammographers is constantly expanding and cutting-edge technology, such as tomosynthesis, a type of 3D imaging, is being studied to track down more and more small lesions, contributing to a surge in incidence of cancers without a significant reduction in mortality. (still 12,000 deaths/breast cancer/year).
Proponents of EBM (the concept of tripod-based medicine - scientific studies, physician's professional experience, and patient preferences and choices) advocate enlightened information and shared decision-making with the patient, who must be informed of the uncertainties of screening. This concept is defended in France by the independent journal Prescrire. In the United Kingdom and Canada, very detailed brochures are issued to patients, while in France this is not the case.
The effectiveness of cancer screening is defined by :
- a drastic and significant reduction in mortality from the disease,
- a reduction in incidence of advanced cancers,
- a lightening of treatments.
The meta-analysis of the Cochrane collective that we have just mentioned above alerts us of an unexpected guest of screening, namely overdiagnosis. This concerns the discovery of cancerous and pre-cancerous lesions which, undetected, would not have endangered the woman's health or life, but which will all be treated with the same determination.
Together with false alarms, that is, suspected cancers that are not confirmed after further examinations of the patients, the risk-benefit balance of screening does not appear to be favorable. For the Cochrane, for every 2,000 women screened over 10 years, for one life saved, there will be 10 overdiagnosed and overtreated women and 200 false alarms. In the years following this publication, international and national studies on the benefit/risk of breast cancer screening by mammography have multiplied and have highlighted an important issue: an increasing overdiagnosis of small lesions (<2 cm) and precancerous lesions responsible for overtreatment, and a parallel reduction in mortality that is very minimal, little or not perceptible. [8] [9] [10]
Indeed, when comparing populations of women subjected to different screening intensities, we find that among women screened, more cancers are found for identical survival in both groups. [11]
Overtreatment is the materialization of overdiagnosis for women, and it has destructive effects.
Women are doubly victims, in their body and in their illusions, convinced that they have been "saved" while they are suffering the stress of a ruined life and the potentially major adverse effects of treatment.
Treatments are primarily surgical, with an increase in total and partial mastectomies since screening, contesting the widespread myth of therapeutic lightening through screening. [12]
Women also undergo unnecessary radiation therapy with cardiac risks and an increased risk of hemopathy. [13] [14]
The quality of their lives is diminished; after being diagnosed with cancer, women suffer from anxiety and depression syndromes, some lose their jobs and become poorer. Their sexuality and self-image are altered, sometimes leading to suicide. [15]
Thus overdiagnosis leads to a number of deaths that are not reliably measured but which, when taken together, could be major, as a British study suggests. [16]
This problem of overdiagnosis took a long time to be recognized by health authorities in charge of organized screening.
Today, this has been done, but this crucial issue, which must be taken into account when assessing the risk-benefit balance of screening, is greatly minimized.
In the 2015 HAS document [17], overdiagnosis is well mentioned, but, taking up only a few lines of the nearly one hundred pages of the report, it is completely drowned out in explanations of the value of screening; therefore, it goes unnoticed.
Furthermore, when it comes to independent scientific studies questioning the value of screening, the HAS document uses the terms "controversy" and "polemical", which inexpensively discredits the debate on the subject.
The document is still in force today, and is very poor in terms of bibliography supporting the interest in pursuing organized screening.
This makes it a very partial document, contrary to what should be expected from a state agency.
The INCa (National Cancer Institute) has also continued throughout these years the same shortcomings in the information provided to women on the subject.
We have just seen that for health authorities, for politicians who decide on successive cancer plans, the question regarding effectiveness of breast cancer screening by mammography is not raised.
They do not question the effectiveness of this screening and they are aiming to intensify it, even though independent meta-analyses, international studies and epidemiological data from the countries where screening takes place tend to show that the objectives of screening effectiveness are not being met :
- Not only does screening significantly increase the incidence of cancer without significantly decreasing the risk of dying from breast cancer, -but also does not make it possible to treat less aggressively, or to reduce advanced forms of cancer that desperately remain at an unchanged rate, in all countries where screening is in place.
Several observations prompted the Minister of Health at the time, Marisol Touraine, to initiate in 2015 a scientific and citizen consultation on breast cancer screening:
- The stagnation of the participation rate of women, which does not exceed 50% instead of the initial 70% objective.
- The variability of participation according to territories and socio-economic groups.
- The growing extent of the debate on benefits and risks of screening, both within scientific and medical spheres and among general public, regularly covered by mass media.
The Cancer Rose collective, of which I am a member, was auditioned during two round tables, one with citizens and the other with health professionals.
Our collective, made up of doctors and a toxicologist, came together with the objective of providing women and healthcare professionals with all independent and recent scientific information available.
Thus, we have developed and launched an website that aims to convey information that will allow women to make an informed decision on the stakes of screening, in an objective manner, without being influenced by media and promoters of the pink campaign.
This collaboration has already led to the development of an information brochure as well as various informative and educational materials.
The report of the scientific and citizen consultation was published at the end of 2016. [18]
The conclusion is very clear: the organized screening program should be stopped based on the two proposed scenarios (see page 132 of the report [19]):
Scenario 1: discontinuation of the organized screening program, relevance of mammography being assessed in the context of an individualized medical relationship.
Scenario 2: Cessation of organized screening as it exists today and implementation of a new organized screening, profoundly modified.
Following the release of this report, INCa sent a letter to Minister Marisol Touraine, dated September 16, although we only became publicly aware of the report on October 2. Professor Ifrah, President of INCa, calls Scenario 1 in this letter a "textbook case" and dismissed it out of hand, thus reducing half of the work to a negligible amount. [20]
Voices were raised, scandalized by such a denial of health democracy. [21]
An action plan is then published by Mrs. Marisol Touraine who entrusts the renovation of the screening to... INCa, the same institute whose lack of information for women was heavily criticized throughout the consultation report.
Currently, in 2020, the citizens' demand of 2015 to stop the current screening is still unheard, the pink campaigns are going well, and this public health program is therefore continuing according to the 2004 plan.
The implementation of a "new, profoundly modified organized screening" based on individual risk is underway with the launch of the MyPeBS study [22].
This is a randomized, non-inferiority study comparing women randomly divided into two groups. One group will consist of women who are routinely screened according to current official recommendations, and the other group will consist of women who are individually screened based on an assessment of their personal risk of developing invasive cancer during their lifetime.
This study poses many problems, ethical (consent form given to women omitting overtreatment and minimizing overdiagnosis), and methodological (absence of a "no screening" arm of the study, recruitment of women as young as 40 years old with annual mammograms for risk groups without information on radiotoxicity), software for calculating individual risk without scientific validation .
Nothing has happened, apart from continuity in the promotion of organized screening.
