Organized Breast Cancer Screening: Evaluation of the Program in the French Overseas Departments and Regions

Santé publique France has released the results of an evaluation of the organized breast cancer screening program for the period 2008–2018 in the overseas departments and regions.

Breast cancer

thematic dossier

Breast cancer is the most common form of cancer in France and is the leading cause of cancer-related deaths among women. It is covered by a national screening program designed to detect the...

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Breast cancer is the most common cancer among women and the leading cause of cancer death among women worldwide, including in the French overseas departments and regions (DROM). The national organized breast cancer screening program invites women aged 50 to 74 to undergo a screening mammogram every two years, supplemented by a clinical breast exam (visual inspection and palpation).

Participation rates in the French overseas departments and regions (DROM) are similar to those in mainland France, with the exception of French Guiana, where the rate is lower. However, the incidence of breast cancer is lower in these territories.

For this reason, it is necessary to analyze the performance of organized breast cancer screening in the DROMs separately and to compare the results with those of mainland France.

A participation rate similar to that in mainland France (with the exception of French Guiana) but with a lower rate of detected cancers

Participation rate

In 2018–2019, participation in this program was approximately 46.5% in Réunion, 46% in Martinique and Guadeloupe, and 23% in French Guiana. Between 2006 and 2019, these rates increased in Guadeloupe and decreased in the other three DROMs.

Figure 1 - Voter turnout among women in the target population of all ages (50–74) in the French overseas departments and territories and mainland France – 2006–2019 [smoothed over two years]

Figure 1 - Taux de participation parmi les femmes de la population cible tous âges (50-74 ans) DROM et Hexagone – 2006-2019 [lissage sur deux années]
Because the Regional Cancer Screening Coordination Centers follow a strategy of issuing invitations every two years, the number of women invited for screening may vary from year to year. We used a two-year smoothing method for the graph.

The participation rates observed in French Guiana may be linked, for example, to problems with the distribution of invitations, access to health services, and the high number of immigrants from neighboring countries who seek medical care less frequently (despite having access to social security).

Screening Results

The trend in the rate of detected cancers is generally similar across the DROMs and mainland France, but the rate is significantly lower in the DROMs. In 2017–2018, the rates of detected cancers in the four DROMs were lower than in almost all mainland departments, particularly in French Guiana.

Figure 2 - Cancer detection rates among screened women, overall and by age group – French overseas departments and territories and mainland France – 2008–2018 [two-year smoothed data]

Figure 2 - Taux de cancers détectés parmi les femmes dépistées tous rangs et par rang – DROM et Hexagone – 2008-2018 [lissage sur deux années]

Screening program performance is lower in the overseas departments and regions than in mainland France

The lower rates of detected cancers in the DROMs can be explained by a lower incidence of breast cancer in these territories, but also by the screening program’s lower performance. Indeed, the evaluation of the program appears to show that its performance is lower than in mainland France: fewer follow-up ultrasounds performed in cases of reading difficulties, fewer diagnostic tests performed in cases of positive screening results, lower positive predictive values, and lower rates and proportions of small-sized cancers detected.

Estimating the impact of the cancer screening program on reducing breast cancer mortality, its benefits for quality of life, and the associated risks are important issues, including in the DROMs. Improving screening practices in the DROMs, particularly in French Guiana, would help boost the program’s performance in these territories.

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enquêtes/études

16 August 2023

Evaluation of the Performance of the Organized Breast Cancer Screening Program: Results and Trends in Performance Indicators in the Overseas Departments and Regions, 2008–2018

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What does the organized breast cancer screening program entail?

Women aged 50 to 74 are invited to undergo a free screening mammogram every two years to detect any abnormalities or cancer as early as possible, before symptoms appear. This includes a clinical examination performed by a radiologist and two images per breast (frontal and external oblique), plus an additional image if necessary, as well as a routine second reading in the event of a normal result. The exam is covered under the third-party payment system (no upfront costs).

Mammograms are performed in both public and private radiology practices. The patient chooses their radiologist from the list of radiologists participating in the program. If the exam reveals no abnormalities in the first or second reading, a repeat exam will be recommended within two years. If an abnormality is detected, it is not necessarily cancer, and in such cases, appropriate monitoring will be recommended.

Regular screening through this program for all eligible women would significantly reduce the number of breast cancer cases.

Reducing the risk factors for developing breast cancer by making changes to daily habits

Among the known risk factors for breast cancer, lifestyle-related factors have been identified, including alcohol consumption, smoking, being overweight or obese, and lack of physical activity.

Santé publique France has developed information and support resources accessible to everyone to help understand health issues, reduce risks, and adopt behaviors that promote good health.

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