Evaluation of costs and benefits of mammography screening for breast cancer in the context of French resources

Breast cancer is one of the major causes of mortality among American and European adult women. In the last two decades the probability for a woman of developing breast cancer in one's lifetime has changed from 1 in 20 to 1 in 11. The overall ten years survival is no more than 50% and the death rate from breast cancer has been stationary for the last 40 years. According to the available data from some regional tumor registries the annual incidence of breast cancer in France is about 0.8%. Approximately 25,000 new cases of breast cancer are annually diagnosed among the 12 000 000 French women above 40 years old. About 9,000 of them will die of the disease. This represents about 20% of the deaths from cancers, and 4% of deaths from all causes among women. The overall five years survival rate is approximately 60% for white females. However, if breast cancer is diagnosed and treated while localized, the five years survival is greater than 85% for women without nodal involvement while it drops to 47% when nodes are involved. Moreover, while the standard treatment of breast tumors more than 3 cm involves at least a simple mastectomy, a more conservative approach is increasingly accepted as a safe solution for tumors less than 3 cm in size. The Rational behind Breast Cancer Screening (BSC) is that early detection provides the chance to treat patients at a time when the treatment is more likely to be effective in reducing morbidity, mortality or both. The only diagnostic test whose effectiveness for early detection of breast cancer has been proven is mammography. However, this radiologic test involves risks and costs that have led to considerable controversies concerning its overall efficacy and safety. We shall present in this paper the current evidences and assumptions about the effectiveness, the costs, and the benefits of mammography as a breast cancer screening test. We shall focus in the last section on the feasibility of such a program in France taking into account the existent facilities and their capacities to met an increased demand