To detect breast cancer at an early stage and thereby reduce mortality rates, a national organized breast cancer screening program (PNDOCS) was launched in France in 2004. The program invites women aged 50 to 74 to undergo a mammogram every two years. The mammogram images are then analyzed on-site by a first radiologist and, if necessary, followed up with an immediate evaluation. All normal images are subsequently reviewed by a second experienced radiologist.

A common cancer in women but with a good prognosis

With an estimated 59,000 new diagnoses in 2017, breast cancer is the most common cancer among women and is also the leading cause of cancer-related death in women, with approximately 12,000 deaths per year. The number of new cases rose significantly between 1980 and 2000 (an average of +2.7% per year), then declined between 2005 and 2012 (-1.5% per year). Furthermore, mortality has been steadily declining since 2005 (-1.5% per year). In fact, breast cancer is among the cancers with a favorable prognosis, with a 5-year age-standardized survival rate of 87% for cancers diagnosed between 2005 and 2010.

Implementation and Evaluation of the Screening Program

The PNDOCS is organized at the national level by the Directorate General for Health (DGS), in collaboration with the Health Insurance Fund and the National Cancer Institute (INCa); at the regional level by the regional health agencies (ARS); and at the departmental level by screening management organizations.

The data collected annually by these bodies is transmitted to Santé publique France, which is responsible for compiling the PNDOCS national database and then calculating national and sub-national indicators to produce the epidemiological evaluation (screening activity, screening results, detected cancers, etc.).

A high-quality French program but insufficient participation

The Santé publique France study indicates that:

• After a ramp-up phase between 2004 and 2008 followed by a stabilization phase between 2008 and 2012, the participation rate began to decline, reaching 50.1% in 2016.

• The participation rate varies significantly from one department to another.

• Positive screening results decreased from 13.5% in 2004 to 8.7% in 2014.

• The rate of cancers detected following the screening procedure remained stable over the entire period: 7 per 1,000 women screened.

• In 2014, these detected cancers were distributed as follows: 1.0 ductal carcinoma in situ, 1.9 small invasive cancers, and 3.9 invasive cancers without lymph node involvement. These results have remained stable since 2004.

• The positive predictive value of a positive screening result prior to further evaluation—that is, the probability of having cancer if the screening is positive—was 8.5% in 2014. It has been steadily increasing since 2004.

• Overall results at the various stages of the screening program vary by age.

• Most performance indicators, in line with European benchmarks, attest to the quality of the French program, a necessary condition for reducing mortality.

For more information

Quintin C, Rogel A. Evaluation of the organized breast cancer screening program: results and trends in performance indicators since 2004 in metropolitan France. Saint-Maurice: Santé publique France, 2019. 48 p.