Breast cancer: Before 40 years and especially after 75 years, there is also a risk

Women under 40 or over 75 are less on the radar for breast cancer detection, despite the existence of risks for elders, warn specialists who advocate better surveillance.

Breast cancer is the most common and deadliest in women worldwide, with around 54,000 new cases each year and more than 12,000 deaths in France.

But “mortality has gone down thanks to treatments and screening,” stressed Pr. Emmanuel Barranger, general director of the Antoine Lacassagne Center in Nice, on Thursday during a press conference of the French Society of Senology and Breast Pathology.

The earlier cancer is detected, the better the chances of survival and the less severe and aggressive the treatments.

Many rich countries therefore run an organized screening policy, which is also promoted each year in France through Pink October, a variation of the Anglo-Saxon National Breast Cancer Awareness Month campaign.

In France, since 2004, women aged 50 to 74 have been invited to a screening with mammography – 100% coverage – every two years to detect a possible tumor.

After a sharp increase in the early years, this screening has stalled and affects about half of affected women, which worries some specialists in a context where the incidence of breast cancer in almost all age groups except 55-65 year olds increases.

Above all, however, the question of strategy arises when one is too young or too old to benefit from such organized screening. There is also a risk of possible ‘overdiagnosis’: tumors can be detected even though they would never have developed into cancer, with the risk of initiating heavy and useless treatment.

For the French Society of Senology and Breast Pathology, “the issue of screening for women under 40 does not arise, except for women at high risk of cancer (genetic predisposition, family history of breast cancer)”, but it is “more complex for women over 40 up to 50 years, since 15% of cancer cases occur in this age group”.

In order to be able to “detect cancer more and better”, the European Commission recommended on Tuesday, among other things, that the age from which women in the EU are eligible for organized breast cancer screening should be reduced to 45 years.

– 3 cm crab –

Under 40, what supervision?

“You have to already identify a risk factor with a doctor or not,” and “otherwise there is no reason to have a mammogram under 40,” said Thursday Luc Ceugnart, President of the SFSPM and Head of the Medical Division Imaging Center at the Oscar Lambret Center in Lille.

The vigilance of women is also important. For example, “if there is a breast lump, a breast that looks different, and it persists after a change in the menstrual cycle, you should get it checked out” and “don’t bury your head in the sand,” he stressed.

Concern is greatest for women over 75, even as life expectancy increases and age increases cancer risk.

“Many women over 74 feel that there is no longer a need for follow-up care, prompting treatment for late-stage cancer,” the SFSPM worries in a press release. “Sometimes we see 80-year-old women who come in with cancer of 3 centimeters, they haven’t had a mammogram because they haven’t received an invitation to be screened,” Professor Barranguet said.

The risk is increased in the case of a large tumour, affected lymph nodes or even cancer with metastases. And the older you get, the harder it can be to recover from chemotherapy, for example.

Should systematic screening be extended to these older patients? No for specialists, but they would like to encourage patients and doctors to continue monitoring individually.

For those over 75, the SFSPM therefore defends “a great communication effort” and a prescription mammogram every two years.

An annual clinical examination (palpation) is also desirable, but is “rarely carried out, in particular due to the medical-demographic crisis, but also due to a lack of information from health workers”.

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