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At the head of the National Cancer Institute (INCa) for two years, Professor Norbert Ifrah is rare in the media. But critics who swell on bad cancer screening worry and annoy him. In our columns, he gives a warning cry.
In France, less than one in two women participate in organized screening. Is this figure satisfactory?
PROFESSOR NORBERT IFRAH. No, all the less satisfying as we have lost 2% of participation in two years and we are far from the European recommendations that advocate 70%. That a scientific debate exists on the limits of screening is healthy. But we are witnessing in France a campaign of surreal denigration, especially on social networks. Its detractors, few but very active, are irresponsible. Let's not forget that 59,000 new bad cancers are detected every year and that 12,000 women die from it.
In particular, screening is accused of overdiagnosis. Clearly, to detect lesions that would not necessarily have evolved into cancer …
Today, a certain number of localized cancers do not evolve, without one knowing why. It is a major subject of research. But 80% will evolve, hence the need for regular monitoring. I am not saying that there is zero useless operation, but they are very few. On the other hand, we know that with organized screening, we save nearly 12% of women a heavy surgery and that a third "only" will have chemotherapy for more than half off screening. For those concerned, it's not nothing!
But the number of treatments does not decrease with screening!
It does not decrease but does not increase either as the target population increases. We went from 7 million women aged 50 to 74 at the end of 1992 to 9.3 million in 2012. That is more than 35%.
A group of badociations, including Cancer Rose, reproaches the INCa to "misinform" women to fill quotas. What do you answer?
We do not inflict anything, we propose. Every woman is free to accept, or not, the screening. Our duty is to inform so that everyone can make an informed choice. While its benefit is challenged by therapeutic progress, according to global studies, screening can prevent between 15 and 20% of deaths. That's why reading on the networks that there would be fake cancers I am amazed. This term, catastrophic, is harmful.
What's the risk ?
That misinformation leaves women, often the most at risk and the most precarious, out of the health care system. That cancers are treated later. But with this disease, we have no time to lose.
BREAST CANCER SCREENING: WHO IS CONCERNED
In France, there are organized screenings for three cancers: the cervix (since May 2008), the colorectal (since 2009) and the bad, since 2004. The latter concerns all women between 50 and 74, without symptom, nor any particular risk factor except … their age.
It is during this period that they are most exposed to the disease. A mammogram and a clinical examination done every two years make it possible to detect early a cancerous lesion to take it more quickly.
But screening has its limits: the risk of overdiagnosis or overtreatment, hence the criticisms that take root in France. Of the 28 Member States of the European Union, 25 have an organized bad cancer screening program.
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