Breast cancer screening is still included in the Public Health Objectives Remuneration ( ROSP), but it must be recognized that the objective asked to the general practitioner (between 60 and 70% participation of patients) is very difficult to reach in order to get the maximum of this remuneration.
Every year, October month turns pink with multiple incentives for women to be screened. 2020 was no exception to the rule.
Broadcasts for general public (Stars à nues) on TV channels are making an unbridled and uncontrolled promotion of the screenings without any authority being concerned, nor the CSA Higher Council for Audiovisual that we had alerted.
It was decided by the authorities to set up organized breast cancer screening by mammography in 2004 when already early warners were expressing their doubts. Fifteen years later, knowledge on the subject has been enhanced. A large number of studies have been published that are consistent on a perceptible lack of benefit from breast cancer screening by mammography, and on the presence of risks whose reality is tangible and accountable. According to the most recent studies, overdiagnosis now concerns one-third to one-half of the cancers detected by mammography [23].
According to the journal Prescrire, for every 1,000 women over the age of 50 participating over a period of 20 years, there are approximately 1,000 false alarms in France, leading to 150 to 200 biopsies, sometimes several on the same woman during her successive screenings [24].
So why is it important for the French authorities to continue this screening, since women who undergo it do not gain any conclusive benefit from it?
Several possibilities can be evoked.
- After having literally conjured up women, for three decades, to get screened, through slogans and media campaigns, it seems difficult for the health authorities and opinion leaders promoting it to disregard it.
- Conflicts of interest among certain actors in the field of screening cannot be denied and weigh heavily on the omerta that reigns over the scientific debate in France [25] [26].
- Beliefs based on intuitive concepts are often easier to anchor ("sooner is better", "finding earlier saves lives") than explanations of the much more complex natural history of cancers in real life. This requires a longer pedagogy and explanatory development, to make people understand why some cancers remain indolent for a lifetime, why people can die with their cancer but not because of it, why others are fast and kill their host no matter is done, screened or not.
- Obvious laziness in tackling true prevention contributes to the persistent buzzing of well-oiled pink campaigns.
- Primary prevention remains the weak side of public health in France. Smoking, alcohol, but also obesity and a sedentary lifestyle are among the risk factors for cancer in general.
In addition to many other social factors, such as poverty, night work, certain professional environments are well known as risk factors for developing breast cancer and other cancers.
But few resources are invested in massive campaigns to combat smoking, alcoholism, obesity and these socio-professional factors.
They would certainly be more relevant than Pink October campaigns or health fair shows that are inflicted on women with coercive and scary messages.
In this respect, the latest cancer plan 2021/2025 announced by President Macron on February 4, 2021 is symptomatic: even if it talks about tobacco and alcohol, it largely confuses prevention and screening, giving the latter a clear advantage at the expense of prevention policies worthy of this name [27].
It is particularly difficult for the public, faced with opposing opinions and a highly technical debate, to get a clear idea of realities at hand.
The health sector has seen in this year 2020, during the coronavirus crisis, medical "clashes" with diametrically opposed opinions.
How can one cope as a layperson who has no expertise on the subject?
This is exactly the problem that every woman who is asked to get screened has to face.
This is all the more difficult for her, since the authorities are "Blind" with regard to the scientific knowledge they have acquired, and "Deaf" to all questions on the subject.
This is why I think it is necessary that all women be aware of this simple infographics, based on the evaluation of the Cochrane review, in concordance with other audited evaluations, whose results have never been contested by the international scientific community [28].
This simple visual, summarizing the entire issue of screening, must be given to women BEFORE they undergo the organized screening test for breast cancer.
[1] Tabar L, VitakB, Chen HH et al.The Swedish Two-County Trial twenty years later. Updated mortality results and new insights from long-term follow-up, Radiol Clin North Am 2 000 ; 38:625-51.
[2] Efficacy of screening mammography : Kerlikowske K, Grady D, Rubin S M, Sandrock C, Ernster V L. Efficacy of screening mammography : a meta-analysis. JAMA 1995 ; 273(2) : 149-154.
[3] https://has-sante.fr/upload/docs/application/pdf/mamo.pdf
Recommendations :
Routine screening is recommended in the 50-69 age group.
In the general population, the benefit of breast cancer screening in terms of avoided mortality is demonstrated in the 50-69 age group. Therefore, in this age group, routine screening is recommended.
In the 70-74 age group, the incidence of breast cancer is high, but data on mass screening are scarce. Taking into account the large-scale organizational difficulties, extending screening to this age group currently seems premature in France. On the other hand, it is logical to recommend the continuation of screening between the ages of 70 and 74 for women previously included in the systematic screening program between the ages of 50 and 69.
[4] https://www.e-cancer.fr/content/download/59052/537324/file/Plan_cancer_2003-2007_MILC.pdf
5] In 1998, Professor Paul Schäffer of the Bas-Rhin Laboratory of Epidemiology and Public Health (faculté́ de médecine de Strasbourg), in charge of the evaluation of screening, published an article in the French Medical Council's Bulletin 19.
"Tumour screening campaigns: caution is needed. "Screening should not be harmful. If it can bring health benefits, its potential to harm individuals should not be forgotten.For reasons of efficiency and ethics, preventive action should not have major disadvantages.
[6] https://www.cochrane.org/fr/CD001877/BREASTCA_depistage-du-cancer-du-sein-par-mammographie
7] "Gotzsche and Olsen's meta-analysis challenges the consensus on the effectiveness of breast cancer screening. "and : "The evaluation of Gotzsche and Olsen's meta-analysis, carried out by ANAES with the help of a multidisciplinary group of experts, concludes that it is not legitimate to question ANAES' recommendations in favour of breast cancer screening. »
[8] Breast Cancer Screening, Incidence, and Mortality Across US Counties,Charles Harding, AB ; Francesco Pompei, PhD ; Dmitriy Burmistrov, PhD ; et alH. Gilbert Welch, MD, MPH ; Rediet Abebe, MASt ; Richard Wilson, DPhil, JAMAIntern Med. 2015 ;175(9):1483-1489. doi:10.1001/jamainternmed.2015.3043
The results of this 2015 study :
- An increase in the number of breast cancer diagnoses (+16% for a 10% increase in screening participation), mainly by tumors smaller than 2 cm.
- No reduction in breast cancer mortality.
- No reduction in the number of advanced breast cancers.
- No reduction in mastectomies.
[9] RevuePrescrire 2006 https://www.prescrire.org/aLaUne/dossierKcSeinDepSyn.php
"In terms of total mortality, a benefit of mammographic screening in the general population has not been demonstrated. If there is an effect (positive or negative) on total mortality, it is small. »
10] Mammography screening: A major issue in medicine, Philippe Autier, Mathieu Boniol, Eur J Cancer, 2018 Feb ;90:34-62. doi : 10.1016/j.ejca.2017.11.002.
