Breast Cancer Screening In France Research Articles

Coverage rate of opportunistic and organised breast cancer screening in France: Department-level estimation

ObjectiveIn France, the national breast cancer screening programme (NBCSP), targeting women aged 50–74 years was rolled out nationwide in 2004. It aims at reducing breast cancer mortality. In addition to the NBCSP, the use of opportunistic screening is permitted in France. The objective of this study is to estimate both opportunistic use and overall coverage rates of breast cancer screening, among women 40–84 years of age, in France. MethodsThe French medico-administrative health data system (SNDS) was used to identify women performing an opportunistic or organised mammography screening in France in 2016–2017. ResultsThe two-yearly opportunistic mammography screening is 18 % among women aged 40–84; it is 11 % among women aged 50–74, i.e., the target age range for organised screening, 36 % among women aged 40–49 and 13 % among women aged 75–84. The overall two-yearly screening coverage is 48 % for all women aged 40–84; it is 60 % among women aged 50–74, 36 % among women 40–49 and 16 % for those aged 75–84. Geographical variations in screening are lessened when the two screening strategies are considered, as they balance each other. ConclusionAlthough coverage in the NBCSP is around 50 % in France, more than one third of the women make use of opportunistic screening within and outside the target age range. Organized screening appears to improve equity of access to mammography screening service. The lack of data on opportunistic screening practices hinders the evaluation of French screening practices as a whole.

Interest of individual breast cancer screening by mammography in women aged over 75 years

Retrospective study of a continuous monocentric series of women over 75 having undergone surgery for breast cancer. The following variables were studied: addressing after screening or not, age at diagnosis, UICC stage and therapeutic measures (surgery by lumpectomy or mastectomy, lymph node dissection, adjuvant treatment with chemotherapy, radiotherapy or hormone therapy). 185 women aged 82.8 ± 5.2 years [extreme ages 75 to 95] were included in the study. 136 (73.5%) breast cancers were discovered after palpation and 49 (26.5%) after screening mammography. The distribution by stage was: I - 38.8%, II - 39.5%, III - 15.1% and stage IV - 7%. 164 (87.7%), patients received surgical treatment: 115 lumpectomies (61.2%) and 49 mastectomies (26.5%). 51 (27.6%) patients underwent lymph node dissection. The distribution of adjuvant treatments was: chemotherapy 21.1%, radiotherapy 68.6%, or hormone therapy (79.5%), sometimes combined. Women not screened are older than women screened (84 ± 5.3 versus 79.5 ± 3.6 years; p < 0.0001). Cancers are diagnosed at a more advanced stage in non-screened patients compared to screened patients (p < 0.0001). While there is a higher proportion of stage I among screened patients (75.5%), stage II is the most frequent in women not screened (47%). Stage I and II are the majority in the latter (72%). In multivariate analysis with adjustment for age, screening made it possible to make a diagnosis at a less advanced stage (stage I-II vs II-IV: OR = 5.593; 95% CI [1.575–19.866]; p = 0.0078) and to have conservative surgery more often (lumpectomy vs mastectomy: OR = 2.645; 95% CI [1.079–6.493]; p = 0.0333) without more recourse to surgery (OR = 1.856 95% CI [0.207–16.612]; p = 0.58). After adjusting for age and stage, screening was no longer a determining factor in the choice of type of surgery (OR = 1.934; 95% CI [0.753–4.975]; p = 0.170). At the age when organized breast cancer screening in France stopped, there was a decrease in survival, a diagnosis at a higher stage and an increase in co-morbidities. Our study shows a change in management with heavier treatment, more complications and a greater loss of autonomy without screening. This pleads for a continuation beyond 75 years of the practice of mammography screening for breast cancer in elderly women.

