Breast cancer screening: join in, it could save your life

Professor Anne Vandenbroucke was coordinator of breast cancer screening for Wallonia-Brussels for many years and knows the pros and cons of the Mammotest, the name by which screening is known in the French-speaking part of the country, like the back of her hand. Vandenbroucke bit the bullet at the annual breast cancer symposium organized by Europa Donna Belgium with the support of Pink Ribbon and Vivre comme avant on Sept. 28, 2024. "Nine out of ten women will never get breast cancer," underlined Professor Anne Vandenbroucke. "We should not frighten women, but the biggest risk group, the women between 50 and 69, should participate in the biennial screening for breast cancer, for which they are called." That happens far too little now.

Thresholds and obstacles

In Wallonia and Brussels, less than 10 percent of women in the 50-69 age group accept the invitation to sign up for a free screening examination. Flanders also scores insufficiently, but much better: between 50 and 60 percent of women there participate in the population screening. According to the World Health Organization, every country should aim for a participation rate of at least 75 percent.

There are several explanations for the great difference between our two parts of the country. First, the invitation is different. In its invitation letter, Flemish Population Screening immediately suggests a time when women can sign up for screening in their neighborhood, without having to do anything. You don't have to confirm this, you are expected there. Unless that doesn't work out. If the time is not convenient for you, you can easily change the appointment right away via a phone number found in the letter. The invitation for the Mammotest, south of the language border, asks women to make their own appointment at an approved screening center. This is an additional barrier. Women also indicate that waiting times can be very long: it sometimes takes months to get an appointment. A second explanation for community discord is the ingrained habit of having your breasts screened by a radiologist outside the population screening program. A lot of women are convinced that the screenings they request on their own, i.e. privately, are of better quality. Something that unfortunately is not always contradicted by radiologists who make money from breast cancer screening. Third, there is a cultural difference: the French-speaking side is somewhat more suspicious of government recommendations than in Flanders. And population screening is organized by governments.

Misunderstandings

Those who participate in the breast cancer population screening program pay nothing: it is free for women between the ages of 50 and 69. If you have a screening mammogram outside the population screening, you usually have to pay a limited surcharge. "Individual screenings are not free," Professor Vandenbroucke stresses, "they are reimbursed but not always in full." Much more important than the price difference is the quality of the screenings. It is better with population screening. Anne Vandenbroucke: "Screening mammograms - always two per breast - done through the population screening are taken by specially trained technicians, the x-rays are viewed by a physician-radiologist and then delivered to a second physician-radiologist from another center." This second physician does not know the first physician's conclusion. Both assessments are then compared. If there is a discrepancy, additional examinations occur. In 10 percent of cases, the conclusions are effectively different and the woman is called for further examination. Thanks to this second reading, population screening detects 10 percent more breast cancers. In a private setting, you never have a second reading and the result depends on the skill of the radiologist evaluating the pictures. In addition, additional tests are requested more quickly in private. Outside of population screening, more screenings give rise to false-negative diagnoses: people think they see something suspicious, which ultimately turns out to be a false alarm.

Because of the second reading and comparing conclusions, women have to wait a little longer for the result, which is another final obstacle. This waiting time takes about two weeks. You will be informed of the result in a personal letter and you will also find it in your medical file.

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