[Estimated impact of the current colorectal screening program in France]

Area of Science:

• Public Health
• Cancer Epidemiology
• Health Services Research

Background:

• Colorectal cancer (CRC) is a major health concern in France, being the third most common and second deadliest cancer.
• A nationwide CRC screening program, established in 2009 for asymptomatic individuals aged 50-74, utilizes the Fecal Immunochemical Test (FIT) since 2015.
• The program's current participation rate of 34% falls short of European targets, necessitating an evaluation of its impact at various participation levels.

Purpose of the Study:

• To assess the epidemiological impact of the French CRC screening program.
• To evaluate the program's effectiveness at the current participation rate (34%) and at higher rates (45% and 65%).
• To determine the potential benefits of achieving European screening participation objectives.

Main Methods:

• An individual simulation model, adapted from the Microsimulation Screening Analysis Colon (MISCAN-Colon) model, was employed to estimate the epidemiological impact.
• The model was calibrated and transposed to the French population context.
• Two analyses were conducted: one assessing individual screening impact and another evaluating the entire eligible population's impact at different participation rates.

Main Results:

• The Fecal Immunochemical Test (FIT) is associated with a significant lifetime risk reduction for CRC (24% in men, 21% in women) and CRC-related mortality (51% in men, 43% in women).
• At the current 34% participation rate, the program reduces CRC incidence by 5% and mortality by 14% compared to no screening.
• Increasing participation to 45% and 65% could further reduce incidence by 3% and 8%, and mortality by 8% and 22%, respectively.

Conclusions:

• The organized colorectal cancer screening program in France is an effective strategy for reducing CRC incidence in the medium-risk population.
• Achieving higher participation rates, aligned with European objectives, is crucial for maximizing the program's effectiveness and reducing CRC mortality.
• Innovations in FIT delivery methods may be necessary to attain higher screening participation rates.