Cancer: Few people in Saint-Martin participate in the organized screening sessions

Whereas Pink October had barely started, the Ministry of Health announced on Monday October 3, 2016 the "deep renovation" of breast cancer screening following the scandal caused by the conclusions of a report ( http://www.concertation-depistage.fr/wp-content/uploads/2016/10/depistag...) which criticizes the current system, particularly, overdiagnoses and overtreatments.

Despite the controversies, all health professionals agree on one point: the earlier a cancer is detected, the more the patient increases their chances of survival and healing. In the Carribean, the priority for healthcare professionals is first to convince the target populations to come to the organized screening exams. In Saint-Martin, where organized breast cancer screening has been around for more than 10 years, more than 6  women out of 10 do not participate. Yet, according to the figures of the League against Cancer, 1 woman out of 8 will be affected by breast cancer at some point in her life.

Breast cancer

Breast cancer affects 53% of women between ages 50 and 75 (the age group targeted by the organized screening) and 29% between ages 40 and 49. Women should not wait to receive the invitation in order to start. With the Agwadec, organized breast cancer screening has been around since 2004 in Guadeloupe. The target population (women, benefitting from social health insurance, aged 50 to 74 with no risk factors) is invited every two years based on the health insurance’s files. The exam, which is free, consists in a mammogram with at least four images.

In Saint-Martin, the target population currently consists of 3727 women. Between January 1, 2015 and October 26, 2016, 5851 e-mails were sent to them (3727 invitations + 2224 reminders).  Therefore, 5.6 e-mails are necessary to convince a woman to come for screening (compared to 3.2 letters for the whole department). "A participation rate of less than 30% isn’t good" said Dr. Bachelier Billot, the coordinating doctor of the Agwadec screenings, who also pointed out that a woman who has a mammography has a 95% chance that everything will be normal.

Colorectal cancer

Since 2008, the Agwadec is also in charge of the organized screening for colorectal cancer. Since October 2015, screening for this cancer which is the second most frequent one (after breast cancer for women and prostate cancer for men) is done with the Oc Sensor test, which is directly forwarded to the mainland in order to search for blood in the stool.

The target population for the organized screening of colorectal cancer in Saint-Martin consists of 6100 men and women. 5968 were invited by mail between October 1, 2015 and October 27, 2016, and 2220 have been reminded, in order to go to withdraw their test kit at the pharmacy and send it back to be analyzed. But it took 10.7 e-mails on average to convince a person to do the test. In the end, only 764 tests were received, mostly from women. Only 4% were positive. However, 28% were non-analyzable. It is indeed necessary to directly mail the sample and preferably on a Monday morning.

The Agwadec hopes to be able to launch the screening for cervical cancer in 2017.

* Guadeloupe Association for Cancer Screening