Lacour A, Mamelle N, Arnold F, Bazin B, Bohec C, Brégeault A, Chaperon J, Dubuc M, Duru G, Exbrayat C, Fontaine D, Manuel C, Obadia Y, Piette C, San Marco J L, Schaffer P, Trugeon A, Brémond A, Charles R, Cohen M, Cordier B, Dubreuil A, Namer M, Renaud R, Allemand H
INSERM U 265, Lyon.
J Gynecol Obstet Biol Reprod (Paris). 1997;26(5):470-83.
The purpose of this work was to comparatively assess the results of mass screening programs for breast cancer implemented in six French departments in 1986, within the scope of the National Fund for Health Prevention, Education and Information of the National Health Insurance Office of Salaried Workers.
The data collected by the screening centres were analyzed by ten assessment teams that were independent from the program promotion staff, all using the same evaluation form. A complementary population study performed in eight French districts then, allowed assessing the frequency of self-referred screening (mammography performed out of program).
The rate of participation in screening programs, in relation to the invited population, ranged from 21 to 48%, according to the district (36% in average). This low participation was probably related to the extent of self-referred screening. In fact, 19 to 40% of women, according to the district, had previously had a screening mammographic coverage: rate was around 68% in women aged 50 to 69 years. Positive findings with mammography ranged from 4.5 to 15.8% (10.1% in average), while intervention rates ranged from 0.7 to 1.6% and detection rates from 3.8 to 6.2%. The ratio between benign tumors and cancers ranged from 0.7 to 2.1 according to the district. In order to enlighten the judgement on French results, we propose a comparison with the international standards in force.
The various experiences with breast cancer screening in France show that this screening is technically feasible on the basis of existing medical structures. However, some criteria are still below the expected values, especially if compared with international standards. This result is probably accounted for by the high rate self-referred screening before age 40 in France. In these conditions, the question is whether extending breast cancer screening programs in France is an appropriate course of action.
本研究旨在对1986年在法国六个部门实施的乳腺癌群体筛查项目结果进行比较评估，该项目属于国家健康保险办公室受薪工人健康预防、教育与信息国家基金的范畴。
筛查中心收集的数据由十个独立于项目推广人员的评估小组进行分析，所有小组均使用相同的评估表。随后在法国八个地区进行的补充人群研究，有助于评估自行转诊筛查（计划外进行的乳房X光检查）的频率。
根据地区不同，参与筛查项目的人数占受邀人群的比例在21%至48%之间（平均为36%）。参与率较低可能与自行转诊筛查的程度有关。事实上，根据地区不同，19%至40%的女性此前已接受过乳房X光筛查：50至69岁女性的筛查率约为68%。乳房X光检查的阳性结果率在4.5%至15.8%之间（平均为10.1%），而干预率在0.7%至1.6%之间，检出率在3.8%至6.2%之间。根据地区不同，良性肿瘤与癌症的比例在0.7至2.1之间。为了更好地评判法国的筛查结果，我们建议与现行国际标准进行比较。
法国乳腺癌筛查的各种经验表明，基于现有的医疗结构，这种筛查在技术上是可行的。然而，一些标准仍低于预期值，尤其是与国际标准相比。这一结果可能是由于法国40岁以下人群自行转诊筛查率较高。在这种情况下，法国扩大乳腺癌筛查项目是否是一项合适的举措值得探讨。
