In France, cervical cancer affects nearly 3,000 women each year and causes approximately 1,100 deaths. However, the World Health Organization (WHO) considers this cancer preventable through two complementary measures: vaccination against human papillomavirus (HPV) and regular cervical cancer screening.

Until 2018, the French approach relied primarily on an opportunistic strategy: Pap tests were performed at the initiative of women or their healthcare providers, on a three-year cycle. Organized screening trials conducted in thirteen departments from 2010 to 2014 supplemented this system, but failed to ensure sufficient participation or to reduce social and regional inequalities in access to screening.

To address these challenges, a National Organized Cervical Cancer Screening Program (PNDOCCU) was established in 2018 based on several pillars: targeted invitations via postal mail to women who are not up to date on their screening and, if necessary, follow-up reminders, personalized follow-up of all abnormal results (from both spontaneous and invitation-based screenings), intensified information and awareness-raising efforts targeting healthcare professionals, patients, and women in vulnerable situations, as well as experimental strategies such as health mediation and the use of mobile screening units. Its goal is to reduce the incidence and mortality associated with this cancer by 30% over ten years by increasing screening participation, reducing social and regional disparities in screening uptake, and improving the quality of professional practices.

The program is aimed at asymptomatic, immunocompetent women aged 25 to 65, whether vaccinated or not, who have not undergone a total hysterectomy1. It is based on the screening strategy recommended by the HAS in 2019: between the ages of 25 and 29, a cytology test is recommended every three years following two normal Pap smears taken one year apart; between the ages of 30 and 65, an HPV test is offered every five years, starting three years after the last cytology test and without delay if no previous screening has been performed.

As with other organized screening programs, the PNDOCCU is governed by a set of specifications appended to a ministerial decree in accordance with European recommendations (decree of March 23, 2018, followed by the decree of January 16, 2024, which, among other things, transfers the responsibility for sending invitations to the Health Insurance Fund). Until 2023, its operational implementation was entirely managed by the regional cancer screening coordination centers (CRCDC). Santé publique France conducts the national evaluation, notably by calculating participation rates.

Evaluation of the National Organized Cervical Cancer Screening Program

Participation in cervical cancer screening

Participation rates in the organized cervical cancer screening program are presented at the national, departmental, and regional levels for the year 2024 and from the year 2017 onward.

Key findings

At the national level, for the year 2024:

• The national standardized participation rate for the target population was 60.9%, an increase since the implementation of the PNDO (+9.7 percentage points compared to 2017) but below the acceptable European threshold of 70%.

• Participation is higher than in 2023 across all age groups, including among those aged 60–65 (an increase of 4.3 percentage points).

• Four departments meet the acceptable European threshold (Finistère, Morbihan, Isère, Hautes-Alpes), but significant regional disparities remain. In mainland France, more than 25 percentage points separate the department with the highest participation rate (Hautes-Alpes at 73.5%) and the one with the lowest rate (Seine-Saint-Denis at 45.7%). For the overseas departments and regions (DROM), there is a 48.4 percentage point gap between Réunion (65.8%) and Mayotte (17.4%).

• 8.8% of screenings were conducted via invitation-based screening in 2024, representing a decrease of 4.3 percentage points compared to 2023.

• Among women aged 30 to 65, the uptake of the HPV test continues to rise: 90.5% of screenings in this age group were performed using this test (versus 30.7% in 2020).

Further reading

• Hamers FF, Duport N, Beltzer N. Population-based organized cervical cancer screening pilot program in France. Eur J Cancer Prev. 2018 Sep;27(5):486-492. doi: 10.1097/CEJ.0000000000000365. PMID: 28362653.

• Audiger C, Bovagnet T, Bardes J, Abihsera G, Nicolet J, Deghaye M, Bochaton A, Menvielle G. Social Inequalities in Participation in Cervical Cancer Screening in a Metropolitan Area Implementing a Pilot Organized Screening Program (Paris Region, France). Int J Public Health. 2022 Jul 4;67:1604562. doi: 10.3389/ijph.2022.1604562. Erratum in: Int J Public Health. 2022 Oct 05;67:1605236. doi: 10.3389/ijph.2022.1605236. PMID: 35859669; PMCID: PMC9289096.

• European Commission: Directorate-General for Health and Food Safety, Karsa, L. v., Dillner, J., Suonio, E., Törnberg, S. et al., European guidelines for quality assurance in cervical cancer screening – Second edition – Supplements, Karsa, L. v. (editor), Dillner, J. (editor), Suonio, E. (editor), Törnberg, S. (editor), Anttila, A. (editor), Ronco, G. (editor), Franceschi, S. (editor), De Vuyst, H. (editor), Dillner, L. (editor), Patnick, J. (editor), Arbyn, M. (editor), and Segnan, N. (editor), Publications Office, 2015, https://data.europa.eu/doi/10.2875/859507