Participation in Opportunistic and Organised Breast Cancer Screening in France: Department-Level Estimation

Participation in Opportunistic and Organised Breast Cancer Screening in France: Department-Level Estimation

Abstract P6-08-07: Decline in compliance to breast cancer screening in France: Results of the 5th EDIFICE survey

Abstract Background The EDIFICE surveys have been conducted since 2005 to provide a better understanding of the participation of the French population in cancer screening programs. The breast cancer (BC) screening program is nowadays widely implemented throughout the target female population: women aged 50-74 years are invited for a mammogram once every two years. We analyzed the behavior of women over time (between 2005 and 2016) regarding BC screening according to age-group, socioprofessional categories (SPC) and social vulnerability. Methods The fifth nationwide observational survey, EDIFICE 5, was conducted by phone interviews using the quota method. A representative sample of 1299 subjects aged 50-74 years with no history of cancer was interviewed between November 22 and December 7, 2016. Interviewees (women aged 50-74 yrs; N=657) were asked about their uptake of BC screening, and the date of the last examination to determine the follow-up rate. Demographic data on social characteristics and SPC were also collected to determine the level of social vulnerability (validated EPICES score). Results Compliance with BC screening (a mammogram within the past 2 years) decreased significantly from 81% in 2014 to 75% in 2016 (P=0.02). From 2014, a significant impact of age was observed (P=0.02 in 2014 and 2016). In 2016, and for the first time, a significant and disturbing decrease in follow-up rate was recorded among younger women (age 50-54 yrs: 88% in 2014 vs 74% in 2016, P=0.01). SPC had no effect on compliance with screening. However, since 2008, fluctuations have been observed among unemployed individuals (U), with a significant decline in compliance in 2016 (U: 81% in 2014 vs 73% in 2016, P=0.03). In 2016, social vulnerability was seen as a factor that negatively impacts on compliance with BC screening (P≤0.01), but not in 2011 or 2014. We also observed a significant overall decrease in 2016 among both vulnerable (76% in 2014 vs 65% in 2016; P=0.04) and non-vulnerable populations (85% in 2014 vs 79% in 2016, P=0.04), highlighting a general loss of confidence. Conclusion For the first time since 2005, compliance with BC screening dropped significantly in France in 2016. A significant overall decline was observed regardless of social vulnerability status. Disturbing significant decreases were observed among the younger age-group (women aged 50-54 yrs) of the target population of the organized program, and among unemployed women. Although organized programs have been shown to ensure equitable access to cancer screening, this achievement remains precarious and requires regular monitoring. Citation Format: Morère JF, Eisinger F, Blay J-Y, Greillier L, Brignoli-Guibaudet L, Lhomel C, Cortot AB, Couraud S, Viguier J. Decline in compliance to breast cancer screening in France: Results of the 5th EDIFICE survey [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-07.

Facteurs comportementaux, radiologiques et histopronostiques des cancers du sein de plus de 20 mm détectés dans le programme français de dépistage organisé

Grâce à la collaboration de l’ensemble des médecins coordinateurs chargés du dépistage en France, les auteurs ont étudié des facteurs relatifs à l’histoire personnelle, les caractéristiques des mammographies précédant le diagnostic et des tumeurs de femmes présentant un cancer du sein de plus de 20 mm. Cette étude rétrospective a concerné 7 407 cancers diagnostiqués dans le cadre du dépistage organisé et mesurant plus de 20 mm. Si les critères d’agressivité de la tumeur sont plus marqués ou des facteurs technologiques plus souvent rencontrés, il apparaît que la fidélité au dépistage organisé soit un élément déterminant dans la découverte de ces « grosses tumeurs ». Il est impératif que les citoyens s’emparent de ces programmes de dépistage organisé si l’on espère jouer un rôle décisif dans le pronostic du cancer du sein.

Impact assessment of a pay-for-performance program on breast cancer screening in France using micro data.

