Mammo or not mammo?

In August 2021, publishing of the book "Mammo or not mammo?" by Dr. Cécile Bour, Radiologist

  • A radiologist outlines the benefits and risks of screening mammography.
  • A guide based on questions asked by Dr. Bour's patients brings together information and decision-making tools based on objective scientific data.

The media, health insurance, and doctors make all women aware of the benefits of breast cancer screening... but how many are aware that having a mammogram every two years carries risks

Be informed before deciding

Indeed, there are numerous risks, beginning with the risk of overdiagnosis, which can result in unnecessary and distressing examinations and treatments. Other consequences that can be harmful to women's health should also be considered: false alarms, radiation exposure, treatment side effects,...

These risks are such that mammography screening is now the subject of a lively controversy in the scientific community. Women are kept out of this debate...

Because they were never given balanced data, some readers are likely to discover only now that the appropriateness of breast cancer screening is scientifically debatable.

Dr. Cécile Bour

In this benevolent book, the author rightly reminds us that the decision to undergo screening is a personal choice, which needs to be thought through.

My own experiences as a radiologist and discussions in the privacy of my consultations have made it clear that a woman's decision to attend or not screening cannot be made in a clear-cut manner but is the result of a process. As a matter of fairness and ethics, it is indeed necessary to properly inform every woman.

Dr. Cécile Bour

Objective information to help each woman make HER own choice

This book is for all women who have questions about breast cancer screening or consider screening on their own or their doctor's initiative. Based on patient questions, it provides the necessary information to aid each woman in better understanding the stakes of this screening, knowing its disadvantages, and discussing it with her doctor.

Among the questions addressed in the book:

"Is that all right? You'd have seen it if there was anything there, right?"

"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?"

The author

Cécile Bour is a Radiologist in the Metz region.

She is the president of the association Cancer Rose, which advocates for women to have access to independent and adequate information about breast cancer screening.

Download the press release (french)

Editor's website

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.

Other information tools

Harding Center of literacy

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Harding Center for Risk Literacy, University of Potsdam, Faculty of Health Sciences

https://www.hardingcenter.de/en/early-detection-of-cancer/early-detection-of-breast-cancer-by-mammography-screening

5 out of every 1,000 women aged 50 and over without screening and 4 out of every 1,000 women with screening died from breast cancer over a time period of approximately 11 years.
The numbers in the fact box are rounded. The numbers are calculated from eight studies that included a total of about 600,000 participants [1].
Screening did not affect the total number of deaths when all potential causes of death are considered. About 84 out of every 1,000 women died in total, independent of whether they were screened or not.
Furthermore, women who receive false alarms (positive test results that turn out to be false positives) can suffer from psychological distress, including anxiety and uncertainty, for years afterward [1].
A positive result from a mammography does not automatically mean that a woman has cancer. Mammography screening also detects preliminary stages of breast cancer, such as ductal carcinoma in situ (DCIS), which is characterized by abnormal cells in the mammary ducts that have not spread to other tissue (non-invasive). In some women DCIS remains harmless; in others it develops into an invasive tumor, which can be life-threatening [4].
Any screening can lead to overdiagnosis. In the case of breast cancer, this means that women are diagnosed with breast cancers that would have remained undetected without the screening. One instance of these are small tumors that grow slowly or not at all (non-progressive cancer) and might never have caused any complaints. Because it is difficult for physicians to assess whether a tumor will continue to grow, they often advise their patients to receive treatment.
Overdiagnosis often leads to overtreatment, which means unnecessary surgery or radiation [4].

[1] GøtzschePC, JørgensenKJ. Dépistage du cancer du sein par mammographie. Cochrane Database Syst Rev2013(6) doi : 10.1002/14651858.CD001877.pub5.
[4] IQWIG. Einladungsschreiben und Entscheidungshilfe zum Mammographie-Screening 2014. [www.iqwig.de/de/projekte-ergebnisse/projekte/gesundheitsinformation/p14-03-einladungsschreiben-und-entscheidungshilfe.2019

OMS - a short guide about screening programmes

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WHO Screening programmes: a short guide. Increase effectiveness, maximize benefits and minimize harm. Copenhagen: WHO Regional Office for Europe; 2020.
https://www.euro.who.int/en/publications/abstracts/screening-programmes-a-short-guide.-increase-effectiveness,-maximize-benefits-and-minimize-harm-2020

