Mammogram: YES or NO? “Should I get Screened ?” By Dr. Cécile Bour, Radiologist
Since the Nordic Cochrane Collaboration alert in the 2000s questioning the effectiveness of mammography screening and pointing to its risks, new studies have emerged in 2023, evaluating the overdiagnosis caused by screening on the rise. Meanwhile, a recently published systematic review suggests that life expectancy gains from mammography screening are uncertain and unlikely.
Unfortunately, women are deliberately left outside the loop of this new knowledge and are still subjected to the promotion of screening without being informed of its risks and harms. It's time for this knowledge to finally progress and become accessible to all women in all countries.
The book "Mammogram: Yes or No ", first published in French in a paper version in 2021, is now available in English in ebook format for a wider, English-speaking audience. This is a practical book for all women who have questions about breast cancer screening.
A handbook for women
Based on patients' questions heard during consultations, the author, a Radiologist practicing in France, provides the information needed to help every woman better understand the implications of screening and to be aware of its drawbacks.
As closely as possible to scientific data, she strives to answer such questions as..:
"You're sure you'll see everything if you get a mammogram, an ultrasound, or an MRI, right?"
"There are ten women at my workplace. We all have screening mammograms because one of us will get it. I've heard it's one in every eight! Is that correct?"
"I read that the cure rate for breast cancer is 90%. Is this true?”
"The Radiologist informed me that it was a very small cancer. Isn't it true that the earlier it's discovered, the better?"
"Shouldn't mammograms be done earlier, before the age of 50?"
"What is overdiagnosis?"
"Is it really so bad to detect harmless cancers?"
Why?
Because they've never been presented with the data in a balanced way, some readers are only now likely to discover that the appropriateness of breast cancer screening is scientifically debatable.
Women will find clarifications to the fundamental questions that every woman asks herself without necessarily finding answers on the official sites. They can discuss with their doctor and make their choice, following the principle of an informed decision, whether they live in a French-speaking country or beyond our borders.
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.
The French Association Cancer Rose proposes an interactive decision-support tool in three languages (French, English, German) on breast cancer screening to help each woman assess her own benefits/harms balance.
This tool can easily be used alone or with the help of a practitioner during a medical consultation. https://oad.cancer-rose.fr/
The tool presents two versions for the balance of benefits and harms:
A benefits/harms balance based on unfavorable hypotheses to screening.
A benefits/harms balance based on favorable hypotheses to screening.
It is possible to enter the age for the start and the end of participation in screening to obtain a personalized estimate of expected benefits (avoided deaths) and harms (overdiagnosis and false alarms) associated with screening.
Access to the decision tool possible too from the home page
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.
Dr. Jean Doubovetzky, a senior editor at the independent journal Prescrire, and author of the AntiDrKnock blog, presented on June 10 on the topic of unnoticed harms of breast cancer screening, "Under the radar: unnoticed harms of breast cancer screening."
Dr. C. Bour was a speaker on June 11 on a panel discussing "Promotional versus neutral messages - impact on individual breast cancer screening decisions when information is suppressed."
Dr. Jean Doubovetzky presented his innovative project of an international collaborative information website to inform the public about overmedication. "Call for an international platform of collaborative websites to fight "the harms of too much medicine."
La Maison de la Culture et de la Médecine (The House of Culture and Medicine of Nice) in collaboration with Cancer Rose, presented a poster concerning the dissemination of medical knowledge for a medicine integrating more the patient.
"Dissemination of shared decision support knowledge in popular education and medical training regarding cancer screening " Abstract
Cécile Bour, Md1, Jean-Michel Benattar, Md 2 3, France Légaré, PhD. 4, David Darmon PhD. 3 5 6, Luigi Flora PhD. 3 6
Citizens’ association (NGO) (ONG) Cancer Rose
Citizens’ association (NGO) Maison de la Médecine et de la Culture (MMC)
Patient and Public Partnership Innovation Center (CI3P), Côte d’Azur University, France
Shared Decision-Making Knowledge Translation, Laval University, Québec, Canada
Department of Teaching and Research in Family Medicine (DERMG), Côte d’Azur University, France
Interdisciplinary Research Laboratory RETInES, Côte d’Azur University, France
Keywords: Shared decision making, patient partnership, cancer screening, informed information, popular education, medical education.
