At under 40 or over 75, women are less on the radar for detecting breast cancer despite the existence of risks for the oldest, warn specialists, who plead for better monitoring.
Breast cancer is the most frequent and deadliest in women worldwide, with some 54,000 new cases each year and more than 12,000 deaths in France.
But “mortality has decreased thanks to treatments and screening”, underlined Pr Emmanuel Barranger, general manager of the Antoine Lacassagne center in Nice, Thursday during a press conference of the French Society of Senology and Breast Pathology.
The earlier a cancer is detected, the greater the chances of survival, and the less heavy and aggressive the treatments.
Many rich countries therefore conduct an organized screening policy, also promoted each year in France by Pink October, a variation of the Anglo-Saxon National Breast Cancer Awareness Month campaign.
In France, women aged 50 to 74 have been invited, since 2004, to screening including mammograms every two years – 100% covered – to detect a possible tumor.
After a strong increase in the first years, this screening has stalled and concerns regarding half of the women targeted, worrying some specialists in a context where the frequency of breast cancer is increasing in almost all age groups except 55-65 year.
But, above all, the question arises of the strategy to adopt when one is too young or too old to benefit from such organized screening. The risk of a possible “over-diagnosis” also exists: tumors can be identified, whereas they would never have evolved into cancer, with the danger of starting a heavy and useless treatment.
For the French Society of Senology and Breast Pathology, “the question of screening does not arise for women under 40, apart from women at high risk of cancer (genetic predisposition, family history of breast cancer)”, but it is “more complex for women aged 40 to 50 since 15% of cancers occur in this age group”.
To “detect more and better” cancers, the European Commission also recommended on Tuesday, among other things, to lower to 45 the age from which women are eligible for organized screening for breast cancer in the EU.
– Cancers de 3 cm –
Under 40, what supervision?
“You must already identify, with a health professional, a risk factor or not”, and “there is no reason to do a mammogram under the age of 40 otherwise”, judged Thursday Luc Ceugnart, president of the SFSPM and head of the medical imaging center at the Oscar-Lambret center in Lille.
The vigilance of women is also important. For example, “if there is a lump in the breast, a changed-looking breast, and it persists following a change in the menstrual cycle, you should get checked” and “do not put your head in the sand” , he insisted.
The alarm is greatest for women over 75, even as life expectancy increases and aging increases the risk of cancer.
“A large number of women over 74 think that it is no longer necessary to carry out follow-up, which induces the management of cancer at late stages”, worries the SFSPM in a press release. “We sometimes see 80-year-old women arrive with cancers of 3 centimeters, they did not have a mammogram because they no longer received an invitation to screening”, according to Professor Barranguet.
With a large tumor, affected lymph nodes, or even cancer with metastases, the danger is increased. And, the older you get, the more difficult it can be to recover from chemotherapy, for example.
Should systematic screening be extended to these older patients? No for specialists, but they want to encourage patients and doctors to continue monitoring individually.
For those over 75, the SFSPM thus defends “a major communication effort” and a mammogram, on prescription, every two years.
An annual clinical examination (palpation) is also desirable, according to her, but “rarely carried out, in particular due to the medical demographic crisis but also to a lack of information from health professionals”.