« Screening programmes should provide unbiased and easy-to-understand informa­tion so that people can make an informed decision on whether to participate in screening.
Both laypeople and clinicians tend to overestimate the benefits of screening and underestimate the harm of screening. Training personnel on communicating risk and tools such as infographics, videos and decision aids can be used to facilitate understanding and promote informed consent and evidence-informed practice (Fig. 15, p38). » « Fig. 15. Use of infographic to illustrate overdiagnosis in breast cancer screening, » (Above)

CanTaskForce

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Cantaskforce - Canadian Task force on Preventive Healthcare, established by the Public Health Agency of Canada 
https://canadiantaskforce.ca/lignesdirectrives/lignes-directrices-publiees/cancer-du-sein-mise-a-jour/?lang=fr
« Low-certainty evidence indicates that screening for breast cancer with mammography results in a modest reduction in breast cancer mortality for women aged 40 to 74 years with the absolute benefit lowest for women less than 50 years of age. Screening leads to overdiagnosis resulting in unnecessary treatment of cancer that would not have caused harm in a woman’s lifetime, as well as physical and psychological consequences from false positives. »

« Screening is a personal decision. It is important to understand and weigh the benefits and harms for women in your age group (as shown below) with your health care provider. This will help you get a better understanding of the issues so that you can decide what is best for you. Some women may wish to not be screened if they are concerned about potential harms. »

Canada Booklet

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Information on Mammography for Women Aged 40 and Older: A Decision Aid for Breast Cancer Screening in Canada” is a product of the Canadian Breast Cancer Screening Initiative (CBCSI). The CBCSI is a part of the Canadian Breast Cancer Initiative. The Initiative includes the Public Health Agency of Canada, provincial/territorial breast screening programs, professional associations, non-governmental organizations, and women. 
https://www.prhc.on.ca/wp-content/uploads/2020/02/Information-on-Mammography-Decision-Tool.pdf

Australia (Breast Cancer Screening, it's your choice)

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Breast cancer screening decision aid for women aged 50, updated in 2017
Its' your choice
Authors: Jolyn Hersch, Members of the Screening and Test Evaluation Program at The University of Sydney

Abstract: Why is there a decision to make about having breast cancer screening? Many people think screening for early signs of breast cancer is always a good thing. But breast screening has advantages and disadvantages. This booklet is designed to help you make an informed choice about whether you would prefer to have screening or not.This booklet was developed in 2013 by members of the Screening and Test Evaluation Program at The University of Sydney, Australia. It was developed and evaluated as part of a research study which has been published in the following article: Hersch J, et al. Use of a decision aid including information on overdetection to support informed choice about breast cancer screening: a randomised controlled trial. Lancet 2015; 385: 1642. The booklet was updated in 2017 to reflect the extended age range for screening.

https://ses.library.usyd.edu.au/bitstream/handle/2123/16658/2017%20updated%20breast%20screening%20DA%20(Hersch%20et%20al).pdf;jsessionid=F0396C69AD95F6431008EA16CB3B9195?sequence=1

United Kingdom

This leaflet was developed by an independent team of information experts at King’s Health Partners, with advice and writing support from Cancer Research UK. Through a public consultation, over 1000 members of the public contributed to developing the approach to information about the NHS cancer screening programmes. The information in this leaflet used recommendations from a citizens’ jury of 25 women about how to present the possible benefits and risks of breast screening.
Process described here :
Forbes, Lindsay JL, and Amanda-Jane Ramirez. “Offering Informed Choice about Breast Screening.” Journal of Medical Screening, vol. 21, no. 4, Dec. 2014, pp. 194–200, doi:10.1177/0969141314555350, https://journals.sagepub.com/doi/pdf/10.1177/0969141314555350
Complete leaflet

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NHS Breastscreening - Helping you decide
https://www.gov.uk/government/publications/breast-screening-helping-women-decide/nhs-breast-screening-helping-you-decide

« It is your choice whether to have breast screening or not. This leaflet aims to help you decide. »

US-US Preventive Services Task Force

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https://jamanetwork.com/journals/jama/fullarticle/2040228

Breast Cancer Screening: Benefits and Harms 

Author : Jin Jill
JAMA Patient Page
JAMA. 2014;312(23):2585. doi:10.1001/jama.2014.13195
Balancing Benefits and Harms
The pros and cons of breast cancer screening are different for everywoman.
Eachwoman also has different personal values, especially toward the idea of unnecessary
medical tests and treatments.