The strong points :
- After 20 to 30 years of mammography screening, the incidence rates of advanced and metastatic breast cancer have remained stable.
Breast cancer mortality rates have not declined more rapidly in areas where screening mammography has been in place since the late 1980s.
- One-third to one-half of breast cancers detected by mammography are estimated not to be symptomatic during a lifetime (overdiagnosis).
- Randomized trials of breast cancer screening have adopted distinctive methods that have led to exaggerated screening effectiveness.
- The influence of mammography screening on mortality decreases with the increasing effectiveness of cancer therapies.
11] Twenty year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial, Miller AB, Wall C, Baines CJ, Sun P, To T, Narod SA, The BmJ, 2014 Feb 11;348:g366.
Conclusions :
- No difference in mortality between the two groups (mortality = number of deaths relative to the total number of people screened).
- Survival rates are identical, regardless of the stage of the tumour at the time of detection (by screening for some, by a symptom for others).
22% over-diagnosis
- No difference between the two groups in the rate of fatal cancers.
[12] Le dépistage organisé permet-il réellement d’alléger le traitement chirurgical des cancers du sein ?, Vincent Robert, Jean Doubovetzky, Annette Lexa, Philippe Nicot, Cécile Bour, Revue Médecine, Volume 13, numéro 8, octobre 2017.
https://www.jle.com/fr/revues/med/e-docs/le_depistage_organise_permet_il_reellement_dalleger_le_traitement_chirurgical_des_cancers_du_sein__310529/article.phtml
[13] Causes of death after breast cancer diagnosis : A US population‐based analysais, Ahmed M. Afifi MBBCh, Anas M. Saad MD, Muneer J. Al‐Husseini MD, Ahmed Osama Elmehrath, Donald W. Northfelt MD, Mohamad Bassam Sonbol MD, ACS Journal, 16 December 2019
https://doi.org/10.1002/cncr.32648
[14] Evaluation of the Incidence of Hematologic Malignant Neoplasms Among Breast Cancer Survivors in France, Marie Joëlle Jabagi, PharmD, MPH, Norbert Vey, MD, PhD, Anthony Goncalves, MD, PhD, Thien Le Tri, MSc, Mahmoud Zureik, MD, PhD, and Rosemary Dray-Spira, MD, PhD, JAMA Netw Open, 2019 Jan ; 2(1) : e187147.
Published online 2019 Jan 18. doi : 10.1001/jamanetworkopen.2018.7147
[15] Bouhnik AD et Mancini J, « Sexualité, vie affective et conjugale » In La vie deux ans après un diagnostic de cancer - De l’annonce à l’après cancer, collection Études et enquêtes, INCa, juin 2014, 454 pages.
[16] Harms from breast cancer screening outweigh benefits if death caused by treatment is included, BMJ, 2013 ; 346 doi : https://doi.org/10.1136/bmj.f385 (Published 23 January 2013). Cite this as : BMJ 2013 ;346:f385 - https://www.bmj.com/content/346/bmj.f385
Michael Baum, professor emeritus of surgery, Division of Surgery and Interventional Science, University College London, London WC1E 6BT, UK
[17] https://www.has-sante.fr/jcms/c_2024559/fr/depistage-et-prevention-du-cancer-du-sein
[18] https://www.e-cancer.fr/Institut-national-du-cancer/Democratie-sanitaire/Concertation-citoyenne-sur-le-depistage-du-cancer-du-sein
[19] http://www.concertation-depistage.fr/wp-content/uploads/2016/10/depistage-cancer-sein-rapport-concertation-sept-2016.pdf (read: https://cancer-rose.fr/en/2020/12/14/final-report-of-the-citizen-consultation-report-of-the-steering-committee/)
[20] https://www.atoute.org/n/IMG/pdf/Courrier-Ministre-concertation-depistage-cancer-sein---.pdf
[21] https://formindep.fr/cancer-du-sein-la-concertation-confisquee/
[22] https://cancer-rose.fr/my-pebs/ (read: https://cancer-rose.fr/my-pebs/2019/06/13/argument-english/)
23] Mammography screening : A major issue in medicine, Philippe Autier, Mathieu Boniol,
Eur J Cancer, 2018 Feb ;90:34-62. doi : 10.1016/j.ejca.2017.11.002.
[24] Revue Prescrire, février 2015/Tome 35 N°376.
[25] https://www.atoute.org/n/article308.html
[26] MitcHell ap, BascH em, Dusetzina sB. Financial Relationships With Industry Among National Comprehensive Cancer Network Guideline Authors, JAMA Oncology, 2016 Dec 1 ;2(12):1628-1631.
[27] https://cancer-rose.fr/2021/02/08/nouveau-plan-cancer-2021-2030-une-planification-sovietique/
[28] https://www.hardingcenter.de/en/early-detection-breast-cancer-mammography-screening
Cancer Rose est un collectif de professionnels de la santé, rassemblés en association. Cancer Rose fonctionne sans publicité, sans conflit d’intérêt, sans subvention. Merci de soutenir notre action sur HelloAsso.
Cancer Rose is a French non-profit organization of health care professionals. Cancer Rose performs its activity without advertising, conflict of interest, subsidies. Thank you to support our activity on HelloAsso.
Annette Lexa, PhD Toxicology
It is easy to see in this frenzy of screening and explosion of patient recruitment in clinical trials a fool's game that primarily serves industry.
However, it is almost certain that reality is more complex, and this angle of analysis is not only one that can explain this situation, it is only a consequence and not the primary cause.
It seems more and more certain that this much promoted early detection indiscriminately detects cancers with good and poor prognosis. The problem is just that treatments which follow don't discriminate either ("We are going to cure you of a disease that you don't have yet", says a doctor in the France 5 documentary, « In the name of all breasts »).
This leads to over-treating a number of patients with new supposedly "innovative" anti-cancer drugs, extremely expensive and no more effective than those already on the market and whose serious side effects (death, second cancer) are largely unknown to general public.
In terms of public policy, cancer is receiving a great deal of attention, with a certain tropism for women's cancers, partly due to a captive and docile clientele (see on this same site "Breast cancer screening, the latest avatar of medical misogyny").
There are equally serious deadly diseases such as multiple sclerosis, cardiovascular disease, AIDS, diabetes that do not receive the same attention as cancer through its major National Cancer Plans. And we are not talking about nosocomial and iatrogenic diseases. It is not a question here of a silence of the body but of a societal silence or even of an indifference or a kind of fatality difficult to explain, assuming that the State' s vocation in health care is to reduce premature mortality and increase life expectancy of its citizens.
Unlike other pathologies, even the most serious and deadly, cancer is treated apart as if it was " the devil, the invincible predator ". Because cancer is more than a disease, it is a symbol of extraordinary power.