Two citizens' associations, Cancer Rose and the Maison de la Médecine et de la Culture (MMC), have addressed, in their respective roles, the expectations of the citizen consultation on breast cancer screening in France (2016). Based on the work of Cancer Rose, which included the publication of a decision-aid based on French data, enriched by a small illustrated decision-aid, it was decided to offer monthly webinars on medical education in the health sciences, which would also be open to citizens.
Since 2015, Maison de la Médecine et de la Culture has specialized in this type of event, a project that has been carried out in collaboration with the Center for Innovation of Partnership with Patients and the Public (CI3P), an entity of the Department of Teaching and Research of Family Medicine DERMG at the University of Côte d'Azur since late 2019. The MMC is an association of citizens, not healthcare system users, that proposes through artistic works, meetings-films-debates that raise questions among citizens, whether they are relatives, patients, future decision-makers, or practicing healthcare professionals, on health issues that affect us all.
Since its first year, this activity has caught the attention of the Department of Family Medicine. Since 2015, MMC has been able to give additional teaching hours to family medicine interns for their participation in ethical reflections on health beyond peer-to-peer, physician-to-physician discussions.
At the same time, MMC has advocated for introducing a new approach initiated in Quebec with the current patient co-director of CI3P in France. MMC has co-designed a training program in collaboration with the Faculty of Medicine and the DERMG and commissioned by the Dean of the Faculty of Medicine: a university diploma course in the Art of Care in Partnership with the Patient. A training course recognized by the Ministry of Higher Education and Research as a pedagogical innovation in its first year of application in 2018. (Prix Passion Enseignement et Pedagogie in Higher Education in the " life-long education ").
This first partnership between citizens and academics resulted in the creation the Center for Innovation in Partnership with Patients and the Public (CI3P) within the Université Côte d'Azur's Faculty of Medicine, as announced by the program's founders at the award ceremony.
Cancer Rose and the MMC will host monthly webinars between the autumns of 2021 and 2022, between two Pink October campaigns dedicated to organized screening in France. These webinars provide free and informed information that is likely to foster critical thinking and shared decision-making for citizens, patients, health professionals, and medical students.
This webinar series is enhanced by the participation of a collaboration between CI3P and the Canadian Research Chair on Shared Decision Making and Knowledge Translation. A partnership that strengthens the historically strong links between these francophone universities, Laval University from Canada and Université Côte d'Azur from France.
Thus, CI3P and the Canadian Research Chair in Shared Decision Making and Knowledge Translation contribute to a long-standing collaboration between these two universities, France and Quebec, and thus between Canada and France.
These monthly participatory webinars, which were initially co-designed by members of the two associations and citizens (consisting of patients, health science students, and doctors), propose an exchange initiated by a work of art, which can be a work or an excerpt from a film or documentary, a literary work or a comic strip, a graphic illustration, or a theatrical or performance work. These works are mainly narrative, but not exclusively so. This artistic approach is proposed as an introduction to the theme.
The topics addressed then enable the development of a critical mindset among citizens because each person is mobilized singularly in their sensitivity and the unique interpretation that emerges from it. This approach opens up the Art of Care in partnership with the patient, which provides the means to reach a shared decision, within the framework of the doctor-patient relationship, following the ethical values of a medical practice adjusted to the patient.
This is the proposed cycle represented by this poster.
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.
Click on the image to access Preventing Overdiagnosis website
We are invited to Preventing Overdiagnosis Conference in Calgary (9 - 12 June) as speakers for the theme: Promotional messaging vs neutral messaging – impact on individual breast screening decisions when information is suppressed.
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 May 2020, about thirty French editorial societies denounced "with the greatest firmness" the section entitled "Fake news Coronavirus" launched by the Government (1).
The French journalists argued that "the State is not the arbiter of information". This site was removed, a few days later. The lesson has obviously not been learned.
Thus, today in the same logic, the National Cancer Institute (2) has decided to study the creation of a "CSA of Health" (CSA is the acronym of “Conseil Supérieur de l'Audiovisuel », French regulator of audiovisuel) in order to "establish rules in the field of health information”.
This “CSA of Health device will not be limited to the field of cancer”, and will therefore concern all health blogs, all doctor bloggers on social networks (websites, twitter, facebook) and all health articles in the media (online press). This decision is foreseen in a framework agreement with the hosts of content (media, social networks) to do a "work of elimination of the fake news identified by a college of experts."
