Participation rates in the organized breast cancer screening program for 2022–2023 and trends since 2005

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 has been available nationwide in France since 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 2023, 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 CRCDC 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 localized population estimates (ELP) from INSEE. Each year, INSEE estimates the population of regions and departments (mainland 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

The tables, figures, and map describing temporal and geographic variations for the period 2005–2023 are available for download at the bottom of the page.

For the period 2022–2023

(Figures 1, 2, and 3, Map, and Tables 1 and 2)

  • The target population for screening is estimated at 10,825,132 women.

  • 5,045,065 women underwent an organized screening mammogram, representing a standardized participation rate of 46.5%.

  • In 2023, the standardized participation rate is estimated at 48.2%, compared to 44.8% in 2022.

  • The highest regional standardized participation rates are observed in Bourgogne-Franche-Comté, Normandy, and Brittany (54%). The lowest regional participation rates are observed in French Guiana (15.7%), Corsica (30.4%), and PACA (36.2%).

  • While the 2022–2023 rate is stable or declining compared to the previous period in most regions of mainland France, an increase is observed in Hauts-de-France, where turnout reaches 48.5%.

Trends in participation since 2005

After rising through 2011–2012 to peak at 52.3%, participation in the program has since declined across all age groups and regions. In 2020, due to the first lockdown and the suspension of invitations by the CRCDCs, the participation rate had dropped significantly, both overall and across all age groups and departments. The year 2021 showed a recovery across all age groups and all departments, reflecting increased activity by CRCDCs and radiology practices to offset the decline in 2020. In 2022, participation was lower than in 2021, explained by a lower number of invitations sent two years after the disruption caused by the COVID-19 pandemic. In 2023, two years after 2021, the invitation cycle remains disrupted with a high number of invitations sent.

The suspension of invitations by the CRCDC and the closure of radiology practices in 2020 caused delays in the invitation cycles. The CRCDC adjusted their scheduling, for example by shortening the interval between invitations. Invitations became more frequent, which led to delays in scheduling appointments at radiology practices and, consequently, in performing mammograms. The gradual decline in breast care services had already caused difficulties in scheduling appointments, with a gradual increase (beginning around 2015) in the time between two mammograms. To address this increase, the CRCDC decided in 2023 to once again reduce their invitation interval by one to two months. An increase in participation is therefore observed in 2023 compared to 2022, but participation for 2022–2023 remains lower than that of 2021–2022. It is likely that the consequences of disruptions caused by COVID-19 will again impact the calculation of participation in 2024, a year that will also mark the implementation of the new organized screening program, with health insurance resuming the issuance of invitations.

Tables to Download

Figures to download

Map to download

References - Further Reading