Presentation « Reduction of total mastectomies for breast cancer through organized screening - Myth or reality in France ? » by Dr. Cécile Bour, Radiologist and president of Cancer Rose during the Conference of the French Society of Mammary Senology and Pathology (French Society of Mammary Senology and Pathology), November 2017, Lille. 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.

1. www.cancer-rose.fr
Reduction of total mastectomies
for breast cancer
through organized screening
Myth or reality in France ?
Robert Vincent 1, Doubovetzky Jean 2, Lexa Annette 3, Nicot Philippe 4, Bour Cécile 5
1 Robert Schuman Hospitals, Medical Information Department (DIM), 9 rue Edward Steichen
L-2540 Luxembourg
2 General practitioner, senior editor at the Medical Journal Prescrire, Albi, France
3 Doctor of Toxicology (Eurotox), Metz, France
4 General practitioner, expert at the HAS, Panazol, France
5 Liberal radiologist, President of the Organization Cancer Rose, Talange, France
Speaker: Dr Bour Cécile,
Radiologist, Talange, France

2. www.cancer-rose.fr
Verify whether, in
France, the
generalization of
organized breast
cancer screening
has been
accompanied by a
decrease in the
most mutilating
interventions,
total
mastectomies.
One of the
arguments
advanced by its
proponents
would be a
reduction in
heavy
treatments, made
possible by
diagnosing
smaller lesions.
This assumption
has not been
evaluated in
France.
OBJECTIVE OF STUDY

3. www.cancer-rose.fr
METHODS
The annual
number of total
mastectomies is
estimated from
the PMSI
informations
system on hospital
stays listed in GHM
root 09C04 "Total
Mastectomies for
Malignant
Tumors".
This number of
hospital stays has
been extracted,
year by year, from
the ScanSanté
platform delivering
PMSI data
(www.scansante.fr)
The study covered
the period
2000-2016.
Using data on
the incidence of
invasive breast
cancer, available
for 2000, 2005,
2010 and 2012
on the INVS site,
the ratios of total
mastectomies
per 1,000 new
cancers are
calculated.

4. www.cancer-rose.fr

5. www.cancer-rose.fr
RESULTS
The annual number of total
mastectomies increased over the
study period from 17,403 in 2000 to
19,997 in 2016. This increase is
statistically significant.
In order to judge whether or not a
treatment has de-escalated or not, it
is necessary to look at whether, for
the same number of prescriptions,
more or fewer procedures are
performed. The ratio number of total
mastectomies per 1000 new cancers
has remained stable: approximately
400 total mastectomies per 1000
cancers.

6. www.cancer-rose.fr
The PMSI data is an exhaustive record of all
interventions performed in France during
hospitalization. Any decrease in total mastectomies
should therefore be reflected in the data.
Over the period 2000 - 2016, we are instead seeing an
increase in the annual number of total mastectomies and a
stable ratio of total mastectomies per 1,000 new cancers.
Two hypotheses :
-The small tumor size at the time of diagnosis would not be an essential
determinant of the indications for total mastectomy (other factors would
come into play, such as small breast size, or a retro-mamelonal lesion, or
surgical habits).
-The reduction in total mastectomies made possible by diagnoses of
smaller lesions would be offset by an increase in total mastectomies due
to over-diagnosis. (lesions that are not invasive carcinomas are surgically
removed)
DISCUSSION

7. www.cancer-rose.fr
Real-life" studies: a
necessary and
complementary approach
to clinical studies.
The decline in total mastectomies for breast
cancer attributable to organized screening is
not confirmed by the PMSI data.
Communication to
women about
screening should
contain this
information.
Additional studies
would be useful to
clarify the causes,
and in particular the
role of over-diagnosis.
CONCLUSION

8. www.cancer-rose.fr
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.
This study is published in :
Revue Medecine , Volume 13, numéro 8, Octobre 2017
DOI: 10.1684/med.2017.233
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