Breast Cancer Screening Guidelines 2016

Breast Cancer Screening Guidelines 2016 - The Organized Screening program - Organized breast cancer screening was generalized in France in 2004. It has the dual objective of reducing breast cancer mortality and improving the information and quality of care for the people involved. In particular, it guarantees every woman equal access to screening throughout the territory and a high level of quality.
Breast Cancer Screening Guidelines 2016

Screening organized in a few digits - In 2016, the rate of participation (gross rate) of the target population of this screening was 31.5% (51.5% in 2015). The participation rate for the 2015-2016 period was 51.1%. After a significant progression in the early years (from 42.5% in 2004-2005 up to 52.7% in 2011-2012) a bearing has been observed since 2008 and the new data show a slight decrease which will have to be confirmed in the coming years. Breast Cancer Screening Guidelines 2016 - Regional disparities are observed: some regions with rates above 60% when others are less than 40%.

Breast Cancer Screening Guidelines 2016

At this overall participation rate is added an estimated 10 to 15% of women from 50 to 74 years of age being screened as part of an individual detection approach. As a reminder, the European target is 70%. For the period 2013-2014, 36 889 cancers (invasive and in situ, with the exception of in situ Lobular carcinomas) were recorded, representing a rate of 7.4 cancers for 1 000 women detected in the context of organized screening. Of the total cancers detected by the program over this period, 14.8% are in situ cancers.

The number of breast cancer deaths is estimated at 11 913 in 2015 in France. The mortality of this cancer decreased overall by 1.5% per year between 2005 and 2012. This is partly linked to the early diagnosis, as well as to the progress of therapeutic management.
Related: Breast Cancer Screening Family History
Screening procedures - The organized screening program targets women aged 50 to 74 years at moderate risk, i.e. without any apparent symptoms or specific risk factors. They are invited every two years to perform a mammogram and a clinical examination of the breasts with a licensed radiologist. This program is based on a specification published in the Official Journal of 21 December 2006, which defines and frames its modalities, monitoring and evaluation.
  • Every two years, management structures send a personalized invitation letter to women aged 50 to 74 years, from files transmitted by health insurance schemes;
  • Women are invited to visit a licensed radiologist whose contact information is included in the list attached to the email;
  • The examination includes a mammogram (two snapshots per breast, face and oblique) and a clinical examination of the breasts. It is supported at 100% by health insurance, with no advance fee;
  • If no anomaly is detected, mammography is then systematically reviewed by a second expert radiologist. The organized screening program benefits from a framed double reading: The participating radiologists known as "first readers" must perform at least 500 mammograms per year. The radiologists providing for second reading must, for their part, undertake to read at least 1 500 mammograms in the context of this second reading activity;
  • When an anomaly is detected, the first-reading radiologist will immediately carry out a diagnostic workup to shorten the delay of possible care and avoid an agonizing wait for the patient.

The Organized Breast cancer Screening Program benefits from a quality assurance approach. So the material is the subject of strict standards. Breast Cancer Screening Guidelines 2016 - The quality of the French mammography chain is controlled twice a year by approved bodies, according to the latest recommendations of the National Agency for the Safety of Medicines and health products (ANSM).

This quality assurance process incorporates, after review, new technological or medical advances. In this context, digital mammography was introduced into the National Breast cancer Screening program via an order published in the official Journal in 2008, and then recently clarified by the order of 16 November 2016 on digital mammography In the organized Breast cancer screening program. During the year 2014, 95% of the screenings were conducted with digital technology.

This program is also the subject of an epidemiological evaluation carried out by the National Public Health Agency – Public Health France, on the basis of data collected and transmitted by management structures.

Breast Cancer Screening Guidelines 2016: Target Population

The national Organized Breast cancer screening program targets women from 50 to 74 years without any apparent symptoms or specific risk factors. Are therefore not eligible for the women's Organized Screening program:
  • High risk of breast cancer (personal history of breast cancer; abnormal image during the last mammogram; the existence of lobular neoplasia; atypical epithelial hyperplasia). A specific monitoring is then put in place with, most often, an annual mammogram.
  • At very high risk of breast cancer ( a hereditary form of breast cancer, the presence of genetic mutations, including BRCA1 and BRCA2). In case of suspicion of a very high risk of breast cancer, the patient should be oriented towards an oncogenetics consultation. Specific surveillance is put in place if the very high risk is proven (mammography, ultrasound, MRI).
See also: Breast Cancer Screening Age
The Institute had seized the High Health Authority (HAS) to update the recommendations on breast cancer screening in high-risk women, with the exception of women with genetic predisposition BRCA 1 or BRCA 2. These recommendations, published in May 2014, define the screening procedures most appropriate to the personal situation of each patient concerned. For its part, the Institute has published the update of its recommendations on the follow-up of women with genetic predisposition BRCA 1 and BRCA 2 (very high risk).

