Cancer Rose is a French non-profit organization of health professionals.  Independent French medical doctors and a doctor in toxicology, have created the site www.cancer-rose.fr to inform you of the most recent and relevant data on breast cancer mass screening. By decoding and popularizing the most recent research findings published in the most important international medical journals, analyzing the controversy and providing a social and feminine analysis, our objective is to inform women concerned by breast cancer mass screening in order to help them making their choice and to provide independent information resources to interested physicians. Cancer Rose has no sponsorships, honoraria, monetary support or conflict of interest from any commercial sources.

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CANCER AND SCREENING

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Cancer and cancer
• In the public mind, cancer and cancer cells are
the same thing.
• Well, it's not. We produce hundreds of cancer
cells every day, and fortunately our immunity
eliminates them.
• Sometimes our defenses are overwhelmed, and
then a cancer may develop.

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From cell to nodule
■ Sometimes these
cells accumulate into
small cancerous
nodules (small balls).
■ They can remain
latent during the
person's lifetime, and
even disappear.
■ In rarer situations,
these cells get out of
control, will multiply,
invade the body and
lead to the death of
the patient.

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Cells, in everyone!
■ In the case of the
prostate, cancerous cells
in men, this is very
common.
■ Half of all men over 60,
and almost all men over
90 have cancer cells in
their prostate.
■ 80% of men over 80
years old have silent
cancer.
■In the case of breast cancer, a
study on autopsies of women
who have died of other causes
shows that 37% of women are
carriers of unexpressed cancers
between the ages of 40 and 54,
39% between the ages of 40
and 49.
■ Out of 686 autopsied women
who died from causes other than
cancer, the rate of tumors found
in the breasts is 4X that of the
living population, at the same
time of the study. These tumors
remained "silent".

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■ Prostate cancer accounts for only 3% of
deaths in men. The average age of
death is 80 years old and only 0.1% of
men die from it before the age of 70.
■ It is detected by a blood test, the PSA
level, and a blood test.(Prostate specific
antigen<4ng/ml)
■ PSA is a protein that circulates in the
blood and is secreted exclusively by the
prostate gland.
■ If the level is elevated, the diagnosis
must be confirmed by prostate
biopsies.
■ Even a simple benign hypertrophy of the
prostate gland, or inflammation, can
cause the blood level to rise.
■ Out of 100 deaths of
women, there are 4
cases of breast cancer,
20 by other causes of
cancer, 30 by
cardiovascular disease.
(Ref : C.Hill,2014, IGR)
■ It is detected by a
mammogram and
confirmed by a breast
biopsy.
Prostate Breast

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■ Searching for cancer cells
when we know they are so
common is exposing a person
to detection of a disease that is
not, and will not become one.
■ 7 out of 10 men with high PSA
do not have cancer.
■ Example of the cervix
■ In this case it is a useful
screening, because this
cancer evolves
pejoratively and kills
Mortality from cervix cancer in Nordic countries
Start of screening in Norway and Denmark
Start of screening in Finland and Switzerland

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The prostate is a gland
located under the bladder. It
is important for reproduction
by providing the necessary
nutrients for sperm, and by
producing a liquid that
makes it fluid.
It also produces a protective
envelope for sperm.
Prostate
Testicles
Bladder

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■ The most aggressive
cancers release their
metastases at the onset
of the disease.
■ In this case the treatment
will not protect against
death.
■ Treatments for this
cancer have negative
effects that can be
significant (urine leakage,
impotence).
■ Beyond the age of 75,
there is no reason to look
for this cancer because
its evolution is very slow.
■ We will alter the patient's
life more than we will
"save" it.
■ Elderly patients are likely
to die before, from
something other than
their cancer.
Prostate

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Problem for men between 50 and 75
years old, encouraged by urologists to be
screened.
■ There is no evidence
that screening for this
cancer would save
people. (HAS High
Health Authority in
France)
■ The WHO (World Health
Organization) also does
not recommend this
screening.
■ But if one is screened, does it
increase his chance of survival
and better health?
■ Canadian Study on 46,000
men, half screened (PSA and
rectal exam), half not
screened); followed over 11
years.
■ Ref: http://onlinelibrary.wiley.com/doi/
10.1002/pros.20017/abstract;
■ Labrie, Quebec, 2004

