Adapting the frequency of breast cancer screening according to individual risk could be interesting according to a study conducted in France.
A mammogram, once every two years, from the age of 50. The message is firmly rooted in the minds of French women. But it could change. Adapting the frequency of examinations according to the risk of each woman is an interesting approach, according to the RIVIERA study presented at the French-speaking Radiology Days, organized at the Palais des Congrès de la Porte Maillot (Paris) from October 13 to 16.
Dr. Suzette Delaloge, oncologist at the Gustave-Roussy Institute (Villejuif, Val-de-Marne) is behind this work. Carried out on 450 women with several city doctors, they tested a new method of screening for breast cancer.
Optimize resources
Changing the practice in France seems necessary. For several years, the controversy has swelled around screening mammography. If it has improved the diagnosis, it also promotes over-diagnosis. And the number of women adhering to it is too low.
“10% of identified cancers would not have evolved if they had not been treated, explains Suzette Delaloge to Why Doctor. The other annoying point are the false positives, these images that are identified as cancers but which turn out to be benign lesions on biopsy. »
This is where “stratified screening” presented by the oncologist comes in. It is based on software, MammoRisk, which assesses the individual risk of breast cancer according to several parameters: age, family history, history of biopsy, breast density. Eventually, a genome analysis could be added.
“The idea is that women who really need screening will benefit from more intensive examinations, with different techniques, and those who have no significant risk will have less screening, summarizes Suzette Delaloge. The idea is to use resources differently, for the right people. »
Adapt support
The RIVIERA study has made it possible to lay the first foundations for this adapted treatment. The software has been tested in the context of prevention consultations with city doctors (gynecologists, radiologists, general practitioners). And it made it possible to distinguish three populations of women.
For a third of the participants, more intensive screening would have been justified. Considered to be at high risk of breast cancer, they would benefit from an onco-genetic consultation. Conversely, a quarter of the volunteers could have performed screening mammograms at longer intervals.
Listen…Dr Suztte Delaloge, oncologist in Villejuif: “Between 40 and 50, about 30% of women will need screening. Beyond the age of 65, there are few very high-risk situations. »
This strategy is particularly interesting for women who are not affected by the organized screening currently in place. “We can start at 35 and every five years, we identify the individual risk of breast cancer,” says Dr Delaloge.
A European study
Such a screening method will also allow women to better identify the risk of breast cancer to which they are exposed. At the start of the study, four out of ten women had no idea of their cancer risk. The others overestimated this probability. At the end of the consultations, almost all of them felt that the information they received was clear.
It now remains to confirm the impact of stratified screening on cancer detection. For this, Suzette Delaloge is launching a European study on 85,000 women, 20,000 of whom live in France. Named MyPEBS, it starts in October 2018 for a period of four years.
Physicians will need to compare standard screening to the targeted method. The long-term objective: to show that the latter reduces the number of advanced breast cancers, over-diagnoses, and false positives but also improves the experience of women. “We have no knowledge of the socio-psychological impact of such an announcement, underlines Suzette Delaloge. It is essential to check that this assessment is feasible, acceptable and that the women will behave appropriately. »
New imaging to improve screening
Breast cancer screening mammography has its limitations. Radiologists are aware of this. The “false positives”, these images which suggest a tumor wrongly, are also at the heart of the criticisms of organized screening. A new imaging technique could well help specialists to better distinguish nodules from tumours: tomosynthesis.
A priori similar to a mammogram, it allows to deliver better quality images. “Tomosynthesis makes it possible to increase cancer discoveries while reducing the number of false positives”, underlined Pr Isabelle Thomassin-Naggara, radiologist at Tenon Hospital (Paris). For every 1,000 women, imaging detects one to two more cancers.
Another benefit of this innovative technique: it is possible to reconstruct a 3D mammogram with high image quality. As a result, what appears as a nodule is clearly revealed as a tumour. “Tomosynthesis will be called upon to replace mammography in the future,” predicted Professor Thomassin-Naggara. While remaining cautious: the radiation to which the patients are exposed must still be evaluated.
Listen…Dr Suztte Delaloge, oncologist at the Gustave-Roussy Institute (Villejuif, Val-de-Marne): “It seems to bring a plus, but we do not yet know what benefit it brings in relation to the risk assessment. »
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