It replaced plague of the Middle Ages, tuberculosis and syphilis of our ancestors. It represents the devious evil, the silent killer, it seems to arise without any obvious cause (except the proven cases of smoker's cancer). For experts, it remains extremely difficult to prove causal link between exposure to a substance and appearance of a cancer, as environment and genetics seem to interfere and create favourable conditions for its development until metastasis and death.
Medical imaging tools have only been available for a few decades to confirm diagnosis. In the past, we would die without really knowing what caused the death. Now we still die, but we know from what, and the prognosis is even announced with a staggering techno-scientific coldness ("you only have 6 months to live").
Medicine has made great progress in oncology, that is not the point. What is important here is to recognize that this progress had little impact on what we modestly call cancers with a poor prognosis (lung cancer, gliomas, sarcomas, acute leukemia, certain skin cancers...). .
So why do we continue to focus so much on the "fight against cancer" all around? There are many equally deadly diseases where we could make huge progress through prevention alone or simply by focusing more on research and national plans.
Cancer collectively crystallizes all our thoughts and taboos about death. Yet our societies have "killed" death by killing God.
Existentialism and atheism (with secularism, which became the state religion in France) have become modern philosophies, markers of progress in the flow of History.
In a materialistic vision, when we consider that there is nothing after death, this death having lost all meaning; all that remains is the fight against this absolute "injustice". And the fight against cancer has become the latest eschatological fight (concerning the ultimate destiny of human race) of the postmodern crusaders in a society that has lost any project and common sense.
There are even post-humanist currents of thought that promise disappearance of death (cloning, freezing, transfer of thought from brain to hard disk...).
The discussion about death is therefore now reduced to the "right to" and not to existential questions about meaning of death, whether individual or collective. The individual, the new Man, necessarily emancipated, is supposed to be sent back to himself in the name of his personal convictions about death. And the individual has not necessarily acquired the psychic tools enabling him to take up this personal challenge. He is alone and he is afraid, very afraid and wherever he turns, he no longer finds a satisfactory answer.
If he finds a religion that offers him a turnkey life path, he sometimes signs without hesitation. Is he right? Is he wrong? In any case, we can't blame him too much in front of sidereal void.
In a completely different vision, which we will call "spiritual" (and not religious) of existence, death is a passage and this deep conviction is lived serenely, calmly, with much less anguish. It creates another relationship of trust in relation to life and death. We may feel sorrow at no longer seeing those we love, of course, but we are convinced that something of ourselves survives beyond the disappearance of our body and our self and we attach extreme moral importance to it, for example. It is a 360° vision of Life from birth to death.
Today, terror, fear is no longer in front of the Last Judgment, like our ancestors from the Middle Ages to 19th century, but in front of the void, the nothingness of death: contemporary funerals are the result (absence of rites, ...). This is an unprecedented situation knowing that burial rituals, the first sepultures date back 100,000 years and are the first markers of civilization (even Neanderthal buried his dead).
Asserting that death is nothing like Epicurus, is not true collectively. Individually and collectively it has been the stumbling block to all human life on Earth since Man became aware of his own death. As long as our societies have not transcended this drama that death has become in contemporary societies, we will not be able to get out of this teenage individualism that wants everything right away and especially not to die. There will be no turning back (with the return of traditional religions as they are) but it will be necessary that our societies include and transcend the great monotheistic religions and the other world visions transmitted by the first peoples.
If we are in a position to make this observation, we have no collective answer to date, each one being sent back to himself in front of this dizzying existential question. Death has become a personal matter to which society tries to respond as best it can. And frantic screening for cancer is a technocratic and economic societal response to calm the fear of death.
Biomedicine is still a combat medicine that works on "masculine" war premises. The exorbitant price of anti-cancer drugs, the major cancer plans and their share of "innovative" actions tinged with totalitarian desires that sometimes become ridiculous through obstinacy in reality of death, are result of this vision of the world.
The excesses of obsessive screening aimed at tracking down the slightest allegedly cancerous cell in everyone and by all means of medical imaging in order to "fight" it; are the result of the domination of the small self of the possessive individual, who wants to control everything, anguished by death he cannot control. Worse, like immature teenagers, we have wrapped this too warlike, too virile "fight against cancer" in a dripping pink emotional and regressive marshmallow, aiming to mask the lack of preparation of individuals in the face of death, their daily occupations having totally exempted them from having to reflect on the meaning of their life and death.
Our lives, our distant descent from our Cro-Magnon ancestors, the challenges that await tomorrow's humanity on a planet that will soon reach 10 billion people, deserve better than that. If, instead of turning inward and allowing ourselves to be taken over by a paternalistic state and a monopolistic economy, each of us starts to find the meaning of our lives, the courage to live, common sense in the face of individual and collective destinies, our Western societies will emerge stronger and will know how to restore meaning in the face of death. Otherwise, scenarios such as The Best of the World await us. We still have the choice, it is up to us to choose today and without delay.
Bertrand VERGELY , Entretien au bord de la mort , 2015
Cancer Rose est un collectif de professionnels de la santé, rassemblés en association. Cancer Rose fonctionne sans publicité, sans conflit d’intérêt, sans subvention. Merci de soutenir notre action sur HelloAsso.
Cancer Rose is a French non-profit organization of health care professionals. Cancer Rose performs its activity without advertising, conflict of interest, subsidies. Thank you to support our activity on HelloAsso.
By Annette Lexa, PhD Toxicology
Regulatory Toxicologist-Environmental Health Risk Assessor Expert (Eurotox)
Modern medicine maintains the idea that it is a rational, objective practice, resulting from a scientific approach, in constant progress and in which belief does not enter into account. It relies more and more on state-of-the-art technical tools, on computers, on statistics... It is based on the reductionist postulate that therapeutic activity is purely a molecular pharmacological activity, targeted on the diseased area (by replacing, preventing, regulating or stimulating the synthesis or release of an endogenous molecule).
Medication or therapeutic act is administered to a biological body that is supposed to be "inert", and ignores patient's living body, much like adding oil to an engine or tightening a bolt. It relies on measurement of biological parameters, using standardized anatomical-pathological criteria to diagnose or evaluate effectiveness of a treatment. And it often only addresses an effect, a consequence, but rarely the root cause.
This system of thought has made possible to make great discoveries and achieve major advances (pain, infections, surgery...). But it has also distanced us from common sense, pragmatism and the obvious. Our long dualistic tradition, inherited from Descartes, has separated body and mind and this separation maintains confusion: emotions, thoughts would have no consistency, no biological reality (if it is not by the trace of a nervous influx passage) and no influence on biological body.
This conception of the body suggests that the "spirit" would be an entity separate from the body and would have no connection with the body. This is one of the paradoxes of scientism.
Yet it is science itself that has confirmed what we have always known, that body and mind are intimately intertwined, with mind influencing body and body influencing mind, in a constant back and forth.