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Results of the Canadian study
■ More mortality in the
screened group.
■ Why ? Because the
risks of screening,
the collateral effects,
outweigh the benefit,
which is minimal.
■And after surgery on a man who has
been screened?
■In an 8-year follow-up study, the
overall mortality from all causes was
almost the same for men who had
undergone surgery as for those who
had not.
■Fewer metastases in the operated
group.
■But more mortality from other causes.
■More collateral effects of biopsies
and treatments in the screened
group.

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The choice?
On one side :
■ A medical and
especially surgical
treatment with a very
modest effect on the
disease, and which
does not save lives.
On the other side :
■ A screening that consists in
considering as sick men
who were screened who
were not suffering from
anything!
■ No difference in terms of
survival
■ But important side effects,
impacting daily life.
Reduced life due to heavy
treatments.

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In summary, for every 1,000 men aged 55-69
participating in prostate cancer screening over an average
period of 9 years :
■ 150 will have
abnormally high
PSAs.
■ 30 out of 125 men
who will accept the
biopsy, without
symptoms will
discover that they
have cancer.
■ Of the 30 cancer carriers
who will be treated, 20 will
be permanently impotent,
15 will suffer from urinary
disorders, and 2 will be
totally incontinent.
■ Only one man out of the 30
cancer patients, will escape
death, whereas he would
have died in the absence of
screening.

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Screening "creates" a ill person
who didn't complain about anything,
and risks making him ill because
treatments.
■ Although not
recommended by any
health authority for
asymptomatic men, it is
still prescribed.
■ It is clearly established
that overdiagnosis is
massive without any
reduction in mortality. To
the point that the
discoverer of the PSA
test himself had come to
regret his own
discovery .
« I never dreamed that my
discovery 4 decades ago
would lead to such a profit-
driven public health disaster»
Richard Ablin, discoverer of
PSA

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But who to believe?
■ Urologists, prescribers of
the screening test, are
influenced by what they
experience during their
consultations, they see
patients suffering.
■ But the "experience" in
the office does not
reflect the health of the
population.
■ The urologist is a surgeon,
when he finds a tumor, he
can no longer do
otherwise than remove it.
■ This is the job of the
urologist.
■ And the patient will not
tolerate being told that he
has cancer and not doing
anything about it.
The decision TO NOT prescribe PSA
must be done BEFORE.

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Beware of media campaigns making promotion of prostate
cancer or breast cancer screening.
Advertising campaigns shift the debate in the affective field, and
promoters have many means of persuasion.
Doctor's dilemma: if a patient becomes ill with a prostate cancer,
he will reproach his doctor for not having done the screening
that might have done it "saved" (infinitesimal probability).
But the doctor, by not prescribing this screening, has
really saved men who don't know it.
It's your choice to get tested or not.
It's the same thing for breast cancer.

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In France

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■ Mammography: an imperfect tool
■ Screening is done without completely informing women about its
risks, and there are such risks.
■ The Pink October campaigns are commercial.
…and not
sure it will
save your life
It’s pink, it’s ugly,
and it doesn't fit with
anything
But it can save
your life
It’s yellow,
it’s ugly,
and it
doesn't fit
with
anything

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■ The radiologist must detect in this
difficult texture the image that
reflects a TRUE lesion.
■ But the smaller the lesion, the less
typical it is.
■ And the less typical it is, the more
we examine it. The more we
examine it, the more we doubt.
■ The more you doubt, the more you
tend to classify the examination as
"suspicious", as a precaution.
■ This attitude, human of the
radiologist, nevertheless leads to
the woman having to undergo
many other examinations, including
biopsies, at the cost of significant
stress.
Why mammography is an imperfect tool
for systematic screening?
■ Breast texture is a structure
that changes from one
woman to another, from
one cycle to another, from
one year to the other;
■ Changing also according to
hormonal treatments,
physiological changes
throughout a woman's life,
■ Depending on weight
variations.
■ Depending on hormonal
treatment.

