EDUCATIONAL ACTIONS OF CANCER ROSE IN 2020

To access our actions in previous years: https://cancer-rose.fr/en/2021/01/17/educational-actions-of-cancer-rose-2017-2019-2/

International days on the partnership of care with the patient, Côte d'Azur University, France

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Videoconference Monday, September 28 and Tuesday, September 29, 2020

The complete list of the presentations that took place during the International Days of the Patient and Public Partnership Innovation Centre, here :

https://ci3p.univ-cotedazur.fr/2020/06/06/journee-internationales-2020/

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.

EDUCATIONAL ACTIONS OF CANCER ROSE (2017-2019)

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 ...

We answer all the mails.

Presentations in English on Slideshare :

Conference Preventing Overdiagnosis, Sydney, December 5-7, 2019

Conference "Preventing overdiagnosis" Sydney December 2019, intervention Dr. J. Doubovetkky Saturday, December 7, in the afternoon.

Presentation Cancer Rose in BMJ Evidence Based Medicine, December 2019 issue, vol.4, supplement 2, page A43, abstract 76.

Dr. J. Doubovetzky with Prof. Alexandra Barratt, organizer of the 2019 session of the Preventing Overdiagnosis congress; Sydney

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Conference "Preventing Overdiagnosis" Copenhague August, 20, 2018

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Conference  15th International Meeting of Psychiatry, Psychoanalysis and Clinical Psychology, Budapest, May, 2018

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Conference Women and Health, Bruxelles , November, 2019

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Colloquium - over-medicalization, organized by Princeps group, November 29-30, 2019

Program: https://surmedicalisation.fr/?page_id=5649

Presentation and discussion with sound files

POSTER 4 BOBIGNY

Conference-Debate, Nancy, April 23, 2019

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.

http://www.ucp-nancy.org/conferences/

Category: Nancy-Nature, Life and Health

"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".

With presentation of our new information posters for doctors' waiting rooms.

https://www.facebook.com/LaCaseDeSante/

CINE-CONFERENCE-DEBATE - NICE

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!

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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

"Cancers and screenings"

Dr Bour Cécile

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.

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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.

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Dr Vincent Robert presented the poster, and Dr Bour Cécile presented the 10 minutes oral communication. We proposed an abstract, to be found here

abstract CR

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

slideshow of our intervention : diaporama de notre intervention

Poster

An interactive and humorous presentation in Lyon

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.

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(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";

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presentation of a poster, by Dr. J. Doubovetzky

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.

LETTER of 4 Collectives on the subject of MyPEBS study

What is the MyPEBS study?

https://cancer-rose.fr/my-pebs/wp-content/uploads/2019/12/MyPEBS-Protocol-.V1.2-du-27.07.18-.pdf


MyPeBS is a clinical trial which compares the incidence of advanced breast cancers in a group of women subjected to breast cancer risk-based screening tests and in a control group undergoing current standard planned screening tests.Stratified screening on risk factors is an interesting project in itself, and carrying out a clinical study can only be favorable in order to confirm whether it is or not.


This study, however, would have to be carried out with appropriate methodology, which appears not to be the case of MyPeBS.


1st point: the choice of using standard screening as a control arm is contestable.

Three options can be considered for future screening programs: changing to stratified screening tests, continuing current standard screening tests, or discontinuing all screening tests. Comparing the stratified screening arm to a current standard control arm could hopefully provide the answer to the question: is stratified screening more efficient or less efficient than standard screening? The answer to this question would only enable to make a choice between changing to a risk based strategy and continuing with the standard screening strategy. It will not provide any additional information to enable to make a choice between screening; stratified or standard, and no screening.
It is all the more regrettable that planned screening does not seem as adequate in 2018 as when it became the standard strategy. In terms of benefits, the 20% relevant mortality risk reduction is based on old studies and has not been found in recent studies. In terms of risks, overdiagnosis has possibly been underestimated, as recent studies have evaluated it nearer to 40% than to 10% as initially forecast. It should not be forgotten that overdiagnosis = unnecessary treatment, side effects - sometimes serious- with no benefits in return.
MyPeBS therefore represents a missed opportunity: the opportunity to provide the answer, with current data, to the question: should planned screening tests be discontinued, be continued or be changed to risk-based? To achieve this, including 3 arms in the study: one risk-based screening arm, one standard screening arm, and one with no screening would have been sufficient.
Of course this would mean accepting to reconsider the importance of screening if the study did not demonstrate superiority of screening compared to no screening. The sponsors of MyPeBS do not appear to be ready to call into the possible question.


2nd point: a lax approach as to non-inferiority.


The main objective of MyPeBS is to demonstrate non-inferiority of risk-based screening, as compared to standard screening. Contrary to what one might believe, A non-inferior to B does not mean that A is at least as performant as B. A non-inferior to B, means in effect that A can be inferior to B but that this inferiority does not exceed a certain threshold.`
In the case of MyPeBS, this threshold of non-inferiority is set, arbitrarily, to -25%. In other words, it is easy to think that at the end of the study, risk-based screening is certainly less performant than standard screening with, for example, performance loss somewhere between -5 and -20%; however, as the performance loss does not reach -25%, non-inferiority is confirmed, when in fact at best, the loss is of -5%, and at worst, this performance loss could reach -20%. Supposing your employer were to inform you that your salary scale was going to be revised downwards or upwards. Would you be truly reassured if your boss specified that in any case, if your salary were to decrease, this decrease would not be inferior to -25% ?And would you consider that a decrease of -25% of your income is insignificant? Well, this is exactly what MyPeBS puts forward. Simply replace “employer” by “study protocol” and “salary” by “screening efficiency”.