Medicine has introduced the placebo effect in clinical trials to evaluate therapeutic efficacy, but continues to largely ignore and underestimate this effect for ethical, dogmatic and economic reasons.
The placebo effect, which has been known for a long time, has often been ridiculed. It remains insufficiently studied for its therapeutic potential. All we know is that it acts by influencing physiological defense mechanisms of the body (pain, depression, Parkinson's disease...), brain secreting endogenous substances which in turn are capable of influencing pain circuits for example. It can even cause release of dopamine in Parkinson's patients with a dopaminergic deficit.
But to this day, the initial mechanism (belief, emotion) that led to triggering the biochemical pathway, that ultimately results in the production of dopamine, remains a mystery to science.
And if the placebo effect, whose origin is still poorly known, is that of an object that conveys hope, the nocebo effect is even more mysterious.
The definition of the nocebo effect is what causes the disease by anticipation of the disease in a favorable emotional context. The subject expects a well-defined negative event via social, media, professional, popular messages, etc., and this event will occur. Of course, not everyone is sensitive to this nocebo effect. It will depend on mental state, the person's inner world, his or her way of being in the world, beliefs, capacity for self-analysis, time and social context in which this person lives.
This is the case of voodoo death described by the first anthropologists, or closer to our societies, collective hysteria or categorization of pathologies (you are pre-menopausal, bipolar, pre-hypertensive, your child is dyslexic, he has an attention disorder with hyperactivity ...).
The nocebo effect is based on 3 main mechanisms of the mind:
We have forgotten how much we are symbolic animals. Animals because we are gifted with reflexive learning abilities, symbolic because we need strong representations and signs that make sense.
We are capable of autosuggestion and suggestion (Coué method, hypnosis...), capable of mental manipulation (Mesmer's tub and magnetism, voodoo death...) and we neglect to what extent medical visit, white coat and red or blue pill, imaging devices have replaced these curious rituals which seem to us to come from another time and seem ridiculous. We have forgotten how reality is constructed by our minds and that we all need to believe and convince ourselves.
The American philosopher Charles Sanders Peirce helps us to understand how our beliefs, such as the belief that "the earlier a cancer is caught, the better the chance of a cure:
The play "Doctor Knock or the triumph of medicine" by Jules Romain is a perfect example of the effect of convictions on health. He denounces the manipulation of a medicine that has become so powerful that it transforms all healthy people into patients who ignore themselves. Yet this dated comedy is totally modern, since today we are witnessing the creation of diseases and pre-diseases everywhere (disease mongering) and everyone wins... except the healthy individual surrounded on all sides (and still amazed to be alive in the face of so many diseases) and the real patient that an overwhelmed medicine ends up not being able to treat properly, because of an inflation of non-patients and pre-diseases cluttering up the waiting rooms.
Faced with an anxiety-provoking situation, we have three options: suffer, flee or fight. If we cannot flee, we can fight. If we cannot fight, we are doomed to suffer. During stressful situations that we cannot avoid either by fleeing or by fighting (moral harassment for example), our body secretes chemical messengers, such as cortisol, which end up causing pathologies: immune system overload, heart attack, hypertension, psychic disorders (memory loss, fatigue, insomnia, anxiety, depression), infections and cancers due to immune system collapse, suicide, death.
The role of cholecystokinin (a neuropeptide secreted by the duodenum but also by the brain) is evoked: it provokes a reaction of pain in a person who is afraid (as well as nausea). The deactivation of the endogenous dopamine and opiate systems are also involved in pain.
A search of the PubMed database in 2011 revealed that the keyword "nocebo" was indexed to 151 publications. In comparison, more than 150,000 were linked to the keyword "placebo". 2200 studies were related to the placebo effect while only 151 publications were related to the nocebo effect of which 20% were empirical studies, the rest being letters to the editor, comments, editorials and reviews.
Main tool for verifying the effectiveness of a therapy is a randomized, double-blind clinical trial. Two cohorts of patients are randomly selected (matched by age or other criteria), with the patient and the physician not knowing whether the therapy is placebo or active ingredient. It is easy to understand that it is ethically impossible for medicine to do harm (primum non nocere) and that the nocebo effect cannot be studied in a case of randomized clinical trials.
However, nocebo effect has been observed when switching from drugs to generics. And it was studied because there were economic stakes. The content of excipients changes, appearance of capsule and its color change, engraving, size, taste, speed of dissolution under the tongue ... Yet active ingredient remains unchanged. And yet reporting rate of adverse reactions explodes.
There is no need to look for someone else to take responsibility for your own actions to harm yourself sometimes:
Medical profession bears its share of responsibility, often unconsciously or negligently, for certain words, silences, acts or gestures:
Finally, at collective level, nocebo effect is well known:
Systematic breast cancer screening, which is performed on a massive number of women in Western countries, most of whom will never die of breast cancer, poses an ethical dilemma for medical profession and community: by trying too hard to "do well", to "save lives", are we not doing the opposite?
Should the taboo that surrounds the panic fear of a de-spiritualized society, that has nothing left to offer other than over-medicalization to calm existential anxieties, continue to hold normative categories of populations hostage (such as women between 50 and 74 years of age for example)? Should economic criteria lead medical profession to betray one of its main precepts, primum non nocere?
How can a truly targeted and effective screening be carried out, while avoiding inducing a long-term nocebo effect on healthy women who may be over-diagnosed and over-treated (30% over-diagnosis, or even 50% in the case of ductal cancers in situ) and on their descendants? This is the question that professionals in healthcare system should be asking themselves today.
Because the impact of early detection of breast cancer on overall quality of life of women concerned (their well-being) is underestimated, denied and not studied at all in risk-benefit balances. And yet...
All these consequences are not taken into account in what should be a global benefit-risk assessment in terms not only of mortality reduction, but also in terms of quality of life.
Well-being (physical and mental) is at center of all concerns. The smallest psychological unit is set up in case of more or less traumatic events. Except apparently when it is a question of enlisting entire female populations, without any special care or precautions, in organized breast cancer screening.
This repeated examination generates chronic discomfort for a certain number of women, a discomfort that is denied and underestimated by social and medical institutions, which nevertheless try to "play it down" and trivialize it, even though it carries within itself potentially devastating individual and intimate consequences. It is somewhat as if society accepted such a price to pay, such sacrifices in name of medical progress.
We live in an anxious society, creating pathologies and spending crazy energy to repair the diseases and pollutions it has created itself (so-called diseases of civilization including diabetes, cardiovascular diseases, autoimmune diseases, cancers ...) and while our fundamental knowledge on development (and regression) of cancers by an organism is still at a standstill.
Words are a powerful tool at the disposal of modern medicine. But words are double-edged weapons that can cure but they can also kill. And medical personnel are neither prepared nor encouraged to use this formidable therapeutic tool.