In addition, the has been seized by the health branch of the interest of a possible extension of the invited age group to the organized Screening program: On the one hand to women from 40 to 49 years and on the other hand, beyond 74 years.

Screening actors - Organized cancer screening programs are placed under the authority of the minister in charge of health. The Director General of Health is responsible for the strategic management of the programs in coordination with the Director of Social Security, medical insurance organizations (CNAMEs, MSA, RSI), the National Cancer Institute and the National Health Agency Public health-France.
The operational and technical management of the program is carried out by the National Cancer Institute, which has the authority to manage structures. The National Cancer Institute is responsible for the organizational evaluation of the screening programs.
The epidemiological evaluation of the program is carried out by the National Public Health Agency – Public health France.
As the regional pilot of health policy, the Director-General of the Regional Health agency, in connection with the Director Regional coordinator of Risk Management of sickness insurance (DCGDR) and the director of the Regional Association of Caisses of agricultural Social mutuality (ARCMSA), piloted cancer screening programs in each region.
The programs are implemented by management structures responsible for the organization and coordination of the screening programs organized and financed in particular by the endowments of health insurance and state agencies.

The management structures implement it. They are responsible:
  • The harmonized implementation of screening programs in support of regional and national pilotage;
  • Relations with the population (information, communication, awareness-raising, invitation, Relaunch, registration of refusals and balance sheets, actions to combat inequalities) as well as the monitoring of persons detected (transmission of results and follow-up);
  • Relations with professionals involved in screening (information, mobilization, training, feedback);
  • Of the management of the information system of the screening (integration and updating of the files, data retention, interfaces with the other information systems, compliance with the obligations related to it law and freedom and data protection Personal);
  • The evaluation of organized screening programs, the valorization of data from programs and the health vigilance of the device;
  • Of the quality assurance of the device, both in its organization and with the health professionals involved in the programs (training required and quality control of the materials);
  • The contribution to the continuous evolution of the device through the coordination or participation in studies or the experimentation of technical, scientific or organizational innovations.
  • To find out which screening structure to address your patient, you can consult the chart of their contact information.

Organized screening and individual detection approach - Screening mammography can now be proposed as part of the National Screening program, or outside of this framework. We are talking about individual screening or an individual detection approach. The real issue of the organized Breast cancer screening program was to set up a quality assurance system, in the French context of the practice of breast, based on the establishment of a specification at the national level, following the European recommendations for the quality assurance of screening mammography.

In relation to an individual detection approach, which is not the subject of a specific collection or evaluation, participation in the organized screening program allows for superior guarantees in terms of quality and performance :
  • System for the systematic invitation of women of the targeted age group and taken over at 100% by third-party health insurance;
  • Breast clinical examination proposed during the screening visit to minimize the risk of not detecting radio-occult cancer;
  • Second systematic reading of mammograms considered normal or benign by a second independent radiologist of the first: about 6% of the detected cancers are found at second reading;
  • Accreditation and specific training of radiologists;
  • Immediate diagnostic assessment in case of positive mammography, to minimise the delay of possible care and avoid an agonizing expectation;
  • epidemiological, technical and organizational evaluations of the program.
Towards an evolution of organized breast CANCER screening - In 2015, the ministry in charge of Health commissioned the Institute to organize a national, citizen and scientific consultation on breast cancer screening. Breast Cancer Screening Guidelines 2016 - The aim was to increase its relevance, quality, and effectiveness in a process of healthy democracy. In the light of the findings and proposals made during this consultation, which was the subject of a report to the Ministry of Health in October 2016, a scenario of the profound renovation of the current screening program was selected. A new action plan, presented in April 2017 and based on the findings of this report, proposes to all women, irrespective of their age and level of risk, personalized, better coordinated and more involving the treating physician.