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

This paper presents the epidemiological and economic resultspertaining to the first round of breast cancer screening programmesin France. Breast cancer screening is based within existingradiologic facilities in the private and public sector and on-goingcompetition exists between organized and spontaneous screening.The mean screening attendance rate was 36.7%, the mean recallrate was 10.4%, the positive predictive value (PPV) for thescreening test 5.8% and the biopsy rate 1.2%. There were 5.1carcinomas detected per 1,000 women screened. Of these, 30.7%were smaller than 10 mm in diameter and 69.0% had no nodal involvementA retrospective resource-based cost analysis revealed a meancost of US$63 per woman screened. This cost includes all directprogramme costs excluding diagnostic testing and treatment costs.Organizational as opposed to technical aspects of screeningaccounted for 38% of this cost in the first round. These resultsreveal discrepancies in the quality, cost and estimated efficacybetween 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 testand biopsy. In addition to the strict adherence to quality controland interpretation protocols, the shift of French women awayfrom individual screening practices towards organized screeningbehaviour will be necessary to enable the French breast cancerscreening programmes to reach their optimal efficacy.