On the occasion of the new publication of his book “Cancer du sein, s’information pour se caré”, published by Doctor Lemoine, Professor Gilles Freyer looks back on the advances in breast cancer screening in 2022, which allow in particular early diagnosis of the disease.
- According to statistics, 1 in 8 women will develop breast cancer during her lifetime.
- Breast cancer detected early enough is cured in 90% of cases.
Overall, like every year, are all the treatments progressing?
Overall the treatments are progressing. We know that breast cancer mortality is decreasing. We simply have the reflection of the last ten years. But I think in four or five years the new data will be even more encouraging.
Breast cancer mortality: 37% drop thanks to screenings
Let’s talk a bit about this decrease. A study from Stanford University in the United States, and published by JAMA, showed that breast cancer mortality decreased by 49% in 2012 compared to what it was in the absence of screening. and treatment…
This is the great strength of the Americans! They are able to make considerable databases and the follow-up of patients for years or even decades. It is a modeling study that must be taken with a bit of perspective. We have what to give the modeling studies of the Covid, for example! I still want to emphasize that it is a very beautiful work that deserved a publication.
The originality is to distinguish between what screening does in this reduction of risk and mortality, and what treatment does. For the entire population that was studied, we actually have a decrease of 49%. Of this decrease, about 37% is attributable to screening according to the authors and 6% to therapeutic progress. But it changes a lot at the level of cancer subtypes and without going into detail, it’s extremely encouraging.
Another confirmation that we felt was coming and which goes beyond breast cancer: a simple blood test could allow the detection of fifty types of cancer, including breast cancer?
Indeed it is a big study. Out of 6,621 volunteers, we found 92 people to be positive for the test and in these 92 people we diagnosed 35 cancers. However, we do not have the miracle blood test. Why ? Because it is necessary to test more than six thousand people to diagnose 35 cancers and because we create enormous anxiety among the sixty of them who have nothing and who are going to undergo heaps of examinations. Then, we are not sure that even when the patient has cancer that the test is always positive. In other words, I would say that it is a small step among others towards something that can be refined in the years to come. But today, it really must be said that in no case do we have the blood test that diagnoses cancer in general.
Organized screening: nearly 1 in 2 women still do not participate
Early diagnosis increases the chances of remission and participation in organized screening rose above 50% in 2021 because it had dropped during Covid. Does this mean that one in two women still does not?
Yes, whereas the models suggest that we would have to exceed 60% for there to be a very significant effect observed in the population. We must continue to encourage women over 50. Now we also know that we can do it sooner. And above all, we must stop scaring them.
More surprising news, in our country, for breast cancer. Are we considering a consultation at 25?
It’s quite different. Until then, we have dogma guided by 50-74 year old studies. But like any dogma, it is made to be relativized. First, we could very well go beyond 74 years because the older we get, the easier it is to monitor the breast, to find tumors on palpation and mammography. There is evidence that older people benefit from screening. When it is done earlier, it is above all guided by the notion of risk. As today, we have discovered more and more genes differently associated with risk, indeed for part of the population guided by this genetic risk, and sometimes guided by stories of breast density, we will be able to offer more screening early. And of course, a different screening. When you’re young, we don’t, for example, do mammograms because it’s an examination that won’t be profitable in terms of diagnosis. And above all, we will absolutely avoid giving small doses of radiation throughout life. The exams will therefore be different.
Does it already happen like this in other countries?
European countries are probably the most advanced countries in the world in screening. In the United States, it is a little more complicated because of the size of the territory. It is not very easy to have access to radiology and examinations. And then unfortunately, we have a slice of the world that is economically disadvantaged and where screening does not exist at all.
You can find the interview in pictures here:
Professor Gilles Freyer’s book, Breast cancer, information for treatmentpublished by Doctor Lemoine, is available via this link.
