To date, in France breast cancer remains the leading cause of cancer death in women. Detected at an early stage, it can be healed in nine out of ten. This year marks 32e Edition of “Pink October”, the breast cancer campaign, which aims to encourage screening and inform women.
When should you do a mammography? What are the proven risk factors? Who are the women concerned? This annual meeting is an opportunity to take stock of the main questions that we ask.
What does breast cancer represent in France represent?
Table of Contents
- What does breast cancer represent in France represent?
- Is systematic screening necessary?
- Why is it important to regularly make breast self-use?
- Does breast cancer only affect women aged 50 and over?
- What is the share of inheritance in breast cancer?
- What are the other proven risk factors?
- Do hormonal treatments for menopause increase the risks?
- Do hormonal contraceptives increase the risk?
Breast cancer is the most common in women. According to a study by the National Cancer Institute distributed in September 2024, breast cancers are the most frequent in women, with more than 61,000 cases detected in 2023. It is also the deadliest female cancer, with more than 12,000 dead per year.
Is systematic screening necessary?
Every two years, women who are between 50 and 74 years old (the most risky age group) are invited, by mail, to perform a mammography of screening. This examination is 100 % covered by Social Security, without advance.
Like any medical act, this screening mode has both profits and limits. Several drawbacks are highlighted, including:
- overdiagnostics and ontrement: the diagnosis and treatment of cancerous lesions which would not necessarily have evolved in cancer;
- Exposure to X-rays which can, in some cases, increase the probability of radio-induction cancer. This is one of the reasons why screening is recommended only every two years and from 50 years;
- Interval cancers: These are cancers that appear between two screenings. It is indeed possible to develop a tumor very quickly, in the months following an examination. However, these situations are rare.
For the head of the pathology service and the diagnostic and theranostic medicine pole at the Curie Institute, Anne Vincent-Salomon, the balance of benefits/risks nevertheless leans largely in favor of screening. “These exams are unpleasant and stressful. But they allow you to spot small and less advanced tumors. However, the more the breast cancers are detected early, the more the chances of healing are important ”she explains. Detected at an early stage, this cancer can be healed in nine out of ten.
The specialist also recalls that the cancers detected early allow – generally and apart from cases where the tumor is said “Triple negative” or « HER2 positive » – less heavy and less aggressive treatments, with fewer sequelae (less use of total mastectomy and/or chemotherapy).
Why is it important to regularly make breast self-use?
“A serious tumor can develop between two screening mammograms. It is therefore essential to monitor your breasts by regularly enhance. The two are complementary ”insists Anne Vincent-Salomon. This self-examination is also highly recommended for women under the age of 50, who do not benefit from systematic screening every two years. Do not hesitate to consult your doctor or gynecologist if we see:
- a size at the level of a breast or a armpit;
- redness or orange skin appearance of a breast;
- a retraction or a deviation of the nipple;
- a breast flow.
In parallel and in addition, from the age of 25, it is recommended to carry out a clinical breast examination (palpation) once a year. This rapid and painless examination can be carried out by a general practitioner, a gynecologist or a midwife. “Whatever his age, you have to remain vigilant and be followed by a doctor or a gynecologist”summarizes Anne Vincent-Salomon.
Does breast cancer only affect women aged 50 and over?
The median age at diagnosis is 63 years. Nevertheless, each year it is nearly 3,000 women under the age of 40 to whom breast cancer is diagnosed, or 5 % of patients affected by this type of cancer, points out the Curie Institute. “Young women are therefore concerned, just like older women”says the specialist, who adds that “Breast cancers occur in women under the age of 40 are generally more aggressive than in older women”.
Only 5 % to 10 % of breast cancers are hereditary, that is to say attributable to a certain number of hereditary genetic changes, according to figures in maladie. Note that it is not because a woman in your family has had breast cancer that you necessarily have genetic predispositions. In addition, being a mutation on one of these genes does not necessarily result in the appearance of cancer, but this increases the risk of developing one. “Consulting a specialist doctor makes it possible to assess the genetic risk and, if this risk is proven, to set up specific monitoring”explains Anne Vincent-Salomon. This means:
- a clinical examination every six months from the age of 20;
- Radiological examinations for annual monitoring (breast and/or mammography, depending on the case, sometimes supplemented by an ultrasound) from 30 years.
What are the other proven risk factors?
Breast cancer is a multifactorial disease. This means that several factors influence the risk of its occurrence. In addition to age and genetic predispositions, certain factors linked to lifestyle play, such as overweight or obesity (especially after menopause), lack of physical activity or alcohol consumption.
Personal history also has their importance: after breast cancer, a woman is about four times more risk of developing one tumor in the other breast compared to women who have never had them. The risk is also increased after ovarian and/or endometrium cancer. Other non -modifiable risk factors: having had an early puberty and/or a late menopause.
Do hormonal treatments for menopause increase the risks?
Data published in the scientific journal The Lancet, In August 2019, confirmed that women who follow a hormonal substitution treatment (HRT) for menopause have an increased risk of developing breast cancer. All types of HRTs are associated with a breast cancer outfit, except local treatments.
Five years of HRTs from 50 years old increase the risk of an additional case for fifty women treated with the treatment combining estrogens and progestins continuously. The increase is lower with the treatment combined with intermittent progestins (an additional case for seventy women treated) and lower with estrogen alone, but this treatment is reserved for women whose uterus has been removed.
The study results also suggest that the risk for a ten -year treatment period is twice as long as for five years.
Do hormonal contraceptives increase the risk?
A vast Danish study (1.8 million women followed over almost eleven years on average), the results of which were published in December 2017, shows a 20 % increase in the risk of developing breast cancer in women taking hormonal contraception or having done it recently. The authors of this work believe that an additional breast cancer will be discovered among 7,690 women taking this type of contraception for a year. A harmful effect, however, which must be considered with regard to the protective effect of these drugs on the risk of ovarian, endometrium and colorectal cancer. It is, moreover, an effective means of contraception.
Note that the extent of the risk is linked to the duration of use. If the risk does not increase significantly when taking hormonal contraception for less than a year, it increases by 26 % after more than ten years of taking. The increase in risk persists for at least five years after stopping treatment. No risk was found in women who had previously used hormonal contraception for less than five years.
