Organized colorectal cancer screening was rolled out nationwide in France in 2008. Screening is coordinated at the local level by a management organization (one organization serves one or more departments; there are a total of 89 management organizations for 99 departments). Participation rates, calculated for the years 2009 and 2010, are presented in this document.

Materials and Methods

Numerator

The number of people screened (men and women) is provided by the management structures, based on a standardized annual questionnaire.

Participation rate denominators

At the national level and for the purpose of comparing departments, the denominators used to calculate participation rates are population data provided by INSEE (2005–2030 projections, scenario 1.8), calculated identically across the entire country.

From this population, individuals excluded from screening are subtracted using the following formula:

The number of people screened in a given year may be influenced by invitation strategies, particularly in the early years of the program’s implementation. Rates calculated over a two-year period allow for a timeframe during which the entire target population should have been invited and thus better reflect participation among the target population.

Benchmarks

The European benchmark recommends a participation rate of the target population of 45% or higher. This benchmark applies to all European countries that have implemented an organized screening program.

Results

Over the 2009–2010 period, nearly 17 million people aged 50 to 74 were invited to undergo screening, and 5.14 million of them participated in the program.

The national screening participation rate for this period was 34.0%.

This rate is below the minimum acceptable European target of 45% participation and far below the desirable rate of 65%.

Participation is higher among women (36.5%) than among men (31.4%).

Participation in organized screening varies by region and department: see maps and tables (pdf).

The highest regional rate is recorded in Burgundy (52.4%) and the lowest in Réunion (23.5%). Only eight departments (Ardennes, Côte-d'Or, Haut-Rhin, Indre-et-Loire, Isère, Loire-Atlantique, Lot-et-Garonne, Saône-et-Loire) reached or exceeded the minimum acceptable threshold of 45% participation for the years 2009 and 2010. The highest rates are observed in Côte-d'Or and Saône-et-Loire (55% participation). Twenty departments have participation rates between 40% and 45%, and 18 departments have low rates below 30%. The Haute-Garonne department has the lowest participation rate in organized screening (16.4%). The participation rate for the 23 pilot departments is 36.5%. It is higher than for non-pilot departments (33.0%) but remains below the minimum target of 45%.

The percentage of people excluded from this program (permanent exclusions for medical reasons or temporary exclusions following normal colonoscopy results) varies by department from 2% to nearly 20%: see maps and tables (PDF), which likely reflect significant disparities in the documentation of these exclusions across departments. The exclusion rate for the 23 pilot departments is 12.4%, higher than the exclusion rate for the other departments (9.8%). This difference may be due in part to the fact that in departments with several years of experience in the program, temporary or permanent exclusions following colonoscopy results are more numerous than in departments just beginning organized colorectal cancer screening.

The percentage of positive tests for France is 2.7% among analyzable tests, or 136,251 positive tests. It is higher among men (3.2%) than among women (2.3%). The two departments with the highest rates are Eure and Deux-Sèvres (4.0%), while Haute-Garonne and Saône-et-Loire have the lowest rates of positive tests (1.7%).

Conclusion

Following the nationwide rollout of this screening program, participation for 2009–2010 was assessed for 95 departments that had invited their entire target population during this period. The national program is being implemented in France, and participation is expected to increase in the coming years.

The 2009–2013 Cancer Plan has, in fact, made a 15% increase in participation in organized screening one of its key goals. This increase is expected to reach 50% in the departments where the rate is lowest, thanks to targeted measures that will be closely monitored by the steering committee chaired by the Director General of Health.