www cancerrose fr Mammography screening in France real

www. cancer-rose. fr Mammography screening in France: real advances and double speaking Jean Doubovetzky (Family medicine) Cécile Bour (Radiologist) Conflicts of interest: none

1980 > 2000 Screening "spontaneously" rises 1980 : 308 mammographs 2000 : 2511 mammographs (x 8) www. cancer-rose. fr Breast cancer incidence x 2 Breast cancer mortality x 1 2000 - Cochrane’s "Screening for Breast Cancer with mammography" 2003 - Jacques Chirac ’s political programme includes extension of the organized BCS to all France

Early french whistleblowers 2003 - Bernard Junod, researcher in epidemiology and public health www. cancer-rose. fr 2003 – Lucien Abenhaïm, Director General of Health and President of the Orientation Commission on Cancer: "the controversy is still open" 2004 - extension of the organized BCS is effective

The work of Prescrire worked on BCS during 6 years In 2006 : it published a series of articles on every aspect of BCS. www. cancer-rose. fr It concluded that: - Benefits of BCS are not proved - Harms are underestimated - Women are not truly informed Prescrire would continue to publish on BCS Scientific work is the basis on which action can be taken

Pressure from the public and the media 2007 – debate in congress of public health - The ENSP asked for a débate and worked on ethical Prescrire, the consumers’ organisation “Que Choisir? ” The FORMINDEP and Cancer-Rose launches coordinated information campaigns www. cancer-rose. fr Critical books on BCS are published ( « No Mammo ? » ) Popular media question the BCS (TV, radio, press, the Internet) Pressure from the public and the media played a critical role

Exposing the role of conflicts of interests The FORMINDEP works on conflicts of interests. For instance, it would publish about: www. cancer-rose. fr - conflicts of interests of investigators on BCS (Tabar) - financing of public information on BCS - links between pharmaceutical firms and the INCa, the Ministry of Health or politicians Showing conflicts of interest was critical to convince the media that something went wrong with the BCS

September 2015, Concertation citoyenne française An Independent Civil and Scientific Inquiry into Mammography Screening http: //www. concertation-depistage. fr/ A Web Site : Independent Steering Committee (without conflicts of interests) v information about inquiry Technical Support Committee Two Consultations : v Civil consultation Healthcare Professionals consultation v Public submit opinion Final Public Meeting for : Presenting recommendations In final report v v v Answer questions

“To the request of the Ministry of Health, the national Institute of cancer organized a broad consultation to push forward breast cancer screening. “ Improve

PAGE 7 We notice that the concerns of health authorities are : PAGE 133 conclusions in final report : two scenarios • the stagnation of the participation. • Complete stopping of screening programme • To maintain screening in a modified form, without challenge of its relevance. • Stopping the screening such as presently proposed and complete revision.

COUNTER ATTACKS A letter of the President of “abandoning screening programme would be a the INCA to the Health complete nonsense. ” Minister : Denigrating and rejecting the first scenario. http: //formindep. org/Depistage-organise-du-cancerdu. html http: //www. atoute. org/n/IMG/pdf/Courrier-Ministreconcertation-depistage-cancer-sein---. pdf Proposal of screening based on the risk level. A report emphasizing the "quality" of the screening programme. (Public French Health Agency +INCA, 4 th oct 2016) http: //invs. santepubliquefrance. fr/fr/Publications-et-outils/Rapports-et-syntheses/Maladies-chroniques-et-traumatismes/2016/Incidence-et-depistage-ducancer-du-sein-en-France

Women are betrayed The French Health Minister • Welcomed the good progress of Pink October In her press release : « Screening is the best chance to be cured of breast cancer. » • http: //solidarites-sante. gouv. fr/archives-presse/archives-communiques-de-presse/article/marisol-touraine-salue-la-mobilisation-contre-le-cancerdu-sein-et-engage-la • Introduction of her 12 points action plan : • « Screening reduces breast cancer mortality. » • « too few women choose to go to organized screening. » http: //solidarites-sante. gouv. fr/IMG/pdf/plan-actions-renov-cancer-sein-2. pdf

MAIN PROPOSALS OF THE MINISTER : • Information tools • Medical consultation at the age of 50 • Communication on the risk/benefit balance • Technical quality of the programme • Implementation of a research programme

IN REALITY • downloadable leaflet (sept 2017) • web site (02/2018) • • http: //www. e-cancer. fr/Expertises-et-publications/Catalogue-des-publications/Livret-d-information-sur-le-depistage-organise-du-cancer-du-sein https: //cancersdusein. e-cancer. fr/ Incomplete information Scree n in P 4 ing rema ins P= Pa y perfo rman for ce Underestimation of overdiagnosis. • Overtreatment not mentioned • Alleged survival proportion of 99 % • No visual medium with real data • Effect of screening on mastectomies not discussed. •

CONCLUSION Appointment of the new Health Minister, Mme Buzyn, former Director of the INCa, 05/2017 v v Still no change in the Ministerial decree for screening, of 29 sept 2006. https: //www. legifrance. gouv. fr/affich. Texte. do? cid. Texte=JORFTEXT 000000460656 A BIG MOVEMENT… TO ENSURE THAT NOTHING CHANGES But it will change anyway

Cancer Rose