Cancer screening: inequalities ... in the data.
Résumé
Palencia et al were rightly concerned by inequalities in the use of cancer screening in 2002.(1) The discussion rightly began by an analysis of the strengths and weakness of the study but I am concerned by two points. The validity of the data could have been discussed, at least for France. For France, the prevalence of breast cancer screening can hardly be found in peer-reviewed journals but data exists.(http://www.invs.sante.fr/presse/2010/communiques/depistage_cancer_sein_060410/index.html) The French organized breast cancer screening programme achieved national coverage in 2004. Acceptance rate for this organized program increased from 40.2 % in 2004 49.3 % in 2006 and 52.5 % in 2008 which are far lower than the 79.4 cited by Palencia et al. Even in 2008 and 2009 only one territory, out a hundred, reached the 70% level (Haute-Vienne), whereas at the opposite Paris has the lowest rate (28.2 %). The second point is the relevance of the definition of screening prevalence (ie. "mammography use in the previous 3years."). The benefit of screening programs is evidenced from randomized trials with durations reaching a decade. Evaluating the prevalence of screening by a cross-sectional analysis is misleading: it overestimates the quality of the programs and therefore the potential benefits. Last but not least, the publication in 2010 of raw data from 2002 underlines the urgent need for an European Cancer Observatory with adequate funding.(http://eu-cancer.iarc.fr/7-about-eco.html) This observatory muts allow to benchmark for reducing inequalities in cancer care among European countries.
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