Pr Claude Linassier is Director of Prevention, Organisation and Care Pathways Department at the French National Cancer Institute (INCa)
How does France compare with its European neighbours in terms of cancer screening?
The way cancer screening campaigns are organised varies widely across Europe. In Spain, for example, screening is a regional responsibility. Other countries recommend screening for breast cancer from the age of 40, whereas in France it’s 50.
Europe has developed its own resources in the fight against cancer, and France is helping to structure and disseminate them. The European Beating Cancer Plan offers interesting benchmarking – we’re ahead in France on a good number of initiatives – and makes it possible to have a common approach, which encourages countries that are lagging behind to make progress.
Secondly, public acceptance of screening is also a cultural issue. In Denmark, Finland and the Netherlands, the participation rate in organised screening is around 80%. In these countries, the culture of prevention is anchored from an early age. The United Kingdom, Ireland and Slovenia have rates of around 70%. France is in the middle of the pack, with a rate of around 50%, as is Germany. There is no rational interpretation of these rates, other than cultural. In France, there is a tendency to systematically question the messages conveyed.
How do you get as many people on board as possible and convey a positive message on a subject as serious as cancer?
One of the French National Cancer Institute’s missions is to convince women to go for screening, in particular through our information campaigns on screening. Our current slogan – “From the age of 50, get screened every 2 years: you’ll thank yourself” – emphasises the importance of women taking responsibility for their own health. The aim is to make women aware of their responsibilities and of the benefits of screening.
What’s more, the justification for screening is based on scientific data. Detected early, breast cancer cures better, with less extensive treatment and fewer after-effects. For example, 5 years after diagnosis at an early stage, 99 out of 100 women are still alive. When the cancer is diagnosed at an advanced stage, only 26 out of 100 women are still alive. Taking charge of your health and not being afraid of cancer are the messages that need to be put across, demystified by clear, positive discourse.
How do you involve healthcare professionals in organised screening campaigns?
There are several levels of information aimed at healthcare professionals and the general public, but all our communications are based on the work of our Institute, which is involved in drawing up guidelines for screening. The documents we have produced include an information booklet for women, which is both scientific and well-argued on the benefits of organised screening, and which health professionals can make available, particularly in their surgeries. The Institute advises them on the best way to communicate with the general public, and posters are available to try and convince people in a simple way.
The INCa is also involved in providing information to the general public, in particular by informing them of the steps to take to limit breast cancer (not smoking, limiting alcohol consumption, eating a balanced and varied diet, etc.) and the best practices to adopt, such as having your breasts examined and palpated by a health professional every year from the age of 25, or consulting a health professional if there are any warning signs. To this end, a number of audio documents are broadcast on radio stations in mainland France and the French overseas departments and territories. TV channels are also being asked to get the message across via a TV advert produced for the occasion.
What are you currently working on at INCa?
On an ongoing basis, we carry out annual monitoring of screening. This is our work with regional cancer screening centres.
The Institute’s work is also helping to improve the quality and technology of tumour detection. We asked the French National Authority for Health (HAS) to study the benefits of tomosynthesis (3D) mammography in organised breast cancer screening. It has just issued a favourable opinion on its inclusion in organised breast cancer screening, combined with the reconstruction of a conventional 2D synthetic image. This is a major step forward.
At European level, we are taking part in the international MyPeBS programme, which is studying a new strategy for personalised breast cancer screening. We will be working on personal risk identification criteria: the aim is to find out whether standard screening every two years is sufficient, whether it should be intensified for people at increased risk, or whether screening should be spaced out for women at low risk. The clinical trial will involve 85,000 women aged between 40 and 70, in 6 countries (Belgium, Spain, France, Israel, Italy and the UK). More than 53,000 women have already been included in the study.
Interview published by FHP-MCO (French Federation of Acute Care Private Hospitals) in the frame of Octobre Rose (Pink October), the breast cancer screening awareness month.