The French breast cancer screening programme: Epidemiological and economic results of the first round of screening

Abstract

This paper presents the epidemiological and economic results pertaining to the first round of breast cancer screening programmes in France. Breast cancer screening is based within existing radiologic facilities in the private and public sector and on-going competition exists between organized and spontaneous screening. The mean screening attendance rate was 36.7%, the mean recall rate was 10.4%, the positive predictive value (PPV) for the screening test 5.8% and the biopsy rate 1.2%. There were 5.1 carcinomas detected per 1,000 women screened. Of these, 30.7% were smaller than 10 mm in diameter and 69.0% had no nodal involvement. A retrospective resource-based cost analysis revealed a mean cost of US$63 per woman screened. This cost includes all direct programme costs excluding diagnostic testing and treatment costs. Organizational as opposed to technical aspects of screening accounted for 38% of this cost in the first round. These results reveal discrepancies in the quality, cost and estimated efficacy between the district programmes during the first screening round. Overall, epidemiological indicators reach European target values, with the exception of a low PPV for both the screening test and biopsy. In addition to the strict adherence to quality control and interpretation protocols, the shift of French women away from individual screening practices towards organized screening behaviour will be necessary to enable the French breast cancer screening programmes to reach their optimal efficacy.