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Effectiveness of and overdiagnosis from mammography screening in the Netherlands: population based study

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5224 (Published 05 December 2017) Cite this as: BMJ 2017;359:j5224

Re: Effectiveness of and overdiagnosis from mammography screening in the Netherlands: population based study

Mastectomies rise in France with breast cancer screening

Autier and coll. show that in the Nederland, a country where 80% of targeted women are screened for breast cancer, specific mortality reduction is far less than expected or even non-existent 1. Overdiagnosis is far more common than expected, and concerns about half of screen-detected breast cancers. The main consequences of overdiagnosis are overtreatment and its unwanted effects.

We assessed the annual number of total or partial mastectomies, using the Scansanté Database, where all French surgical procedures are registered 2. From the year 2000 (4 years before organized breast cancer screening was implemented in every part of France) to 2016, we have documented:

- a steady rise of annual total mastectomies from 17403 to 19997 (+14,9% ; Spearman test, p<2.10-4)
- a steady rise of annual total+partial mastectomies from 53876 to 73655 (+36,7% ; Spearman test, p<10-7)

This means that in France, breast cancer screening increased the number of mutilating surgical procedures instead of decreasing it, as expected and widely advertised to women.

In our opinion, this confirms that the 2015 French citizens’ and scientists’ consultation on breast cancer screening was right to recommend the stopping of the breast cancer screening as currently implemented 3 4. As Mette Kalager wrote, it is time to discuss about controlled deimplementation of invited screening with mammography 5.

1. Autier P, Boniol M, Koechlin A, Pizot C, Boniol M. Effectiveness of and overdiagnosis from mammography screening in the Netherlands: population based study. BMJ 2017;359:j5224. http://dx.doi.org/10.1136/bmj.j5224

2. Robert V, Doubovetzky J, Lexa A, Nicot P, Bour C. Le dépistage organisé permet-il réellement d’alléger le traitement chirurgical des cancers du sein ? Médecine 2017;13 (8):367-371. http://www.jle.com/fr/revues/med/e-docs/le_depistage_organise_permet_il_...

3. Barratt A, Jørgensen KJ, Autier P. Reform of the Natinal Screening Mammography Program in France. JAMA Intern Med online October 30. https://dx.doi.org/10.1001/jamainternmed.2017.5836

4. Cases C, Di Palma M, Drahi E, Fainzang S, Landais P, De Montgolfier S, Paccaud F, Rivière P, Thouvenin D. Ensemble, améliorons le dépistage du cancer du sein – Rapport du comité d’orientation. September 2016. http://www.concertation-depistage.fr

5. Kalager M. Breast cancer screening. BMJ 2017;359:j5625. https://doi.org/10.1136/bmj.j5625

Competing interests: No competing interests

07 December 2017
Jean V DOUBOVETZKY
General Practitionner
Robert V, Nicot P, Bour C
Collectif Cancer Rose
Centre médical de Cantepau, 14 boulevard du Maréchal Lannes, 81000 Albi, Occitanie, France