Less than one in two eligible women (46.5%) participated in organized breast cancer screening (DO) in 2022-2023, a decline compared to the 2021-2022 period (47.7%). If, each year, 10 to 15% of women who do not participate carry out individual screening, coverage remains below the European objective of 70%.
Implemented in 2004, the measure targets women aged 50 to 74, without symptoms or other risk factors other than age. They are invited to perform a screening mammogram supplemented by a clinical breast examination. A second reading of the mammogram is performed by a radiologist different from the one who conducted the initial examination.
A peak of participation in 2012
Thanks to DO, 6 out of 10 breast cancers are diagnosed at an early stage. The cancer detection rate appears to be increasing steadily, consistent with the observed increase in the incidence of breast cancer in the general population and thanks to improved screening practices.
Despite its benefits, DO does not attract sufficient participation. After increasing until 2011-2012, reaching a peak at 52.3%, participation in the program gradually declined, for all age groups and in all regions. A significant drop was observed in 2020, due to the Covid epidemic. And if a catch-up occurred in 2021, the levels reached did not reach the peak of 2012 and participation failed to take off.
The situation mobilizes professionals, while breast cancer causes 12,000 deaths per year. Since 1is January 2024, Health Insurance took over the sending of invitations and reminders, previously managed by the Regional Cancer Screening Coordination Centers (CRCDC). In a report, the General Inspectorate of Social Affairs (Igas) pointed to significant territorial variations, justifying national management. The CRCDCs remain responsible for monitoring screening, training and informing professionals and “to go towards” among the least participating populations.
Actions targeted at populations far from healthcare
Health Insurance, drawing on its experience during the first Covid vaccination campaign, has also created seven telephone call centers to relaunch populations furthest from care. The speeches “motivating” of callers are effective in winning “a few points” of participation, assures Dr Catherine Grenier, responsible for users of the National Health Insurance Fund (Cnam). The latter also provides each treating physician with information on their eligible, unscreened patients.
The High Authority for Health (HAS) is also proposing changes. In an opinion published in 2023, it recommends the introduction of tomosynthesis (3D) in DO, provided that it is systematically associated with the reconstruction of a synthetic 2D image (3D + 2Ds). The technique has been used in France since 2009, outside the DO, in women at high risk of breast cancer or as part of the surveillance of a diagnosed cancer. In parallel with the gradual deployment of this procedure, the HAS recommends maintaining 2D mammography, 2Ds not being usable for second reading without dematerialization of the sending of the images.