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■ THE FALSE ALARM:
■ You think you're dealing with
cancer. This leads to additional
tests, sometimes heavy, and to
biopsies, the number of which
has greatly increased since
screening.
■ The woman has to wait several
weeks before confirmation of
the absence of disease. For
every 1000 women over 50
participating in screening for 20
years, there are about 1000
false alarms leading to 150 to
200 unnecessary biopsies in
France.
■ (Prescrire magazine, February
2015/Tome 35 N°376)
The risks of screening
■ OVER-DIAGNOSIS
■ It is a diagnosis of cancer that
would never have affected the
woman's health during her lifetime
if it had remained unknown.
■ There is an artificial increase in
breast cancer diagnoses through
routine screening, resulting in
unnecessary treatment and stress for
women.
■ Not every cancer cell seen under the
microscope is a cell that will develop
into a real cancer,
■ But once it's "seen", there's no
turning back, and you're forced to
treat, because you can't distinguish
between real cancers and those that
will remain silent.

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What does that mean, a cancer that would
never have affected a woman's life?
■ It was thought that all
cancers develop in the
same linear and
mechanical way.
■ It was believed to be this
pattern:
■ 1.Cancer cells
■ 2. Pre-cancer
■ 3. Small local tumor
■ 4. Regional Tumor
■ 5. Metastases and deaths
■ But all cancers do not grow
at the same rate.
■ Small does not mean early, or
precocious (a small cancer
can stay small for a lifetime,
without growing).
■ Large does not mean late (a
large tumor can develop in
months, weeks, or even
days).

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rapid progressing cancer
slow cancer
very slow cancer
stagnant cancer
cancer that disappears
Different models
for tumors grows
Years
Tumor
size
Tumor
size
Years
These last three forms of cancer do not cause
-palpable tumor
-pain
-metastasis
Do not cause death

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Evidence of over-diagnosis
■ Two groups of women of the same age, one group
screened every two years, the other group screened
only once after six years.
■ Result: 22% more cancers in screened women.
■ If all the tumours had developed into real cancers,
we should have seen the same number of cancers in
both groups of women.
■ If there are more cancers in the group screened
every two years, it means that there was an over-
diagnosis.
■ Ref (Zahl, Maehlen, Welch, Oslo, 2008)

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Tumor
size
Years
Slow-growing
cancer is "caught
up" by screening,
but would have
been
manifested by a
symptom.
The patient would
have consulted in
time
Rapid cancer
is " missed " by the
screening
There, the
screening
is useless.
Screening Death from
other
cause
Symptoms

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On a population of 1000 women

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According to the Cochrane
Collaboration study

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Consequences of over-diagnosis

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The more you search …
…the more you find

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For a
mortality by
breast cancer
which does
not decrease.
Mastectomy (breast ablations)
Progression of number of total mastectomies
Progression of number of total or partial mastectomies

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Survival is not an indicator of the
effectiveness of screening.
We are diagnosing tumors that would not have killed their host anyway.

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It's your choice to say yes or not to screening mammography.
On the other hand, in case of symptoms (lump, retraction of the
nipple, deformation of the curvature of the breast in hollow or bump,
unexplained redness, swelling, lymph nodes in the armpit):
you MUST consult, mammography will then have all its usefulness!

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Some clinical cases, films by courtesy
of Dr. B. Duperray
Small but not early, a stable image during 18 yeas, DCIS

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7 months difference between two images

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Small and of poor prognosis
Diffuse bones metastases

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Big and of good prognosis

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Nothing on the mammogram, but presence of bones metastases

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▪But pink marketing
does nothing to inform
women.
▪We haven't solved the
basic problems:
▪Breast cancer mortality
has not decreased
(11,000 to 12,000
deaths/year in France).
▪The severe forms have
not been reduced.
The pink races give
the illusion "to act".
Pink October
Pink October

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Cancer Rose is a French non-profit organization of health care professionals.
Cancer Rose has no sponsorships, honoraria, monetary support or conflict of interest from any
commercial sources.