Medicine, through its managerial and judicial obsession (Kouchner's law) has entered into a vicious circle that is aggressive, regressive, generating anguish and fear by creating pathologies through excessive interventionism. However, it could find its way back to the path of common sense and pragmatism, and this in interest of real patients who should be able to benefit from all the attention.
To do so, medicine could :
Finally, women, who are too docile and submissive to medical profession, should take care to reconnect with their intelligence and intuition and not rush into the spiral of screening, not to submit to it without first serenely weighing personal, intimate advantages and disadvantages that it represents for themselves.
Finally, medicine and society should ask themselves questions about meaning of life and death other than through techno-scientific answer: recognize the place of medicine, which does not make it absolute master of life and death of individuals, find meaning elsewhere without waiting, and ask medicine for more than it can give.
Beyond capture of the topic by "experts", the limits of screening open us all to exciting reflections on our fears, our fragilities, our limits, our weaknesses, our freedoms. On the meaning of our life and death. In reality, a beautiful challenge.
Nocebo, la toxicité symbolique, ouvrage collectif, Collection Thériaka, remèdes et rationnalités, Jacques André Editeur, 2010, 231p.
Thierry Janssen, La maladie a-t-elle un sens, Ed Fayard, 2008, 351p.
Disease mongering ou stratégie de knock
http://docteurdu16.blogspot.fr/2009/02/disease-mongering-ou-la-strategie-de.html
The patient paradox. Why sexed-up medicine is bad for your health. Margaret McCartney.
http://docteurdu16.blogspot.fr/2015/12/the-patient-paradox-why-sexed-up.html
Raul de la Fuente-Fernandez et al. , Expectation and Dopamine Release: Mechanism of the Placebo Effect in Parkinson’s Disease, Science 10 August 2001 ,Vol. 293 no. 5532 pp. 1164-1166
Winfried Häuser et al, Nocebo Phenomena in Medicine, Their Relevance in Everyday Clinical Practice, Dtsch Arztebl Int. Jun 2012; 109(26): 459–46
Annette Lexa, Le dépistage du cancer du sein, dernier avatar de la misogynie médicale
Cancer Rose est un collectif de professionnels de la santé, rassemblés en association. Cancer Rose fonctionne sans publicité, sans conflit d’intérêt, sans subvention. Merci de soutenir notre action sur HelloAsso.
Cancer Rose is a French non-profit organization of health care professionals. Cancer Rose performs its activity without advertising, conflict of interest, subsidies. Thank you to support our activity on HelloAsso.
ANNETTE LEXA - August 21, 2015
Value of breast cancer screening is not scientifically proven
Breast cancer screening seems obvious to women and we have all been lulled by these "evidences": breast cancer is the first cause of death in women, cancer is a horrible disease that threatens us all, the earlier a cancer is detected, the more it is cured, screening can detect small cancers that can be treated, if we do it early we will have fewer mutilating ablations.
However, contrary to what is asserted everywhere, and even on institutional sites when they intend to promote DOCS (organized breast cancer screening), women die much more in France from cardiovascular diseases 1. While breast cancer mortality has decreased slightly (from 4% to 3%), colon and lung cancer deaths have not changed over the same period [1] .
This small decrease is mainly due to the fact that women have become more attentive and better informed and that surgical and radiotherapy treatments have made great progress.
Since 2009, a scientific controversy (here, here, here, here) has developed around the risk/benefit balance of breast cancer screening, presented as the medical examination of choice that is supposed to reduce this mortality. This controversy has arisen from large epidemiological studies in various Western countries (not in France where epidemiology is a politically incorrect science to be avoided). This controversy is currently heating up with this recent American study (here) which demonstrates more masterfully that early detection not only did not reduce mortality that had become stable, but also did not reduce breast ablations.
Screening's 'assets' continue to be praised with its double reading (in France) in case of a negative result, which would be the top of the top of scientific rigor. Whereas no one seems to matter this simple question of common sense: "why not double reading in case of a positive result? ». What an arrogant and asymmetrical confidence in the infallible reading of the specialist! The risk of false positives (false cancers) with its heavy and disabling prescriptions and the risk of false negatives (with the recurrent discovery by women themselves of the famous "interval cancers" between two examinations) are systematically underestimated. And finally, the risk of developing cancer through an excess of examinations and radiotherapy (here) is most certainly underestimated, whereas recent work (here) should on the contrary incite the greatest caution with radiosensitive women.
But, obviously, the sacrosanct principle of precaution - especially when the risk-benefit balance is not proven - is much more scrupulously applied for chickens, steaks or cereals than for bodies of healthy women (not to mention the use of contraceptive pill, hormone treatment for menopause, breast prostheses, caesarean sections, periodical tampons, etc.).
But then why have we been witnessing for years this veritable military operation of quasi-Stalinist national recruitment [2] of women to the depths of the most remote campaigns and by all means? Doctors, institutions, associations, politicians, all enlisted for the Great National Cause with the numerical objective of bringing recruitment ideally to 70 or even 80%. We go so far as to use "mammobiles" that travel around the Hérault department in the most remote villages to overcome the "reluctance" of "vulnerable" women and "women with a bad self-image" (I'm not exaggerating, go read here) and offer a free "useful" exam to women as early as 40).
Every year, we are entitled to the trickery of the Pink October campaign with the surge of indecent, manipulative, guilt-ridden, infantile messages, to reach women through the emotional supposed to be their main vector of communication and aiming to turn them all into cancerous ninnies ignoring themselves. Even if it means crushing individual lives, intimacy, and fulfilled sexuality, destroying couples and families (overtreating cancer is not a trivial event without risk, it is a personal drama) and leaving women in insurmountable financial difficulties because they are definitively labeled ex-cancerous (job loss, credit insurance...).
Treasures of imagination will be deployed to improve the self-image of the healthy women who are to be recruited by all means. But this does not really seem to be a priority anymore for a ex-cancer patient over 50 years old who must consider herself lucky to still be alive.
You will tell me that men also have their Movember to "fight prostate cancer". The PSA blood screening campaign was a failure and its interest was quickly questioned. It's true that men (including doctors), who care about their virility more than anything else, quickly understood the risk of overdiagnosis and overtreatment with its share of impotence and incontinence.... don't touch my virility.
I will answer that this relentlessness to control women's bodies is not new in French medicine:
- The 19th century saw the invention of Charcot's hysteria, all feminine, which became the sexual neurosis of women who were believed to be deprived of a penis according to Freud.
André Brouillet, Dr. Charcot at the Salpêtrière
- With the praiseworthy aim of fighting syphilis, Pasteurian hygienism led to the control of captive prostitutes in brothels who had to undergo monthly degrading medical visits that clients never had to undergo, even though they were themselves just as vectors (of transmission) of bacteria.