The device to fight against "fake news" is already in place, part of the actions started in 2021. INCa is leading this action as indicated in the roadmap of the Cancer Plan decennial strategy 2021-2030 (Action file I.2., Action I.2.3, page 10, "Setting up a system to combat against fake news") (3).
Actualisation 2022
Project of an High Audiovisual Council of Health confirmed and published in the "Decennial Strategy to Fight Cancer 2021-2030", page 43
Thus, in order to implement this action immediately, the French National Cancer Institute qualifies from the start as "Fake news" the international controversy that exists on the benefits-risks balance of breast cancer screening. This can be found on the INCa website under the tab : "Enlightenment: the information behind fake news" which also presents the graphic charter of the French Republic (4).
The National Cancer Institute has always disseminated partisan and promotional information on breast cancer screening, emphasizing the effectiveness of screening by minimizing overdiagnosis and its serious consequences (overtreatment).
By decreeing that "the information on scientific debate can have a negative influence on women ...", INCa follows the same logic as the State in the affair of the site site "Désinfox Coronavirus": to arrogate a role of censor in the media production, and to grant a conformity to the only media which will deliver the information selected by the "experts" of the Institute.
By qualifying as “fake news” any scientific contradiction, by designating as "fake news" information that does not go in the official direction, by having "experts" do "an elimination work" of all that it considers contrary to its own communication, INCa will simply exercise censorship, in a country where freedom of expression and freedom of press are fundamental.
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.
The French National Cancer Institute (INCa) has always adopted a partisan presentation of the benefits-risks balance on breast cancer screening, emphasizing the effectiveness of screening, although subject to contestation at international level, and minimizing risks of screening, despite of citizen consultation demands in 2016.
Currently, Professor IFRAH, the president of INCa, who is supposed to promote fair information, without bias, enabling women to make their informed decision, launches "the new rubric of INCa to fight against fake news ".
On the page regarding breast cancer screening, questioning the benefits/risks balance of breast cancer screening is qualified as being "fake news".
It is stated: "This scientific debate may have a negative impact on women and turn them away from screening", implying that a scientific debate could be similar to fake news.
Then, an assertion is made without discussion and without nuance of the pretended proven benefit of this screening, on the basis of "proofs" quoted in references which are... a report, a leaflet and a brochure all issued by this Institute. No source of independent scientific study is mentioned.
To deny the worldwide contestation around this screening, to refuse the debate, to downgrade any contradiction to the rank of fake news is unworthy of scientists and scandalous from an Institution in charge of informing about cancer.
Will the next step be the censoring of publications that contest or make unfavorable comments on screening, relayed in the media?
We request that this article on breast cancer screening to be removed from the National Cancer Institute's page website « Enlightening information behind fake news », because it is outrageous, insulting to the media, to scientists and to women who are fighting for an informed choice and no manipulation regarding breast cancer 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.
Cancer Rose launches a new media library for general public and professionals who want to learn more about breast cancer and its screening, as well as about our activities on information and education. You will find it integrated in the menu, among the other categories of the website Cancer Rose.
The new design of our bilingual media library provides improved navigation to help our visitors find information easily. Visitors can conveniently browse content, read and download all open-access documents, and view videos.
For professionals, the media library offers the courses of Dr. Bernard Duperray, lecturer at the Faculty of Medicine Paris Descartes, within the inter-university diploma of breast pathology, as well as a library of clinical cases.
In addition, the media library provides access to Cancer Rose press releases and articles, as well as to presentations given at various events and conferences in France and abroad, since the Association was founded.
Links to Cancer Rose's social networks and the possibility of sharing any content you wish on your favourite social network are present at all times when you browse the media library.
Cancer Rose is a Non-Profit Organization under French law made up of independent Medical Doctors, a Doctor in Toxicology and a patient representative, with the goal of providing fair, transparent and objective information for women on mass screening for breast cancer, based on scientific evidence.Members of Cancer Rose have no sponsorships, honoraria, monetary support or conflict of interest from any commercial sources. They dedicate their time to this activity on a voluntary basis. The funds necessary for the functioning of this website and production of information materials (educational videos, brochures, posters) are generated by individual donations and members contributions.
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.
