Data Sources

The program evaluation is based on data submitted annually to Santé publique France by the Regional Cancer Screening Coordination Centers (CRCDC) using data extraction modules integrated into their specialized software for database management. Two types of data are submitted:

• data aggregated at the departmental level, enabling the calculation of program participation;

• and anonymized individual data, known as evaluation data, which enable the calculation of evaluation indicators.

This data is validated by the CRCDCs and by Santé publique France.

The format of the reported data and the indicators are described in a guide, the first version of which was developed in 2009 by a working group comprising members of the involved institutions: the General Directorate of Health (DGS), Health Insurance, the National Cancer Institute (INCa), Santé publique France (formerly InVS), coordinating physicians from cancer screening management structures, gastroenterologists, and anatomic cytopathologists. The latest updated version of this guide is available.

Aggregated data are provided by age and sex and provide information on the number of people who underwent a screening test, the number of people excluded from screening for medical reasons, and the number of people who tested positive during the evaluation period.

Individual evaluation data are extracted as .txt files, each containing one line per person who underwent a screening test during the evaluation period and approximately sixty variables for each individual.

Program Participation and Evaluation Indicators

Program participation indicators are calculated for rolling two-year periods (2009–2010, 2010–2011, 2011–2012…) that reflect the biennial frequency of program invitations (the entire target population of each department must be invited over a two-year period). The reference population for calculating participation rates is derived from the Localized Population Estimates of the National Institute of Statistics and Economic Studies (INSEE) to ensure consistency of estimates across departments. To calculate the participation rate, individuals excluded from screening for medical reasons during the evaluation period (permanent or temporary exclusions) are subtracted from the target population of 50- to 74-year-olds. Information on the number of people excluded from the program for medical reasons also allows for the calculation of program exclusion rates. These rates are standardized using a direct standardization method based on the age and sex structure of the French population aged 50–74 in 2009 (INSEE population projections, central scenario 2007–2042).

Indicators of the quality of testing, examinations, follow-up, and lesion detection are estimated by department (where sample sizes permit) and for France as a whole. They are calculated according to sex, age, and screening stage (first screening versus subsequent screenings). They are also calculated over two-year periods to reflect the duration of a screening invitation campaign. The rates of positive tests, detection of advanced adenomas, and detection of colorectal cancers are standardized as described above.