A voluntary-based pay-for-performance (P4P) program (the CAPI) aimed at general practitioners (GPs) was implemented in France in 2009. The program targeted prevention practices, including breast cancer screening, by offering a maximal amount of €245 for achieving a target screening rate among eligible women enrolled with the GP. Our objective was to evaluate the impact of the French P4P program (CAPI) on the early detection of breast cancer among women between 50 and 74years old. Based on an administrative database of 50,752 women aged 50-74years followed between 2007 and 2011, we estimated a difference-in-difference model of breast cancer screening uptake as a function of visit to a CAPI signatory referral GP, while controlling for both supply-side and demand-side determinants (e.g., sociodemographics, health and healthcare use). Breast cancer screening rates have not changed significantly since the P4P program implementation. Overall, visiting a CAPI signatory referral GP at least once in the pre-CAPI period increased the probability of undergoing breast cancer screening by 1.38% [95% CI (0.41-2.35%)], but the effect was not significantly different following the implementation of the contract. The French P4P program had a nonsignificant impact on breast cancer screening uptake. This result may reflect the fact that the low-powered incentives implemented in France through the CAPI might not provide sufficient leverage to generate better practices, thus inviting regulators to seek additional tools beyond P4P in the field of prevention and screening.

Women's participation in breast cancer screening in France--an ethical approach.

BackgroundBreast cancer is a major public health challenge. Organized mammography screening (OS) is considered one way to reduce breast cancer mortality. EU recommendations prone mass deployment of OS, and back in 2004, France introduced a national OS programme for women aged 50–74 years. However, in 2012, participation rate was still just 52.7%, well short of the targeted 70% objective. In an effort to re-address the (in) efficiency of the programme, the French National Cancer Institute has drafted an expert-group review of the ethical issues surrounding breast cancer mammography screening.DiscussionPrompted by emerging debate over the efficiency of the screening scheme and its allied public information provision, we keynote the experts’ report based on analysis of epidemiological data and participation rate from the public health authorities. The low coverage of the OS scheme may be partly explained by the fact that a significant number of women undergo mammography outside OS and thus outside OS criteria. These findings call for further thinking on (i) the ethical principles of beneficence and non-malfeasance underpinning this public health initiative, (ii) the reasons behind women’s and professionals’ behavior, and (iii) the need to analyze how information provision to women and the doctor-patient relationship need to evolve in response to scientific controversy over the risks and benefits of conducting mammographic screening.SummaryThis work calls for a reappraisal of the provision of screening programme information. We advocate a move to integrate the points sparking debate over the efficiency of the screening scheme to guarantee full transparency. The perspective is to strengthen the respect for autonomy allowing women to make an informed choice in their decision on whether or not to participate.

Dépistage organisé du cancer du sein en France : pour une optimisation de l’information

BackgroundBased on international and national recommendations, organized breast cancer screening in France raises questions of medical ethics built around the key concepts of individual autonomy and public health policy. Because of the evolving knowledge, professionals and institutions involved in the program must review the ethical values associated with this medical practice. MethodsThe ethical aspects of organized breast cancer screening were studied. In response to newly acquired knowledge highlighted by a review of texts governing this practice in France, proposals for changes resulting from reflections of a working group coordinated by the National Cancer Institute are presented. ResultsEthical issues raised by screening must find expression in the general principles of the program's organization: acceptability of screening, efficiency, adverse effects, equity of access, free care…, but also at different stages of the procedure: information delivery, first and second invitations, refusal of further diagnostic investigation… ConclusionA better match between breast cancer screening and recently developed knowledge requires optimal information delivery to women targeted by the program as well as a stronger role for the referring healthcare professional.

