French colorectal cancer screening pilot programme: results of the first round

Abstract

OBJECTIVES: In France, a national pilot population-based screening programme on colorectal cancer was set up in 2002. In 2006, 23 French districts were included, targeting a population of more than five million people. This programme offers biennial screening using the fecal occult blood test (FOBT) to average risk subjects aged between 50 and 74 years. People receive a letter inviting them to consult their GPs, who in turn provide the FOBT. People with a positive test result are proposed a full colonoscopy. The results of the programme's first-round performance indicators are presented. METHODS: The monitoring centre collected data from GPs and gastroenterologists on follow-up and colonoscopy results for people who were screened positive. Data were transferred to the French Institute for Public Health Surveillance (InVS) for the analysis. RESULTS: The overall participation rate for the 19 districts having completed a first screening round reached 42%. The overall positive test rate was 2.7%. In the eight districts with comprehensive follow-up data for the first round, 86% of colonoscopies were completed after a positive test. A total of 1615 people were diagnosed with cancer, and 4612 people with adenoma. The cancer detection rate reached 2.3/1000 [corrected] it was higher in men than in women (3.4/1000 [corrected] versus 1.4/1000) [corrected] and increased with age. Forty-three percent of invasive detected cancers were stage I, 24% stage II, 23% had lymph node involvement and 10% presented with distant metastasis. CONCLUSION: These results suggest that indicators are consistent with international references. During 2007-2008, the programme coverage will be progressively extended, and all 99 French districts should be actively involved in its implementation.