Germany

Brustkrebs-Früherkennung – Herausgeber: Techniker Krankenkasse, Hauptverwaltung: 22291 Hamburg; in Kooperation mit dem Nationalen Netzwerk Frauen und Gesundheit. Internet: www.tk.de. Konzept + Text: Dr. Eva Schindele, Bremer Medienbüro. Wissenschaftliche Beratung: Prof. Dr. med. Ingrid Mühlhauser, Universität Hamburg, 2013

http://www.nationales-netzwerk-frauengesundheit.de/downloads/BrustkrebsFrueh_Internet.pdf

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Text EN, page 17-18

Earlier diagnosis does not always lead to a longer life span. As this model calculation shows, in this case only the time of diagnosis was brought forward, thereby extending the disease phase by three years. In both cases, the woman dies at the age of 65.

"The earlier breast cancer is detected, the better." You can read this sentence everywhere, and it makes sense at first glance. But isn't it true?

Prof. Dr. Ingrid Mühlhauser , Hambourg University:  “Early detection only has an advantage if early therapy can prevent death from breast cancer. However, according to current knowledge, early detection mammography mainly detects forms of breast cancer that often would not have had a worse course of disease if they had been detected later. In contrast, particularly malignant forms of cancer are often not detected by mammography in time to avert death. Only the time of diagnosis is brought forward and thus the period of time in which the woman lives as a breast cancer patient is extended.”

What does it mean for women when the time of diagnosis is brought forward?

Prof. Dr. Ingrid Mühlhauser : “Imagine that breast cancer is diagnosed at the age of 60. The affected woman dies of the cancer five years later, at the age of 65. With early detection mammography, the cancer could possibly be detected three years earlier, i.e. at the age of 57. If this woman then dies at the age of 65, early detection would not have prolonged her life. It would only have prolonged her time as a breast cancer patient and possibly her period of suffering.”

Perception and reality

How women perceive screening data, guided by optimistic slogans and presentations, versus reality https://cancer-rose.fr/en/2020/12/18/perception-and-reality-2/
Reference: Biller-Andorno, Nikola; Jüni, Peter Abolishing Mammography Screening Programs? A View From the Swiss Medical Board, Obstetrical & Gynecological Survey: August 2014 - Volume 69 - Issue 8 - p 474-475
doi:10.1097/01.ogx.0000453825.77352.6b

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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.

Interview TV of Renée Pellerin

Interview TV of Renée Pellerin, author of Conspiracy of Hope - the Truth About Breast Cancer Screening

Author of Conspiracy of Hope - The Truth About Breast Cancer Screening, Renée Pellerin, reveals the truth about mammograms and how they could be doing more harm than good.

Interview on 19 November 2018, TV Global News Canada

https://globalnews.ca/video/4676346/conspiracy-of-hope-the-truth-about-breast-cancer-screening/

Interview on 20 March 2019, TVO Ontario Canada

https://www.tvo.org/video/the-truth-about-mammography

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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.

Conspiracy of Hope-a book of Renee Pellerin

Book : Conspiracy of Hope - The Truth about Breast Cancer Screening, Goose Lane Editions, 2018

Author Renée Pellerin

Book Excerpt -
Chapter 4 : https://www.thestar.com/news/canada/2018/09/28/is-the-need-for-routine-mammograms-a-big-lie-expose-casts-doubt-on-decades-of-research.html

Book Excerpt -
Chapter 10 https://thewalrus.ca/the-shaky-science-of-breast-cancer-screening/
By courtesy of the Author and Editor (https://gooselane.com/products/conspiracy-of-hope-ebook)

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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.

Informed consent/Letter CMAJ

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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.

Interview with B. Duperray MD

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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.

Point of View of Cancer Rose about MyPEBS-study in BMJ

Letter 4-collectives

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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.

French Inquiry About Breast Cancer Screening in the JAMA

Viewpoint 

Less Is More

February 2018

Reform of the National Screening Mammography Program in France

Alexandra Barratt, MBBS, MPH, PhD1Karsten Juhl Jørgensen, MD2Philippe Autier, MD3

Author Affiliations

JAMA Intern Med. 2018;178(2):177-178. doi:10.1001/jamainternmed.2017.5836

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2659560

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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.

Cochrane Leaflet

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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.

Early Detection of Breast Cancer-Harding

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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.