Understanding barriers to organized breast cancer screening in France: women's perceptions, attitudes, and knowledge

The participation rate in organized breast cancer screening in France is lower than recommended. Non-participants either use opportunistic screening or do not use either screening modality. To assess any differences in perceptions, attitudes and knowledge related to breast cancer screening between users of opportunistic screening and non-users of any screening mammograms and to identify potential barriers to participation in organized screening. Six focus groups were conducted in May 2010 with 34 French non-participants in organized screening, 15 who used opportunistic screening (OpS group) and 19 who used no screening (NoS group). The guide used for both groups explored perceptions and attitudes related to health, cancer and screening; perceptions of femininity; and knowledge about breast cancer screening. Thematic content analysis was performed. Perceptions, attitudes and knowledge differed between the two groups. Women in the OpS group perceived a high susceptibility to breast cancer, visited their gynaecologist regularly, were unfamiliar with organized screening modalities and had doubts about its quality. NoS women had very high- or low-perceived susceptibility to breast cancer, knew about screening modalities, had doubts about its usefulness and expressed negative opinions of mammograms. Differences in perceptions and attitudes related to breast cancer screening partially explain why some women choose opportunistic screening or no screening. General practitioners and gynaecologists are in a unique position to provide individually tailored preventative messages to improve participation in organized screening.

Characteristics of women using organized or opportunistic breast cancer screening in France. Analysis of the 2006 French Health, Health Care and Insurance Survey

BackgroundThis study aimed at (i) estimating the 2-year self-reported breast cancer screening coverage rate; and (ii) analyzing the relationships between sociodemographic characteristics and healthcare access of women and breast cancer screening (opportunistic or organized) practices. MethodsFrom a 2006 French health survey, 2056 women aged 50 to 74 years were selected and divided into three groups according to their breast cancer screening practices during the previous 2 years: organized screening, opportunistic screening, or no screening. The three groups were compared according to self-reported sociodemographic status, healthcare access, screening behaviors, and perceived health, using polytomic regression. ResultsThe 2-year self-reported coverage rate was 75.8%. It was high among women aged 50 to 69 years and lower among older women. Questions relating to medical access (i.e. having consulted a GP in the last 12 months, having consulted a gynecologist in the last 12 months, and having had a Pap smear in the last 3 years) were the variables most commonly associated with a recent mammogram. Women having a regular follow-up by a gynecologist or having had cervical cancer screening within the last three years used organized breast cancer screening more often and used opportunistic breast cancer screening even more often than other women. ConclusionThe study confirmed the key role of gynecologists and general practitioners in encouraging women to have a mammogram. Awareness among healthcare professionals and women of the benefits of organized breast cancer screening compared to opportunistic screening should be sustained and strengthened.

Uptake of breast cancer screening in women aged over 75years

In France, the age range for organized screening for breast cancer is 50-74 years. From a layperson's perspective, the public health message focusing on a specific target population may be difficult to understand. The aim of this study is to assess how women aged over 75 years deal with this absence of screening recommendations for their age group. The population-based survey, EDIFICE, was carried out by telephone in 2008. Women were interviewed with regard to their behaviour, and in particular relating to breast cancer screening. For 136 breast cancer-free women, aged 75 and above and who had undergone at least one mammography in their lifetime, the test had been done within the last 2 years for only 62 (51%) of them. In a multiregression analysis, only one item (i.e. already having undergone at least five mammographies) was statistically associated with a higher rate of attendance (odds ratio=3.3, 95% confidence interval=1.03-11.1). According to our data, for women aged 75 and above, an estimated 17,000,000 Euros are spent each year on breast cancer screening in France, the net benefit of which is still unknown.

Large population survey

In France, mass screening for breast and colon cancer issupported by the French National Cancer Institute (INCa). In these nationwide screening campaigns, individuals aged between 50 and 74 years receive a personalized letter inviting them for a screening examination every 2 years. Prostate cancer screening is, however, still controversial and has not been included in the INCa recommendations so far. Research organizations are particularly interested in screening and indeed, several studies have been conducted in France and other countries to examine the different aspects of the subject. To provide actual benefits, screening should be undertaken on a regular scheduled basis. Therefore, several studies have assessed the factors influencing the participation rate of women in breast cancer screening in France (). The Institut National de Prévention et d'Education pour la Santé conducted one of these in 2005: the Baromètre Cancer (including 4046 individuals aged 15 years or older, interviewed by telephone) analysed beliefs and perceptions about cancer screening and studied attendance rates for breast, colon and prostate cancer (including scheduled screening). No previous survey has ever been conducted simultaneously among the general population and physicians with regard to individual and scheduled screening for breast cancer and colorectal cancer (CRC) or individual screening for prostate cancer. EDIFICE is thus the first large-scale survey to assess screening practices in France by analysing the targeted population on the one hand and the clinical practice of French general practitioners (GPs) on the other hand, using the 'mirror study' method to compare results. Two national surveys were conducted in 2005 and 2008. In 2005, only 22 geographical regions were included in the screening programme for CRC.

