Here is Pink October again, the month dedicated to information and raising awareness among women about early detection of breast cancer.
On this occasion, the South-PACA Regional Cancer Screening Coordination Committee (CRCDC) opened the doors of its Riviera premises to highlight one of the most valuable advantages of organized screening: the second reading of mammograms. Explanations.
Organized screening, how does it work?
Organized screening for breast cancer (but also colon and cervical cancer) is coordinated by the CRCDC. “Every two years, women aged 50 to 74, without risk factors or symptoms, are invited to participate, explains Dr Valérie Zimmerlé, coordinating doctor. Excluded are women with high risk, who due to personal or family history benefit from personalized follow-up.”
Since January 1, 2024, this invitation has been sent by the primary health insurance fund.
Accompanying the invitation letter, the list of radiology centers participating in the organized screening makes it easy to make an appointment in the office of your choice. On the big day, women benefit from a clinical breast examination by a doctor and a screening mammogram, supplemented if necessary with an ultrasound, these examinations being 100% covered by health insurance.
The radiologist gives a first result. In the event of an abnormality, the patient is referred to appropriate treatment. If there is no abnormality, the radiological file is sent to the CRCDC, where the mammogram will be read again by a second radiologist. The results of this second reading are then transmitted to the patient and the attending physician or gynecologist of her choice.
The point of the second reading?
“Two expert opinions are better than one”summarizes the CRCDC team to explain the interest of this second reading. In 97% of cases, the first reading does not identify any suspicious anomaly and the second reading confirms the first in 98.8% of cases. But in a small number of cases, the second expert identifies anomalies not reported during the first reading.
In front of the negatoscope
Concretely, the Côte d’Azur branch of the CRCDC manages around 68,000 files per screening campaign, over two years. 700 mammograms arrive on average each week. Six technicians install them on a light box which allows them to view, side by side, the patient’s mammogram and her old images, the comparison of the two making it easier to identify new anomalies. Expert radiologists take turns in front of this machine every day to carry out a second careful reading.
Specifically approved and trained in organized screening, they interpret at least 2,000 mammograms per year as second readers and are also first readers.
“If an anomaly is detected from the first reading, there is a diagnostic assessment and immediate treatment, zero loss of chance, explains Dr. Catherine Maestro, radiologist and second reader at CRCDC. For other mammograms, the second reading sometimes makes it possible to detect smaller lesions, and therefore to initiate less intensive treatments. We sometimes mention the risk of overdiagnosis: removing suspicious non-cancerous lesions also helps prevent them from degenerating.”
In the Alpes-Maritimes, around 7 to 8% of cancers are detected during this second reading. This is their main interest but it is not the only advantage of organized screening compared to individual screening (for which the patient simply makes an appointment with a radiologist, provided with a prescription from her attending physician or gynecologist ).
“In both cases, the patient benefits from two images for each breast, a clinical examination and an immediate diagnostic assessment. But organized screening is the only one to offer, in addition, the second centralized reading, the management 100% charge by health insurance and compulsory training, for radio technicians as well as for radiologists as well as additional quality criteria on radio equipment, checked every six months. explains Dr. Zimmerlé.
When cancer is detected
In 993 cases out of 1000, organized screening does not find any worrying anomaly. When a cancer is detected, it is generally small, and in 80.6% of cases, there is no lymph node invasion, which allows us to consider the absence of secondary chemotherapy. “Thanks to screening, treatments are less burdensome, and their side effects are fewer.”
Finally, the last advantage of organized screening: patients in whom breast cancer or an anomaly has been detected are followed throughout their care and/or prevention journey by the team of CRCDC technicians. Why deprive yourself of it?
Odile Diagana testifies: “No more complicated than an appointment at the hairdresser!”
Athlete Odile Diagana and her husband Stéphane, French 400-meter hurdles champion, are regularly called upon as part of colorectal cancer screening campaigns. This year, Odile Diagana has also chosen to get involved in promoting organized breast cancer screening.
“Like many women, I myself have been approached, I received an invitation. But when you are fully engaged, when you are a mother, when you work, you easily put it aside. For the children , we don’t postpone appointments, but for ourselves, we do it more easily… It’s a hindrance! However, it’s no more complicated than an appointment at the hairdresser!”
The figures presented by the CRCDC are a plea for women to make an appointment and participate in organized screening. We can discover early cancers, limit treatments, avoid ablation or complications…
“Some women are afraid of having pain. I had mammograms when I was younger, it was unpleasant, today it is much less so. Whatever the case, this apprehension should not be a hindrance. Organized screening also allows for a second reading. We can only have more confidence in its usefulness and effectiveness. We must all, men or women, be ambassadors, talking about it to those around us to get it into the minds of women. It’s important to take care of yourself.”
