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Entertainment: Info France 2. Operations of breast and ovarian cancers: 80% of French institutions do not follow the scientific recommendations

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The investigation of "cash investigation" reveals that the vast majority of hospitals and clinics do not reach Not the levels of activity recommended by scientists. In establishments that do little, lack of expertise can result in multiplication by two of the deaths.

  INFO FRANCE 2. Opérations de cancers du sein et de l'ovaire : 80% des établissements français ne suivent pas les recommandations scientifiques © provided by FranceInfo

in France, clinics or hospitals must achieve at least 30 Breast cancer operations per year to be allowed to practice. According to health insurance, which is based on a meta-analysis of scientific studies, a level of activity below this threshold leads to an overmortality for patients. In a report released in 2018 , the organization even recommends the institutions to operate at least 150 breast cancers per year.

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>> Cancer: 812 hospitals and clinics have operated without authorization in France in 2018

this recommendation, five times higher than the French legal threshold, is also required in Spain and Germany. In view of these requirements from the scientific community and the practices of our European neighbors, the thresholds in France to obtain permission to operate breast cancer seems so binding.

A largely higher mortality rate

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Now, the risk of mortality is much higher in patients operated in places that practice too little. In its report, the health insurance believes that for breast cancer, the mortality rate one year after the operation increases by 84% when the patient has been operated in an institution that practices less than 30 acts each year, in comparison with an establishment that produces more than 150 operations per year.

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The "cash investigation" journalists calculated that between 2016 and 2018, 80% of the institution operating breast cancers in France carried out less than 150 operations per year and therefore did not follow the recommendations of health insurance.

"Cash Investigation" and FranceInfo broadcast for the first time the card that details the average number of breast cancer operations carried out between 2016 and 2018 by hospitals and clinics in France. In blue, establishments that perform more than 150 operations per year. In orange, those who practice less than 150 operations per year.

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For certain cancers like that of the ovary, there is no minimum number of operations to be allowed to practice. However, there is also a strong overmortality is observed in patients operated on ovarian cancer in poorly experienced establishments. According to the health insurance report, the mortality rate one year after the operation increases by 40% when the patient has been operated in an establishment that practices less than 10 acts each year, in comparison with an establishment that produces more than 20 operations per year. Health insurance therefore recommends that hospitals and clinics practice at least 20 operations per year.

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"cash investigation" journalists calculated that 80% of French institutions practiced less than 20 ovarian cancer operations per year, between 2016 and 2018. FranceInfo and "Cash Investigation" post a detailed map of the average number. Ovarian cancer operations made between 2016 and 2018 by each clinic and each hospital in France. In blue, institutions that practice more than 20 operations per year. In orange, those who practice less than 20 operations per year.

In its 2018 Annual Report, health insurance alerted the health authorities on the risks to patients with ovarian cancer or breast cancer. The report recommended at the time to tighten the rules of authorizations to achieve the recommendations of scientists to "ensure an equal

access to quality care and improve the health outcomes

in the population".

Since these recommendations, the rules have not changed. These are the same since the implementation of activity thresholds in 2009. Result, each year, in France, 24,000 women with ovarian or breast cancer are carried out in institutions that do not follow the Health insurance recommendations, according to an estimate made from the data collected by the "cash investigation" journalists.

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