3rd point: deceitful information.

In the information leaflet, large-scale studies which showed that screening had reduced the mortality rate of breast cancer by around 20% are mentioned in the part of the text “Advantages and disadvantages of standard breast cancer screening”. Indication that those studies are old and probably obsolete or that a significant decrease of mortality by screening has not been found in recent studies [1,2] has been carefully omitted.
Concerning overdiagnosis, the leaflet merely mentions 10%, failing to specify that the frequency of overdiagnosis is not well known, with rates of up to 50% in some studies [3,4]. Furthermore, there is no mention of overtreatment that occurs with overdiagnosis. Nevertheless, they are indeed unnecessary treatments, with multiple side effects, which represent the major risks of screening tests.
Present scientific uncertainties make the presentation of benefits and harms of screening difficult. However, no information should be withheld, or for the purpose of clarity, should only convenient statistics be presented and others overlooked.
Studying the interest of stratified screening on risk factors might seem useful, but not haphazardly and certainly not with the main intention of promoting mammography screening one way or the other. This intention is clearly mentioned in Dr Balleyguer’s statement, page 14 in the press folder MyPeBS, 28 September 2018: "MyPeBS will probably encourage more women to enter national screening programs. Today, barely one out of two are taking part” [5 ].

READ MORE :
https://cancer-rose.fr/my-pebs/2019/08/02/mypebs-clinical-trial-failed-before-starting-2/

In response to these concerns

In response to these concerns, 4 European collectives, militating for independence in health, published an open letter, here is the English version:
https://cancer-rose.fr/my-pebs/wp-content/uploads/2020/02/LETTRE-COMMUNE-ANGLAIS.pdf

This letter was picked up by the press and mentioned in an article of the BMJ.

Press feedbacks


Article JIM
Article Quotidien du Médecin du 12 mars 2020 (french)
Article BMJ


Extract from article BMJ


The groups criticise the trial for assuming that breast screening is beneficial and for failing to compare stratified screening with a “no screening” group.
“MyPeBS represents a missed opportunity to provide the answer, with current data, to the question: should planned screening tests be continued, be changed to risk based screening, or stopped?” they wrote.
They also raise concerns about the trial’s “lax approach to non-inferiority” and point out that the two groups will be statistically compared with a threshold of “non-inferiority” arbitrarily set at 25%.
They go on to explain, “This comparison is obscure and conceals disconcerting information. According to the sponsors of MyPeBS, in the standard screening group, 480 new cases of severe tumours per 100 000 women are expected to be diagnosed. If the same rate does not exceed 600 per 100 000 women in the new personalised risk based group, both groups
will be declared equivalent. This means that if the rate of serious cancers is increased by less than 25% (for example 18% or 24%), then the study will be considered a success and the researchers conclude that the new screening methods are ‘as efficient’ as the former ones. In other words, +25% of serious cancers equals zero.”
Karsten Juhl Jørgensen, acting director of the Nordic Cochrane Centre and an author of the Cochrane review on breast screening, said that screening trial data were old, women below the screening age had experienced far greater reductions in breast cancer mortality than those invited, and new treatments have a far more important role than screening.
Jørgensen told The BMJ, “We desperately need a new trial of screening that can inform us about its role today. Whether personal screening strategies can optimise benefits and reduce harms is an important and relevant question. But screening trials need to be done extremely well to be informative, part of which means not relying on surrogate outcomes such as stage at detection, which we know can be misleading. The design of the new trial seems to raise more ethical questions than it answers.”

Ref.

  1. Autier P., Boniol M., Koechlin A., Pizot C, Boniol M. (2017), Effectiveness of and overdiagnosis from mammography screening in the Netherlands: population based study. BMJ 2017;359:j5224 (https://www.bmj.com/content/359/bmj.j5224)
  2. Møller M.H., Lousdal M.L., Kristiansen I.S., Støvring H. (2018), Effect of organized mammography screening on breast cancer mortality: A population-based cohort study in Norway. Int J Cancer. (https://europepmc.org/article/med/30144028
  3. Junod B., Zahl P.-H., Kaplan R.M., Olsen J., Greenland S. (2011), An investigation of the apparent breast cancer epidemic in France: screening and incidence trends in birth cohorts. BMC Cancer. 2011 Sep 21,11(1):401.(https://bmccancer.biomedcentral.com/articles/10.1186/1471-2407-11-401)
  4. Welch H.G., M.P.H., Prorok P.C., O’Malley A.J., Kramer B.S. (2016), Breast-Cancer Tumor Size, Overdiagnosis, and Mammography Screening Effectiveness. N Engl J Med 2016; 375:1438-1447. (https://www.nejm.org/doi/full/10.1056/NEJMoa1600249)
  5. http://www.unicancer.fr/sites/default/files/MyPeBS-DP.pdf

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.