BREAST CANCER: Cancer-Rose decision-aid

*Decision-aid: Decision support for women without risk factors (family or genetic).

BREAST CANCER :

* Decision support tool for women without risk factors (family or genetic).

The 2015 citizen consultation on breast cancer screening stressed the need to create shared decision support tools.
There is currently no official decision support tool for organized breast cancer screening available to women invited to mammography screening in France.

This decision support tool that we propose to you has been developed by our group using available data in France (French epidemiological data) and hypotheses from independent international reviews for missing data in France.

Download the decision-making tool in PDF format :

This document is up to date with scientific data as of July 2021. It has been verified by specialists and will be verified every two years again. The Cancer Rose Association funded it entirely through individual donations, with no assistance or involvement from any administration, firm, or professional group.

Hypotheses and details of calculations used for Cancer-Rose decision-aid

Should I be screened for breast cancer?

Screening for breast cancer. Mammograms (breast X-rays) and sometimes a breast clinical exam are performed every two to three years. Breast cancer screening does not reduce the risk of developing the disease. Its purpose is to detect cancer before it can be seen or felt. On the other hand, diagnostic mammograms are used to detect and diagnose breast disease in women experiencing breast symptoms.

Uncertainties. Screening has not been clearly shown to reduce the risk of dying or developing a distressing disease. And screening has adverse effects.

The decision is up to each woman once she is well informed.

In France. Every two years, women aged 50 to 74 are invited to have screening mammograms. They are free to accept or not. The X-rays, sometimes completed with an ultrasound, are read by two radiologists. The result is given in the following days or weeks. If it is abnormal, additional tests are proposed: X-rays, MRI, sampling (biopsy). The health insurance pays directly for the screening and covers the other tests in the usual way. If the result is normal, the women are invited again two years later.

Benefits of screening.


Mammograms detect some cancers earlier, but not all. In these favorable cases, mammograms sometimes allow a less severe treatment, with better chances of recovery.

Today, advances in mortality reduction are primarily attributed to improved treatment. There is little reliable data for women aged 70 and older. Some breast cancers are not detected by screening and occur between two mammograms. They often progress more rapidly.

The disadvantages of screening mammograms

Anxiety and pain. Waiting for the screening and the results usually causes anxiety. The breasts are compressed during the exam. It is generally perceived as a distressing and, at times, painful exam.

False alarms. Abnormal results affect nearly half of all women. Most of them are false alarms (or false positives): mammograms lead to false suspicion of cancer. Biopsies are sometimes necessary for verification (with very rare complications). False alarms cause anxiety, but a normal result generally relieves women.

X-rays. X-rays from mammograms cause a very small number of cancers. We don't know exactly, but the younger you are and the more mammograms you have, the higher the risk.

Overdiagnosis. Mammograms detect tumors that are diagnosed as true cancers under the microscope but would not have caused any disease during the woman's lifetime: this is known as "overdiagnosis."

It is unknown how to distinguish between these over-diagnosed cancers and the true dangerous cancers. As a result, these tumors are typically treated in the same way as other cancers, with surgery (complete or partial removal of the breast) and possibly radiotherapy (radiation) and chemotherapy (anti-cancer drugs). This is why more breasts are removed in screened women populations than in unscreened populations.

- Consequences of overdiagnosis. Women who are "overdiagnosed" suffer all the other consequences of cancer unnecessarily: sick leave, loss of employment, psychological and family difficulties, loss of income, undesirable treatment effects, depression, heart attacks, etc. Among these consequences, some cause death, but it is not known how many.

In conclusion

Despite numerous trials, the balance of benefits and harms of screening mammography remains uncertain. In the face of this uncertainty, the best decision is one that each well-informed woman chooses to make for herself.

Whether or not screening is chosen, the most important thing is to seek medical attention if a lump (or tumor), breast deformity, bloody discharge, or unexplained redness appears.

See detailed information for women