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43 Breast cancer, another view of the disease. Towards a better information of women
  1. Bernard Duperray1,
  2. Cécile Bour2
  1. 1Radiologist, Retired, Paris, France
  2. 2Cancer Rose Group, Metz, France


Awareness of overdiagnosis reality caused by mass screening is shifting our understanding of breast cancer and obliging us to make a complete paradigm shift. Overdiagnosis reveals a hidden world of breast cancer and opens up a much broader view of the natural history of the cancer disease. Reducing this disease to just a tumor’s histology and its radiological image is obsolete. Over-diagnosed cancers, as well as cancers in situ, are not a first stage. There are not necessarily successive stages that punctuate the disease until death. The disease can appear in an advanced form from the start. Metastases can inaugurate it. This explains why the search for an early diagnosis based on radiological size has led to failure and why advanced cancers have not regressed in number with screening, they have only been diluted by overdiagnosis. Overdiagnosis prompts new questions: When, how and where does progressive disease begin? What is the nature and function of the tumor? Does the tumor define the disease or is it only one element of an interaction with its environment? The time has come for new hypotheses. The disease would not develop like a tree that grows progressively and unidirectionally, but like a bush where interactions and retroactions could lead to the continuation of life as well as to death. The mutated cell or cells would orient themselves from the beginning towards different paths according to the resistances that are an obstacle to their survival. The Halstedian scheme of the natural history of the disease on which mass screening has been based is erroneous and makes screening a totally counterproductive public health operation.

The growing debate on the benefits and risks of breast cancer screening in scientific, medical and public spheres, led the French Minister of Health to initiate a scientific and public consultation on breast cancer screening in 2015. The consultation conducted in France is the third independent consultation in Europe, after the British (2012) and the Swiss (2014) ones. All of them emphasized the need for complete and balanced information and recognized overdiagnosis as a serious harm. Despite the request of French citizens expressed in 2016, the promotion of organized screening continues unchanged, through the Pink October campaigns and incentive TV shows, lacking objective and independent information for women. Breast cancer screening continues to be part of the Remuneration on Public Health Objectives for physicians (ROSP). Pro-screening propaganda is intensifying in the midst of the Covid pandemic through the media. In September 2020, the INCA (National Cancer Institute) launches a new consultation for the decennial strategy to fight against cancer. One of the measures proposed is even to experiment with financial incentives for women to increase their participation in screening, which is stagnating at around 50%, far from the target of 70%. In this context and since its creation in 2015, the association Cancer Rose fights for an objective, fair and neutral information for women, to enable them to make an informed decision on whether or not to be screened.

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