Evolution of breast cancer screening in France from 2005 to 2008: results of the EDIFICE survey.

Abstract Abstract #5010 Background: In 2005, a first EDIFICE survey was aimed to provide a better understanding of population s adherence to the screening tests available in France and results pertaining to breast cancer are reported (Int. J. Med. Sci. 2008, 5: 106-112). In 2008, EDIFICE survey is performed again to assess the evolution 3 years later. Taking into account that the Implementation of breast cancer screening has been generalized in France since 2003: All women aged between 50 and 74 years are systematically invited to perform a mammography every two years.&amp;#x2028; Methods: This second nationwide observational survey was carried out from December 12, 2007 to January 07, 2008 among a representative samples of 1802 French people aged between 40 and 85 years and 600 general practitioners (GPs). Information collected included socio-demographic characteristics, attitude towards cancer screening and actual experience of cancer screening, as well as GPs practice regarding screening. The precision of the results is 4.3% for a 95% confidence interval.&amp;#x2028; Results: In EDIFICE–1 and -2, 501 and 488 participating women aged between 50 and 74 years are assessed, respectively.&amp;#x2028; &amp;#x2028; In EDIFICE-2, there was a significant relationship (p&amp;lt;0.05) between the existence of a first mammography screening on women s own initiative and age (odd ratio 0.35; 95%CI 0.13 – 0.95). Main factors associated with performing the screening test every two years were: knowledge of screening process (odd ratio 3.59 ; 95%CI 1.54 – 8.38), Own motivation (odd ratio 5.03; 95%CI 1.6 – 15.8), First mammography performed in the organized screening (odd ratio 6.53 ; 95%CI 1.15 – 37.3), and gynecologist consultation (odd ratio 8.68; 95%CI 2.21 – 34.11).&amp;#x2028; Of the 600 participating GPs, 68% systematically recommended a mammography to their patients in the screening national plan. GPs perceptions of the reasons for women s avoidance of the screening test were unwillingness to be aware of mammography results (46%) and négligence (24%).&amp;#x2028; Conclusion: The main result of this second EDIFICE Survey is to stress the impact of the breast cancer screening in France. Between 2005 and 2008 the rate of women s attendance at mammography screening has increased and the proportion of women who repeat the test every two years has been dramaticaly improve. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5010.

Connaissance de la double lecture dans le dépistage du cancer du sein

An officially-sponsored and free breast cancer screening in France was extended to all regions in 2004. These mammography procedures include double reading, which reduces the number of false negatives. Together with this official program, administered by associations in each district, voluntary individual screening is still available. The aim of this study is to ascertain what women think about breast cancer screening, why they choose one method of screening or the other, and what they know about "double reading". A postal survey inquiring about the kind of screening chosen and the reasons for this choice was sent to women aged 50 to 74 years covered by the national military health insurance fund. After descriptive analysis of the results, we compared the respondents' knowledge of double reading according to residence (two departments, one rural one and one urban), age, and educational level. 541 of the 994 eligible women responded (54%). More than 94% of them had had a mammography within the past two years, 62.1% through the official program. Women who had participated in the official screening knew more about "double reading" than the others (71.6% versus 50%, p<0.05 in the rural district and 67.4% versus 63.9% in the urban district). In the latter, familiarity with double reading increased as age decreased. Individual mammography depended on prior habits and gynecologists' prescriptions. Women must shift from individual mammography to the official program to receive a standardized, double-read, and quality-controlled mammography. Prescribing physicians should serve as an additional entryway into the organized program.

