Preventing Overdiagnosis Conference-2022

Presentations

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."

Her is the presentation

Download / Télécharger

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."

Here is the presentation: 

Download / Télécharger

Our abstracts

All our abstracts are published in BMJ Evidence Medicine in the links below:

Under the radar

Dissemination of shared decision support knowledge...

Call for an international platform....

Better information of women

Socio-cultural environment

Posters

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

  1. Citizens’ association (NGO) (ONG) Cancer Rose
  2. Citizens’ association (NGO) Maison de la Médecine et de la Culture (MMC)
  3. Patient and Public Partnership Innovation Center (CI3P), Côte d’Azur University, France
  4. Shared Decision-Making Knowledge Translation, Laval University, Québec, Canada
  5. Department of Teaching and Research in Family Medicine (DERMG), Côte d’Azur University, France
  6. 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.

It's Discussed:

Article du CanadianTaskForce

Annonce dans la revue Prescrire

Photos

Editorial in the BMJ

Editor's Choice

A system reset for the campaign against too much medicine

BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1466 (Published 16 June 2022)

By Kamran Abbasi, editor in chief

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.

POD-CONFERENCE

Preventing Overdiagnosis Conference 2022-Calgary

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.

Keynote speakers: https://www.preventingoverdiagnosis.net/?page_id=2354

Presentation from Jean Doubovetzky MD, Under The Radar

Download / Télécharger

Presentation from Cécile Bour MD, Censorship In France

Download / Télécharger




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.

Press Release – Cancer Rose

June 2021

The National Cancer Institute censures and qualifies  as "fake news" information in health that does not follow the official direction line.

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.

[1]https://www.lemonde.fr/actualite-medias/article/2020/05/05/le-gouvernement-supprime-sa-page-controversee-desinfox-coronavirus_6038753_3236.html

[2]https://consultation-cancer.fr/consultations/axe-1-ameliorer-la-prevention/consultation/consultation/opinions/2-prendre-ensemble-le-virage-preventif/mesures-proposees/mettre-en-place-un-dispositif-de-lutte-contre-les-fake-news

[3] https://www.e-cancer.fr/Institut-national-du-cancer/Strategie-de-lutte-contre-les-cancers-en-France/La-strategie-decennale-de-lutte-contre-les-cancers-2021-2030/Le-lancement-de-la-strategie

[4] https://leseclairages.e-cancer.fr/

[5] https://cancer-rose.fr/en/2021/03/08/ou-en-sommes-nous/

Read more :

https://mypebs-en-question.fr/actus/infox_en.php

https://mypebs-en-question.fr/actus/censure_en.php

https://mypebs-en-question.fr/actus/infox_fond_en.php

https://mypebs-en-question.fr/actus/inca_conflit_interet_en.php

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 – Press release June 2021

June 22, 2021

Website page "Enlightening information behind the fake news » set up by INCa - An unacceptable rubric on breast cancer screening

Website page in english

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.

NEW BILINGUAL MEDIA LIBRARY

Cancer Rose, 31 March 2021

Cancer Rose launches new bilingual media library

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 general public, the media library offers posters, brochures, information videos, as well as an excerpt from Dr. Bernard Duperray's book "Dépistage du cancer du sein - la grande illusion".

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.

Enjoy your visit on https://cancer-rose.fr/en/media-library/ !

Cancer Rose collective

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.

Balance of benefits and harms of mammography screening, multilingual

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)

English:

Breast #cancer : download our free information poster (https://cancer-rose.fr/en)

Arabic:

(https://cancer-rose.fr/en) سرطان الثدي: قم بتنزيل ملصق المعلومات المجاني الخاص بنا

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 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

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 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

Click on picture

Conference "Preventing Overdiagnosis" Copenhague August, 20, 2018

Click on picture

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

Click on picture

Conference Women and Health, Bruxelles , November, 2019

Click on picture

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!

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" https://fr2.slideshare.net/CancerRose1/cancer-and-screening-a-presentation-by-cancer-rose-241499601

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.

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

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.

(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";

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

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