The medical visit , Toulouse Lautrec
- The control of childbirth by men from beginning of the 19th century resulted in a hecatomb of deaths in labour caused by the excessive hubris of hospital doctors who had taken over the childbirth. This hecatomb lasted until the 1930s. While 80% of pregnancies are normal, we then witnessed the increasing medicalization of pregnancy and childbirth, whose anxiety-provoking, cold and dehumanized nature did not escape any woman who experienced this event. In addition, there was an obsession with the control and normalization of this natural act with its share of episiotomies, epidurals and caesarean sections. It should be noted that this medical hypertechnicalization has not been accompanied by a decrease in maternal mortality in France.
- The invention of the oral contraceptive "pill" for women (why not for men?) became the symbol of female emancipation, of sexual liberation. However, for 4 decades, the medical profession has minimized and under-informed women about the side effects of this drug taken by women who are not ill. Yet this drug is a real endocrine disruptor classified as a group 1 carcinogen (definite carcinogen) by the IARC in 2012. The list of side effects that women docilely accept the risk of is as long as a poem à la Prévert: weight gain, cellulite, acne, headaches, depression, decreased libido, fatal venous and thrombo-embolic problems, slight increase in breast cancer and uterine cancer, etc.
Yet no feminist, after the euphoria of the 70s and 80s, seemed to see the symbolic violence of this medicalization of women's bodies and sexuality. In a terrible relational asymmetry, men were thus able to dispose of the bodies of women and very young girls brought by their own mothers in a irresponsible manner, and regularly complied with the medical visit to "their" gynecologist, demanding for the most scrupulous among them regular blood tests to monitor their cholesterol levels, accepting without flinching this control of their bodies and their sexuality, and sometimes serious undesirable effects of this constraining intake.
How can we speak of women's liberation ("my body belongs to me") with this passage from patriarchal submission to medical submission and to the desire of men since they are supposed to be 100% "available" from now on, and in case of a decrease in libido caused by taking the pill, they will blame themselves near their doctor-trust-sexologist? Recently, there has been concern about the urinary discharge of pill metabolites (17β-estradiol) present in aquatic environments at a concentration of around ng/L and responsible from this dose for fertility disorders and hermaphrodism in fish.
French society has not ceased to be worried about the impact of certain pesticides, brominated flame retardants, phthalates, glycol ethers, nonylphenol, Bisphenol A (a molecule that mimics estrogenic hormones) in food plastics, phytoestrogens, etc.., on the reproductive system of humans and animals) but it continues to authorize the sale of oral contraceptives "under medical supervision" when it does not give them free of charge to teenagers who have just reached puberty in secondary school, prepared by official Natural Sciences classes where the pill is presented as a simple means of having regular periods [4] ... figure it out. Finally, how many women, struggling to start a pregnancy after 10 years or more of oral contraception, without asking themselves more than that, are complying with heavy methods of medically assisted procreation (MAP) whose violence and constraint have nothing to envy to what has just been described? What is to be thought of a Ministry of Health that advertises oocyte donation[5] without mentioning the heaviness of hormonal treatment and its possible consequences? What about companies such as Facebook and Google that encourage their employees to freeze their oocytes to fight against the biological clock by trivializing hormonal treatments of retrieval and reimplantation?
- In the aftermath, women were convinced that menopause was a pathology and medicalization of menopause was invented with hormone replacement therapy which was supposed to have a preventive role against a host of future diseases. Still today, TSH is too often given to treat simple transitory disorders sometimes felt at this time like hot flashes, night sweats, low libido or vaginal dryness, or even it is given (and claimed by some women) as a "preventive" with the promise of staying young. Let us recall all the same that the treatment of menopause is classified as carcinogenic and that even health authorities today encourage the greatest caution in its use.
Women were made to believe that, now that they lacked hormones, it was natural for them to suffer all sorts of inconveniences that needed to be corrected if they wanted to continue to appear socially young and sexually desirable (unless they naturally questioned at that age about their emotional life, the departure of their children, their desire and sexuality, etc.) . As each woman is unique and is her own witness, none of them can boast of the real effectiveness of TSH on her menopause and it is more than likely that a good part of effectiveness felt is a kisscool effect.
- As soon as craze for TSH waned, we witnessed the mass submission, sometimes from the age of 40, to mammography screening, a painful and anxiety-provoking examination of uncertain benefit to reduce mortality, and which only resulted in a dizzying increase in the number of small cancers that would not have developed, or very slowly or would have regressed, and the number of unnecessary and traumatic breast ablations.
It should be noted that these last two acts of violence against women's bodies concern the "not so-youngest" who no longer represent the ideal of youth and fertility of the young woman, the eternal object of male fantasy, and to which the 50+ woman must comply.
- The trivialization of heavy, painful and sometimes dangerous surgical procedures to have silicone breast implants in order to improve their self-image, to conform to a totally constructed social norm (the very thin woman with very large breasts) and to respond to male fantasies. Would we imagine for one moment 400,000 men in France undergoing surgery to inflate their penis or testicles?
- The submission to cervical cancer vaccines of uncertain benefit, with great reinforcement of campaigns blaming the mothers of young teenagers. Here again, why should women be the main vector of the papillomavirus in question? Why has a mixed campaign not been launched targeting both young heterosexual boys - and homosexuals particularly concerned - and young girls, if not because the medical world has a captive market with women and their daughters, docile, easy to make feel guilty and educated to obey?
This docility of women with regard to medical world has changed little in spite of women's emancipation. And corporations and advertisers in charge of promotional campaigns are well aware of this, when they illustrate the importance of breast cancer screening by using images of young women with perfect bust, when they are not using guilty messages depicting family and "good friends". They continue to go running "against breast cancer" (who would be for, I ask you??) wearing a pink pin, dreadful gendered color, and don't hesitate to attend Tupperware meetings stamped Pink October to convince their reluctant girlfriends to go to the nearest mammobile.
Why this excessive relentlessness of medicine with the complicity of highest authorities of the State and their squads of civil servants in Regions to want to control the normality of breasts of women and to submit them down to their intimacy?
Why can we not find the beginning of an equivalent such control of the male body and such submission in men? Why doesn't medicine strive with same deployment of means to reduce mortality from cardiovascular disease in women, which represents almost 7 times more deaths per year than from breast cancer? Or to lower female mortality from lung and colon cancer? It is true that the heart, lung and colon are organs that are much less sexed. Women, contrary to what they claim, have not emancipated themselves from society's control over their bodies and sexuality. They have swapped one Master (father, husband, priest...) for another, representing the Promethean techno-scientific power supposed to watch over their bodies, which are inevitably disturbed, easily maladjusted, and which, if they are not careful, are the seat of all sorts of frightening feminine pathologies, this submission obscuring the perspective of a life as a woman, as a lover, as a mother in full bloom. Worse, women are women's worst enemies: making a daughter take the pill, recruiting her good friends is tantamount to making themselves accomplices in their submission, just as women are accomplices in the excision of the youngest in other cultures.