Breast cancer screening in France: results of the EDIFICE survey

The EDIFICE survey aimed to investigate the compliance of the general population to the screening tests available in France for the 4 most common cancers: breast, colorectal, prostate and lung. Implementation of breast cancer screening has been generalized in France since 2003: women aged between 50 and 74 years are systematically invited to perform a mammography every second year. Results pertaining to breast cancer are reported hereafter. This nationwide observational survey was carried out in France from 18 January to 2 February 2005 among representative samples of 773 women aged between 40 and 75 years and 600 general practitioners (GPs). Information collected included socio-demographic characteristics, attitude towards cancer screening and actual experience of cancer screening, as well as GPs' practice regarding screening. The precision of the results is +/- 4.3% for a 95% confidence interval. Among the 507 participating women aged between 50 and 74 years, 92.5% (469/507) had undergone at least one mammography: 54.6% (256/469) underwent this test on their own initiative and 44.6% (209/469) of women performed it in the framework of a systematic screening plan. Most women participating in the systematic screening (89.0% i.e. 186/209) had a mammography within the last dating from less than 2 years versus 73.8% (189/256) of those who performed it outside the screening program (Chi(2) test; p<0.01). Interestingly, 422 women (61.9% i.e. 422/682 women aged between 40-75 years with at least one mammography) had performed a mammography before the recommended age for screening. There was a significant correlation (p = 0.009) between the existence of a first mammography before 50 years of age and subsequent screening on women's own initiative (54.6% of 469 screened women). Main reasons for not performing the screening test every second year (77 women aged between 50-74 years) included: feeling unconcerned and/or unmotivated (p = 0.0001), no cancer anxiety (p = 0.020) and no recommendation by the GP (p = 0.015); Of the 600 participating GPs, 68.6% (412/600) systematically recommended a mammography to their patients. GPs' perceptions of the reasons for women's avoidance of the screening test were unwillingness to be aware of mammography results (44.4% - 266/600) and the belief that mammography was painful (52.5% - 315/600). The main result of the EDIFICE survey is the high rate of women's attendance at mammography screening. The EDIFICE survey pointed out that systematic and organized screening played a major role in the regularity of screening tests for breast cancer every second year. GPs and gynaecologist are key actors in heightening public awareness.

Breast Cancer Screening in France — Evolution from pilot projects to a national programme

Breast Cancer Screening in France — Evolution from pilot projects to a national programme

Building a model to determine the cost-effectiveness of breast cancer screening in France.

This paper describes the methods and initial validation of a cost-effectiveness model developed to simulate the breast cancer screening situation in France. The first screening pilot programmes were set up in France in 1989 to test the feasibility of a decentralized screening model based in a large number of existing non-dedicated radiology centres. The present cost-effectiveness model was built as a tool to help guide current policy discussions on the future of screening in France. This Markov model compares the costs and effects expected when a screening programme is offered to a given cohort of women to those expected in the absence of screening. The model was initially validated using current results from the Bas-Rhin screening programme and local cancer registry epidemiological data. Over a 20-year period, 315 274 women would attend for screening, of whom 12 491 would be recalled for further assessment. 4423 cancers would be detected, resulting in 637 deaths. Screening allows the detection of 106 additional cancer cases, thereby preventing 92 deaths, and saves 1522 life-years compared with a situation without screening. Breast cancer mortality is reduced by 12.6%, yielding a cost-effectiveness ratio of 137 000 FF per life-year saved. The results of initial analyses suggest that the model is capable of suitably assessing the impact of breast cancer screening in terms of costs and effects. Further scenario analyses are needed to understand the impact of screening policy changes on the costs and effectiveness of future screening programmes.

Cost evaluation of breast cancer screening in France

Cost evaluation of breast cancer screening in France