The French organized breast cancer screening program offers women aged 50 to 74 a clinical breast exam and a mammogram every two years. It also provides a second reading of every mammogram that is initially interpreted as normal. It also provides a second reading of every mammogram that is initially interpreted as normal. The program was expanded to cover the entire French territory in 2004. Screening is coordinated locally by a management body, which was organized at the departmental level until the end of 2018 (in total, there were 89 management bodies for 99 departments). Since January 1, 2019, the cancer screening system has been organized at the regional level. Participation rates for this program, calculated for 2017 and 2018, are presented below at the national, departmental, and regional levels.

Materials and Methods

The number of women screened is provided by the management structures, based on a standardized annual questionnaire.

The denominators used to calculate participation rates are derived from the most recent population data provided by INSEE, specifically the 2007–2042 population projection (central scenario). They are thus calculated identically across the entire country.

The annual participation rate measures participation for a calendar year. The number of women screened during a given year may be influenced by invitation strategies. Rates calculated over a two-year period allow for a timeframe during which the entire target population should have been invited and thus better reflect women’s participation.

Benchmarks

The European benchmark, updated in 2006, recommends a participation rate for the target population of 70% or higher. This benchmark applies to all European countries that have implemented an organized screening program.

These participation data enable the monitoring and evaluation of progress on the actions of the 2014–2019 Cancer Plan related to breast cancer screening, in particular: addressing inequalities in access to and use of screening programs (Action 1.8). Increasing participation remains a key objective of the new 2014–2019 Cancer Plan.

Results

The national participation rate for 2018 is 50.3%, meaning that approximately 2,595,000 women underwent screening during the year (see table of crude rates, table of age-standardized rates)

Previously published rates were 40.2% in 2004, 44.8% in 2005, 49.3% in 2006, 50.8% in 2007, 52.5% in 2008, 52.3% in 2009, 52.0% in 2010, 52.7% in 2011 and 2012, 51.6% in 2013, 52.1% in 2014, 51.5% in 2015, 50.7% in 2016, and 49.9% in 2017.

For the 2017–2018 period, which corresponds to a screening “campaign” since women are invited to participate in screening every two years, more than 5.1 million women were screened, and the participation rate was 50.1%.

After rising through 2011–2012 to peak at 52.7%, participation in the program has been declining. The latest participation indicators for the 2017–2018 period suggest, however, that this decline appears to be slowing. This slowdown is observed across all age groups (see age-specific graph) and in most regions, with the exception of Pays de la Loire and Brittany, where participation rates continue to fall despite having previously been among the highest. Conversely, in Auvergne-Rhône-Alpes and Grand-Est, participation rates are rising. In the DROMs, significant declines are observed (see graph by region).

The regional variation in participation observed in previous years persists for the 2017–2018 period, with disparities between regions ranging from 35.2% in Corsica and 39.1% in Île-de-France to 58.2% in the Pays de la Loire and 58.6% in Centre-Val-de-Loire (see table). In the overseas territories, rates range from 26.1% in French Guiana to 47.3% in Réunion. This geographic variation is also evident at the departmental level, with rates ranging from 28.5% in Paris to 62.4% in Indre-et-Loire (see map).

Conclusion

It is difficult to interpret recent trends in participation. The decline observed starting in 2011–2012 could be linked, in part, to the controversy over the benefits and risks of breast cancer screening. Under this hypothesis, the slowdown in 2017–2018 would suggest that the effect of the controversy on participation is waning.

It is also important to understand what is happening in regions where participation continues to decline despite previously relatively high participation levels. It is also necessary to study what is happening in the overseas territories.

Finally, there is an urgent need for tools to accurately measure the uptake of individual screening in order to (1) describe any potential shifts between organized and individual screening, and (2) track overall trends in breast cancer screening uptake.