National-level evaluation data make it possible to analyze the performance of each department and the program. The indicators are calculated and analyzed by the InVS. They are validated by each departmental coordinating physician prior to publication in this report. Despite the challenges in aligning programs with the two screening rates per breast recommended by the National Agency for Health Accreditation and Evaluation, participation rates are increasing, reaching 43%. However, they remain highly variable from one department to another. These low participation rates in France can be explained by the high rate of individual screening occurring alongside organized screening. The increase in participation is also reflected in retention rates, that is, in the regularity of screening participation. Quality indicators include recall rates and the predictive value of surgical biopsy. In a prevalence analysis, the average recall rate in the program (the percentage of women recalled for further testing) is 7.6% (ranging from 3.7% to 11.4%). Although there are significant variations between departments, the average recall rate has decreased. It was 8.6% in 1993 and reached 7.7% in 2000. The positive predictive value of surgical biopsy allows for an assessment of the appropriateness of the indication for surgical biopsy. Since the introduction of screening, the positive predictive value of surgical biopsy has been 53% (26.6 to 81.9) for prevalence and 65.6% (48.9 to 77.4) for incidence. This rate has improved over time. It averaged 49.8% in 1993 and reached 57.2% in 2000, values consistent with European recommendations (>50%). Nearly 12,000 cancers were detected through screening, including 2,216 in 2000. The rates of small cancers measuring 10 mm or less are very high: 35% in prevalence and 37% in incidence. The rates of cancers without lymph node involvement reach 71% in both prevalence and incidence. These high rates are linked to high rates of individual screening. In fact, 46% of women presenting for their first mammogram in the program had already had a mammogram. A meta-analysis published in October 2001 questions the effectiveness of breast cancer screening. At the request of the Directorate General of Health, a working group was established by the ANAES to review this meta-analysis and address the resulting controversy. The working group reports that the method (meta-analysis) and the criteria selected by the authors for this study are not appropriate for evaluating an intervention such as screening. The working group concludes that it is not legitimate to call into question the ANAES’s recommendations on screening. However, it emphasizes that, given the current state of knowledge, it is important for women to have access to the most comprehensive information possible regarding the benefits and risks of breast cancer screening. It is therefore essential to emphasize the importance of monitoring evaluation indicators, which allow, both at the local and national levels, for assessing trends and verifying that the program consistently offers women the highest possible quality of care.