Breast cancer is the most common kind of cancer affecting women in France, and is the leading cause of death from cancer among this same group.
October is breast cancer awareness month in France, with a special day to mark the fight against the disease (October 27) organised by the association Ruban Rose (“pink ribbon”).
National cancer group l'Institut National du Cancer (INCa) estimates that around 80% of breast cancer cases occur in women aged 50 and over, which is why the national screening programme begins at this age. Regular screening is considered to be most effective then, and has been found to improve survival rates.
How does it work?
Every two years from the age of 50-74, women living in France will receive a letter at home inviting them to book a breast cancer screening - even if they do not have any symptoms or any risk factors (such as family cancer).
The letter will include a list of nearby radiologists who can undertake this. Women can choose from the list, or make an appointment with a radiologist of their choice - whether in their department or elsewhere.
Can I choose my own radiologist?
You can choose from the list of radiologists recommended with your invitation letter. These are radiologists that have agreed to be part of the scheme, and the list is updated every six months. If your “usual” radiologist is on the list, you can choose them.
The most important thing when choosing a radiologist is to ensure that they are listed as authorised to perform mammograms as part of the breast cancer screening programme.
I have received a letter but my last mammogram was less than two years ago. Do I need to go again?
No. If you had your last appointment less than two years ago, especially if you are over 50, you do not need to make another appointment, until two full years have passed since the date of your last scan.
If you wish you can write back using the reply coupon sent with your letter, noting the date of your last mammogram. Your next reminder letter will then be sent two years after this date.
What if I haven’t received a letter, and it has been more than two years and/or I am now 50 or over?
You can contact your GP or go directly to the breast cancer screening organising body in your department, which may be departmental or work across several departments, depending on your location.
What happens during the appointment?
Before your appointment, you will probably be asked to complete a form listing any other medical conditions or medication, and also to give the details of your GP, so they can be informed of your scan results.
The appointment will include a clinical examination of your breasts by the doctor, as well as a mammogram. This is a radiography scan of the breast tissue, using a mammogram machine. It can detect lesions in the breast tissue that may allow doctors to detect the early signs of cancer even before symptoms appear.
Early detection helps improve survival rates.
Your breasts will be placed between two plates that will press down slightly. Two X-Ray photos will be taken per breast.
The mammogram results are usually looked at by two radiologists, to allow them to get a second opinion and be as sure as possible of the results - even if the scan looks normal.
Does it hurt?
This varies from woman to woman. Sometimes, the mammogram machine’s “pressing” action can be a little uncomfortable or slightly painful, but it is necessary for the scan and should only last a few seconds.
If you are afraid of the procedure, or experience severe pain, you should not hesitate to let your radiographer know at the time, so they can reassure you, explain, proceed with extra caution, or even investigate further.
Do I have to pay for the appointment?
No, it is entirely paid for by the assurance maladie, with no costs paid by you.
However, any extra services, such as an echogram or MRI scan - which may be needed to help the radiologist properly interpret your results - are paid for, and later reimbursed.
These extra services will usually only be recommended if the radiologist believes them to be necessary.
I have breast implants - will this be an issue?
No, the mammogram will take this into account and take special shots to ensure your breast tissue is still screened properly.
Do the mammogram and exam look for all cancers?
Not all types of cancer may be visible, depending on their type or size, and having a scan and mammogram does not mean that you should stop checking your breasts yourself at home, and staying alert to any changes, lumps or unusual pain.
How do I get the results?
The radiologist will tell you their conclusions at the end of the appointment, but the definitive results - and photos - will be sent to you in the post within about two weeks. Normal photos are usually sent securely to a second radiologist to allow the first to get a second opinion.
Your results will also be sent to a GP, doctor or gynaecologist of your choice, if you have given their details.
I have results from my previous scan. Should I take them to my appointment?
Yes - if you have photos or results from a previous scan, do take them along to your appointment. The radiologist may wish to look at them to compare the results from then with your new ones.
What if there is an abnormal result?
Around 90 in 1,000 women receive an “abnormal” result after a routine scan.
Usually, this is not a sign of cancer, but of a benign cyst, which can either be monitored or treated appropriately.
If the abnormality is suspected to be cancerous, further tests may be needed, such as a second mammogram, an MRI, and/or a biopsy. Usually, further tests show that the issue is not cancer.
For seven in 1,000 women, cancer is detected. If this happens, you will be directed immediately for consultation with a specialist and an oncology team who will decide on a tailored treatment plan for you.
What if I notice something that doesn’t feel right in between scans? Should I just wait for my next scan?
No. Do not wait for your scan invitation letter to report anything that doesn’t feel right. Instead, go straight to your GP or gynaecologist and tell them what you feel, even if you are not sure. It is better to report something as a false alarm, than to wait and worry about something that may be serious.
If you find any of the following, tell your GP (they are not necessarily signs of cancer, but should be checked):
- A lump, growth or pain inside the breast or in the armpit near the breast
- A change in skin texture or colour, such as a rash, dimple, swelling or “orange peel” texture
- A change in the nipple or the areola (area around the nipple), such as it becoming inverted, changing colour, or a change in shape
- A change in shape of one or both of your breasts
- Any unexplained and/or unusual discharge or leaking from your nipple
What if I have already had breast cancer? Will I be included in the screening programme?
No, you will not be included as you should already be following a screening protocol organised by your doctors.
What if I don’t want to get the scan?
You are advised to discuss this with your doctor. Studies show that the risk of developing breast cancer increase after the age of 50. Not choosing to have regular scans may mean that if you do develop cancer, it will likely be diagnosed at a much later stage. Later detection can lead to a lower chance of survival, and a marked impact on your quality of life.
Treatment for later-stage cancer is usually more severe and dangerous, with more damaging side-effects.
The French INCa recommends that even if you choose not to take part in the screening programme, you still:
- Request a breast examination by your GP, doctor, gynaecologist - or even a midwife, in the absence of a doctor or nurse - at least once a year
- Perform a regular check on your own breasts at home, by checking for any lumps, bumps, texture, changes in shape, size and appearance of your breasts, as well as the appearance and feel of the nipples, areola, and surrounding skin - and report anything unusual to your GP as soon as possible
What if I am aged under 50 or over 74 and want a scan?
If you do not have any symptoms or risk factors, regular screening is not advised for these groups. Screening can only be done after a discussion with your main GP.
If you have had a mammogram previously outside the ages of 50-74, it is likely that this was done on specific recommendation from your GP.
It is not recommended that women under the age of 50 with no risk factors or symptoms have regular scans as a matter of course, as there are no studies that suggest this has any measurable positive effects.
The information on this page comes directly from the Institut National du Cancer (INCa) website, here (in French).