The new INCa leaflet: again soliciting rather than informing.

Since June 2021, the INCa (National Cancer Institute) has published a new leaflet promoting screening. In this new leaflet, INCa clearly continues to conflate solicitation and information.

In 2015, the citizen and scientific consultation on breast cancer screening requested that women receive « balanced and complete information ». Six years later, the new INCa leaflet demonstrates that there is still a long way to go.

The previous brochure downplayed the risks of screening but at least mentioned them. We've reached a new high with the new leaflet: NONE of the adverse effects of screening are mentioned!
There is no mention of overdiagnosis or radiation-induced cancers. Even false positives are vaguely mentioned in a "literary" and indirect manner that is indecipherable to most people: « No confirmation of cancer after follow-up or complementary examinations ».

There is nothing about the risks of screening, but the INCa's new slogan is heavily emphasized. « The earlier breast cancer is diagnosed, the better the chances of cure ». It's written in large, even very large, letters.
This is probably true, but that is not the point. It is still unclear whether screening detects aggressive cancers earlier or whether it detects mainly cancers with little progression, whose prognosis would have been favorable anyway. The answer to this question is far from clear-cut.

Furthermore, the claim that screening would allow « 99 out of 100 women to be alive 5 years after diagnosis » does not guarantee the effectiveness of screening.
First of all, being alive 5 years after diagnosis does not mean being cured.
Secondly, contrary to what the brochure would like us to believe, the 5-year survival of cancer discovered during screening is not 99%. 99% is the 5-year survival for cancer detected at an early stage. And not all cancers detected through screening are found at an early stage.
Finally, survival is not a good indicator of the effectiveness of screening. There are multiple reasons for this :

• it depends on the effectiveness of treatments at least as much as on screening
• it is artificially "improved" by the lead-time. Survival measures the length of time a patient lives with the knowledge of their cancer. With screening, the cancer is known earlier, and the duration of life with the knowledge of cancer increases even if the death occurs on the same day as it would have occurred without screening. This is illustrated in the diagram below from the WHO Screening Guide
  
• it is artificially "improved" by the overdiagnosis related to screening. Overdiagnosis refers to cancer with little or no progression and would not have harmed the patient if it had not been discovered through screening. By definition, overdiagnosis does not cause death. In turn, they create an illusion of success that artificially inflates survival statistics.

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Dernière mise à jour le 27/10/2021