Each year, nearly 3,000 women are diagnosed with cervical cancer and 1,100 women die from it, even though the World Health Organization states that cervical cancer is entirely preventable through two effective and complementary measures: screening and vaccination, which prevents infections with the human papillomavirus (HPV) strains included in the vaccine. To mark European Cervical Cancer Prevention Week, Santé publique France is publishing an update on national and subnational estimates of coverage for organized cervical cancer screening and is highlighting vaccination coverage rates. HPV vaccination coverage among adolescent girls has been increasing for several years but remains insufficient, and screening participation must improve. The National Cancer Institute emphasizes the importance of informing women about cervical cancer prevention and the complementary nature of vaccination starting at age 11 and regular screening from ages 25 to 65.

59% of women aged 25–65 were screened during the 2018–2020 period

Cervical cancer screening aims to detect precancerous lesions and treat them before they develop into cancer. It also allows for the detection and treatment of cancers at an early stage, thereby improving the chances of recovery. Since 2018, it has been part of an organized national program. Its goal is to reach women who do not undergo screening or do not do so regularly.

Each year in France, 3,000 cases of invasive cervical cancer are diagnosed, and 1,100 patients die from the disease. It is a cancer with a good prognosis, although this has deteriorated, with a 5-year survival rate of 63% for the 2010–2015 period; this rate was 68% for the 1989–1993 period. This decline is a “paradoxical” effect of screening on survival: as the number of invasive cancers decreases due to screening, the proportion of cancers diagnosed at advanced stages (in women who have not been screened)—and thus more aggressive—increases, leading to a mechanical decline in the survival rate.

As part of the program’s epidemiological evaluation, Santé publique France estimates that national screening coverage for all women aged 25 to 65 is 59% for the 2018–2020 period. This represents a slight increase compared to the previous three-year period (58% in 2017–2019). Despite a sharp decline in screening uptake during March, April, and May 2020 (a period during which screenings under the organized program were suspended), the COVID-19 health crisis does not appear to have had a significant impact on cervical cancer screening coverage, as there was a catch-up in the months that followed.
Screening coverage varies significantly by age and region. It is around 65% among women aged 25 to 45 and then decreases significantly with age starting at 50, falling to 45% among women aged 60–65. The lowest coverage rates (<50%) are observed in the overseas departments and regions, with the exception of Réunion, as well as in the Île-de-France departments of Seine-Saint-Denis, Val d’Oise, and Val-de-Marne. The highest coverage rates (>67%) are found in the Rhône, Haute-Garonne, Isère, and Haut-Rhin, with the latter two departments being the ones in mainland France where an organized screening program has been in place for many years.

Coverage is insufficient across all age groups and throughout the country, falling far short of the 70% recommended by the European Union.

The integration of the HPV test into the national organized screening program is proceeding rapidly. Among women aged 30 to 65, the HPV test accounted for less than 1% of screening tests in 2019, 25% in 2020, and 65% during the first six months of 2021.

Only one-third of 16-year-old girls received a full course of HPV vaccination in 2020

Currently recommended for girls and boys aged 11 to 14 (with catch-up vaccination possible up to age 19), HPV vaccination helps prevent genital HPV infections, which cause approximately 90% of cervical cancers as well as other cancers of the genital tract and the head and neck region.

HPV vaccination coverage among adolescent girls has been increasing for several years but remains insufficient. In 2020, it was estimated at 41% for a single dose at age 15 (vs. 35% in 2019) and 33% for the full series at age 16 (vs. 28% in 2019).

In addition to improving vaccination rates among young girls, vaccinating boys—recommended since 2021—will help reduce the transmission of human papillomavirus and protect future generations, regardless of gender, against HPV-related diseases.

Raising awareness among women about the importance and benefits of cervical cancer screening

To raise awareness among women about this screening, the National Cancer Institute has developed a series of audio segments that it offers to more than 1,000 radio stations, web radio stations, and websites in mainland France and the overseas territories, including versions in Creole. Healthcare professionals and experts discuss the key points of this screening.

• Access the program for mainland France: “Cervical Cancer Screening: The Info Minute”

• Access the program for the overseas territories of Martinique, Guadeloupe, Saint Martin, Saint Barthélemy, Réunion, French Guiana, and Mayotte.

In addition, women who have not undergone screening within the recommended time intervals receive a letter inviting them to undergo the exam. This letter is accompanied by an informational brochure explaining the process, the importance of this screening, and the various healthcare professionals they can consult.

For healthcare professionals responsible for women’s gynecological care, the National Cancer Institute offers an interactive tool. This tool allows each of them (gynecologists, general practitioners, midwives, and pathologists) to view the steps of their role in this screening process. It also provides access to recommended tests based on women’s profiles, as well as guidelines and public information materials.

This screening approach complements a prevention strategy involving HPV vaccination.

For more information:

• Cervical Cancer – Santé publique France (santepubliquefrance.fr)

• Géodes - Santé publique France - Indicators: maps, data, and graphs (santepubliquefrance.fr)

• Cervical Cancer – National Cancer Institute