We present the downloadable poster in two formats, A4 and A3, for distribution to your patients or for display in the waiting room, in three languages, french, english, arabic.
You will find them on the French and English homepage.
French:
#Cancer du sein : téléchargez gratuitement notre affiche d'information (https://cancer-rose.fr)
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.
Participation of C.Bour MD as Jury Member for medical thesis
Defended on November 13, 2020, Faculty of Medicine, University of Rennes
Title : Perception by French general medicine interns of a video presenting the relevance of organized breast cancer screening.
Can this video open discussion and enable shared decision making between future GPs and their patients about screening mammography?
The video in question is Cancer Rose's " Screening Mammo, yes or no? "intended for the public and professionals. Click on "parameters" (bottom right of the video) to access to the subtitles of several languages.
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.
To interested people, health professionals, organizations, students, doctors, non-medical professionals :
Do not hesitate to contact us on the contact page if you wish an intervention of our collective for evenings-debates, documentaries, training meetings ...
Dr. Annette Lexa led a conference-debate at the University of Permanent Culture in Lorraine, in the form of a powerpoint presentation followed by a question-and-answer session from the floor.
"Systematic breast cancer screening: what benefits for what risks?"
Evening debate at the Case de Santé Toulouse
On December 18, 2018, evening debate at the Case de Santé de Toulouse animated by Dr Jean Doubovetzky, "Understanding and explaining to women the controversy on breast cancer screening".
On October 27, 2018 at the Maison de la Culture et Médecine, with the participation of Dr. Jean Doubovetzsky who presented a ludic presentation.... After the projection of Agnès Varda's film, "Cléo from 5 to 7".
An evening debate in Lunéville
invitation from Dr Bour Cécile
September 21, 2018
With the midwife who initiated this evening, Mrs. Amélie Henneguelle-Bataglia, once again our warm thanks to her!
Autonomous Grouping of Young General Practitioners and Replacements
Workshop: "Breast cancer screening, explaining the controversy". Animated by Dr Jean Doubovetzky, in Paris on March 17, 2018, as part of the Conferences of the National Union of Young General Practitioners.
The union RéAGIR (Regroupement Autonome des Généralists Jeunes Installés et Remplaçants (ReAGJIR)) is an inter-union federating 15 regional member structures. It represents replacements in general medicine, young GPs who have been in practice for less than 5 years (regardless of how they practice in primary care) and heads of general medicine clinics.
Conference-debate in Sélestat, November 26, 2017. Dr. C.Bour
Cancer Rose was invited to a conference-debate in Selestat by the cultural organization "les Alevis de Sélestat". About sixty participants listened to my presentation in the company of Bilgür, who was translating simultaneously.
It was an excellent moment of sharing, of questions and answers, but also of cordiality and extreme human warmth.
Conference of the French Society of Mammary Senology and Pathology (French Society of Mammary Senology and Pathology)
November 8 to 10, 2017
Cancer Rose participated in the conference of the French Society of Mammary Senology and Pathology November 2017, Lille. Our présentation, click here:
Dr Vincent Robert presented the poster, and Dr Bour Cécile presented the 10 minutes oral communication. We proposed an abstract, to be found here
We should mention the very remarkable presentation of Professor Philippe Autier, epidemiologist at the IRPI (International Prevention Research Institute), Dardilly, to be found here: presentation P.Autier
Dr. Jean Doubovetzky has been invited to participate in a conference-debate on the theme "Understanding the controversy on breast cancer screening", jointly organized on October 31, 2017 by the Lyon pharmacy students' association (AAEPL) and the Lyon East Carabinieri Association (ACLE), in an amphitheater of the University of Lyon I.
The aim of the conference was to give both pros and cons opinions on the subject in order to clearly define the scientific controversy, to be interactive, with numerous interventions from the audience, both to answer questions asked during the slide show or to ask or even give an opinion. Approximately 35 students, mostly future pharmacists, attended the presentation, which was supported by a slide show and left plenty of room for questions from the presenter, students, and discussion. The discussion continued well after the scheduled time, a sign of the students' interest and commitment. The conference lasted about 2h30.
(Shadok motto: "By trying hard, you will succeed. So: the more it fails, the more likely it is to work. »)
"Prescrire" meetings Toulouse June 2017 "Medication in society, everybody's business";
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.
