The French organized breast cancer screening program invites women aged 50 to 74 to undergo a clinical breast exam and a screening mammogram every two years. It offers immediate diagnostic evaluation in the event of suspicious results and a second reading of every mammogram that is initially deemed normal. The program was expanded to cover the entire French territory in 2004. Screening is coordinated at the regional level by the Regional Cancer Screening Coordination Centers (CRCDC). Participation rates for this program, calculated for the years 2005 through 2020, are presented below at the national, departmental, and regional levels.

Materials and Methods

The number of women screened is reported to Santé publique France in February–March of each year by the CRCDCs in a standardized data format, aggregated by 5-year age groups. The 50–54 age group includes women who turned 50 during the year under review, even if they had not yet reached that age at the time of screening; the 70–74 age group includes women who had turned 75 at the time of screening, generally due to a delay in undergoing the mammogram after receiving the invitation sent up to age 74.

At the national level and for the purpose of comparing regions and departments, the denominators used to calculate participation rates are the INSEE’s localized population estimates (ELP). Each year, INSEE estimates the population of regions and departments (metropolitan France and the overseas departments and regions) as of January 1. These annual population estimates are available by sex, age, and department. The estimates are based on the latest population censuses, statistical analysis of civil registry records, and several other administrative sources. They were used to calculate the target screening populations by age group. In the absence of comparable data over time and across different regions, exclusions from screening for medical or family reasons are not deducted from the denominator.

The participation rate is calculated for each calendar year on the one hand and for each two-year period on the other. Indeed, the number of women screened during a given year may be influenced by invitation strategies, particularly in the early years of the program’s implementation. Rates calculated over two years allow for a period during which the entire target population should have been invited and thus better reflect women’s participation. In 2004, not all departments were able to participate in a full year of screening, and some overseas departments did not implement this program until 2005. The results are therefore presented starting in 2005.

Both crude and age-standardized participation rates are presented. They are calculated by age group, by department, by region, and for France as a whole. The age-standardized rates (using the 2009 French population as the reference population, based on the INSEE Omphale projection for 2007–2042, central scenario) allow for comparisons between regions and over time.

Results

Results for the 2019–2020 period and trends in national and age-specific participation

In 2020, 2,251,689 women underwent an organized screening mammogram, corresponding to a national participation rate of 42.8% (see table). For the 2019–2020 period, the participation rate is 45.6% (see table). All annual and biennial standardized rates are available here.

The figure shows the trend in national participation, for all ages and by age group. After rising through 2011–2012 to peak at 52.4%, participation in the program has been steadily declining. However, the latest participation indicators show a significant drop over the most recent period (2019–2020), due primarily to the decline observed in 2020. This decline is evident across all age groups.

Participation Trends by Region and Department

The figure shows the trend in participation by metropolitan region and for the DROMs; the “Participation Trends 2005–2020” table provides annual and biennial participation figures by region and department; and the “Participation by Age Group 2005–2020” table describes the trend in participation by age in each region and department.
The decline observed at the national level is also evident in all regions of metropolitan France and in the DROMs.

Conclusion

A significant decline in participation in the DOCS was observed in 2020 regardless of age group or region. This is likely due to several factors related to the COVID-19 health crisis (suspension of invitations, suspension of second-reading activities for varying durations depending on the CRCDC, closure of radiology practices, and reduced activity upon reopening due to the implementation of necessary health measures).