Some (here and here) have recently questioned the misogyny of the French medical profession, but paradoxically these theses have not seduced our journalists from women's magazines, who are nevertheless quick to liberate the sexuality of their readers. This thesis did not seem to please the various feminist movements either, refusing to see in this pseudo-emancipation another form of alienation, as Marc Girard has very well demonstrated. There is in this submission an absolute unthought, a taboo, a blind spot that the struggle for women's emancipation has been unable to see.
Still today, the majority of women are not very curious and critical of recommendations that are made to them: submissive, constrained or outright exalted followers of the Church of Depistology (Europa Donna and other Pink October with the support of Sephora, Tupperware and Esthé Lauder), they do not go to critical blogs (to those previously mentioned, I will add here and there) to have another point of view and to reflect by themselves.
Even though we live today in a secularized society, the past influence of the Church still unconsciously permeates our morals and mentalities. For centuries, the Catholic Church - like all monotheistic religious institutions - has sought to insist on the inferiority of women. She has sought to control the bodies and minds of women, for whom she has always had contradictory feelings: at once docile, submissive, modest and maternal, women remain for Church also a whore temptress, a witch or a fool incapable of judgment and decision by herself. Without going back very far, let's go back some 150 years. The few progressive women of the time are often put forward, but this is to forget that in the 19th century, while the predominantly male republican minds attacked the Church, the vast majority of women continued to be kept apart from the world, confined to their role as mothers, consolers, and social workers. Fear, restraint, modesty, devotion, virtue, these were the main qualities demanded of women who had only to please God and their husbands. Education was forbidden or very limited, and it was believed that she was incapable of intellectual life. Put aside from leisure, sport and study, women were considered weak and society had to protect them from themselves.
The adulterous woman was guilty when the man could act the most natural way in the world. The woman was excluded from any religious function, unable to relate to transcendence and easily perverted by the Devil. For a long time, menstruation, the mystery of gestation, seduction and sexual attraction, the power of women over domestic life (where she had been locked up) frightened men terribly.
Still at the beginning of the 20th century, priests questioned young teenage girls about their violently prohibited masturbation practices (testimony of my own mother who lived through this in the 1930s at the age of 10).
Since the weakening of warlike societies and religious power, women have gradually been emancipated and immense progress has been made in recent decades. Has misogyny disappeared for all that? Nothing is less certain. Today, women study, divorce, work, have children they want, can have abortions, vote and know in theory the same rights as men. But differences still exist, reminiscent of a past, paternalistic, misogynistic world that still survives in the medical world where difference in treatment between men and women, although having taken a less coercive and more inciting form, remains glaring.
For a long time medicine and religion were confounded, in the same fear of death .
The Age of Enlightenment saw the seeds of a new medicine that was meant to be rational. Did not the doctor with his new rites of medical examination replace the priest in his immense faith in medical progress and science, his interest in so-called ethical questions, his obsession with the control of female bodies from birth to death, whether in physiological, psychological, psychiatric or psychoanalytical field? Church saw woman of the 19th century as a layer, constantly pregnant or nursing. For the past 50 years, she has been put in a chemical straitjacket in a state of constant artificial sterility, now required to live a permanent sexual life where any drop in libido is experienced as suspect. She is also told not to complain about adverse effects ("it's in their head"). Any progress? In a sense yes, of course, but it is not certain that woman has not swapped her dependence for another alienation. And that male body of society is not yet consciously or unconsciously trying to control these bodies, so different from that of men, by their formidable cyclical capacity to seduce, to engender life.
Saint, whore, witch and Ninni, the four women of God, isn't that what contemporary diktats demand of women? At the same time to be a submissive and ignorant virgin, but also a temptress and seducer.
Today we have entered the era of biopower, of state control of bodies from birth to death. Public health is a vast operation of planning, a series of recommendations that seeks to control any form of epidemic (with its vaccine obsession) or the development of aggressive factors (such as cancer); for this, it must also control medical power, doctors.
By necessity of management, the biopower has equipped itself with performance tools. There are no longer individuals, there are only medical images, protocols, populations, statistics. Worse, this biopower is tainted by cynical and soulless consumerism and it knows perfectly well how to talk to "health care consumers" under the guise of simplistic, soft and guilt-ridden arguments mixing fear, security and precaution and enjoining individual well-being as the only eschatological horizon.
Yet, no, we are not condemned to live our lives as women under a medical sword of Damocles, tetanized by fertility and menopause disorders, female cancers and medicalized pregnancies.
No, we are not condemned to live our lives after 50 years cahin-caha, depressed and petrified with anxiety between a mammogram and a biopsy, with the fear of one day finding ourselves mutilated (and rebuilt?), while swallowing our TSH with a glass of alcohol to pass.
We can re-appropriate our bodies in all their beauty and their fertile and erotic power.
We have the freedom not to accept to be a pre-cancerous woman who ignored herself, not to accept to give in to fatalism, fear and control, to the overbidding of long, painful, sometimes humiliating, sometimes dangerous tests, and we can build our lives with our companions in a complementary, responsible and respectful relationship without relying on misinformed doctors who have been trained only to answer our questions as normal and healthy women with tests and prescriptions.
We can demand respect for our values and preferences, in a dignified and respectful relationship with doctors.
For this, there is a wonderful natural remedy called trust in Life.
1] In France (latest available source: INSEE, 2011), where the life expectancy of a woman is 85 years, the main causes of mortality in women are as follows:
73,842 of cardiovascular diseases (28% compared to 36% in 1996)
16,106 lung diseases (6% compared to 8% in 1996)
10,286 of digestive diseases (4% versus 5% in 1996)
5,800 of infectious and parasitic diseases (2% compared to 2% in 1996)
and for cancers :
7,734 in respiratory tract and lung cancer (3% vs. 3% in 1996)
8,113 of cancer of the colon, rectum, anus (3% compared to 3% in 1996)
11,623 women died of breast cancer (2% compared to 4% in 1996).
2] the suppression of the Individual Screening has even been imagined by the High Authority of Health in 2011 (here)
3] France, with its 2.3 deaths per 1000 births is in 17th position in Europe in 2013.
4] http://svt.ac-creteil.fr/IMG/pdf/4emecauseregles-.pdf
5] Campaign of the Biomedicine Agency "Become a Happiness Donor".
Cancer Rose est un collectif de professionnels de la santé, rassemblés en association. Cancer Rose fonctionne sans publicité, sans conflit d’intérêt, sans subvention. Merci de soutenir notre action sur HelloAsso.
Cancer Rose is a French non-profit organization of health care professionals. Cancer Rose performs its activity without advertising, conflict of interest, subsidies. Thank you to support our activity on HelloAsso.