As part of its mission to evaluate the national organized colorectal cancer screening program, Santé publique France has published on its website follow-up data on positive screening results from the 2018–2019 period, based on source data from the Regional Cancer Screening Coordination Centers. These new data confirm the effectiveness of the immunological test but highlight the continuing trend of longer wait times for colonoscopy following a positive test. Given the impact of COVID-19 on access to care, the Agency has also conducted an early analysis of the initial data received for 2020. It is important to remember that when detected early, this cancer can be cured in 90% of cases.

Colorectal cancer: better chances of cure if detected at an early stage

Colorectal cancer develops from the cells lining the inner wall of the colon or rectum. Most often, these malignant tumors originate from a benign tumor that grows slowly and eventually becomes cancerous.

Colorectal cancer can be detected at an early stage through screening for occult blood in the stool. An organized screening program is offered in France to all individuals aged 50 to 74. Those who test positive are invited to undergo a colonoscopy to detect the possible presence of precancerous lesions or cancer. Santé publique France is responsible for evaluating the performance of the screening program and publishes annual participation indicators at the national, regional, and departmental levels, as well as follow-up data every two years for those who test positive.

Colorectal cancer: a more effective screening test, but the time to colonoscopy needs to be improved

Regarding screening tests: the immunological screening test continues to perform well

For the 2018–2019 period, the performance of the immunological test (introduced in 2015) remains significantly superior to that of the guaiac test (2013–2014 period), with:

• a detection rate for advanced adenomas nearly three times higher (9.3‰ vs. 3.3‰);

• a cancer detection rate nearly twice as high (2.1‰ vs. 1.2‰);

• a higher positive predictive value (i.e., the probability of having the disease if the screening test is positive) for the detection of advanced adenomas (28.4% vs. 17.0%);

• a higher positive predictive value for cancer detection (6.6% vs. 6.3%);

• a higher percentage of invasive cancers detected at an early stage (Stage I): 43.9% vs. 37.7%.

However, the median time to colonoscopy following a positive test continues to increase: from 62 days in 2013–2014 to 80 days in 2018–2019. In 2020, the median time to colonoscopy following a positive test was 87 days (a result that needs to be consolidated as it was obtained from partial data*, affected by the onset of the COVID-19 pandemic).

Regarding follow-up of screened individuals: a possible decline in the number of colonoscopies performed since the start of the COVID-19 pandemic

At the national level, the follow-up indicators for individuals who tested positive remained in line with European benchmarks for organized colorectal cancer screening in 2018–2019:

• percentage of colonoscopies performed after a positive test = 86.4%European benchmark: acceptable: ≥85% - desirable: ≥90%

• Percentage of complete colonoscopies = 93.4%European benchmark: acceptable: ≥90% - desirable: ≥95%

However, an analysis of preliminary 2020 data tracking individuals who tested positive indicates a 76.5% rate of colonoscopies performed following a positive test (a result that needs to be consolidated as it is based on partial data*, influenced by the onset of the COVID-19 pandemic).

*Information is currently available for only about 80% of the positive tests performed.

Learn more

• National indicators for 2018–2019 and 2020

• Indicators by region and department 2018-2019