[French screening program of breast cancer. Results from 5 districts (1989-1994)]

Randomized clinical trials have demonstrated that screening by mammography can reduce the breast cancer mortality rate by 30 to 50% in women aged 50 to 69 years. In France, pilot screening programmes were begun in 1989, and a national programme is being implemented since 1994. After 8 years of experience, the present study aims to assess the effectiveness of the French decentralized model of screening. This study presents data obtained by the National Steering Committee from the reports of five district programmes. Efficacy indicators from 1989 to 1994 are presented and compared with European targets. Data are presented by screening round. The prevalent round concerns 260,226 women screened, the subsequent incident rounds concern 119,761 women. Attendance rates at 5 years range from 24.2% to 50.9%. The mean recall rate was 7.8% in the first and 4.5% in the second round 5.4 and 2.7 cancers were detected per 1,000 women screened during the first and second round, respectively. and 30% of invasive cancers were of 10 mm or less and 70% had no nodal involvement. The interval cancer rate was 0.55% one year after screening and 1.05% two years after screening. Results from our decentralized screening system are variable yet satisfactory overall, namely thanks to the progressive implementation of quality assurance. However, attendance rates remain low, whereas actual mammographic coverage is 60% in France. A generalized screening programme can only be foreseen in France if its implementation is very gradual and if the quality of screening is high. The improvement of radiological quality remains the primary objective of the National Steering Committee however this implies training of all personnel. In the long run, organized screening should prevail over spontaneous screening. It is unlikely that we will achieve the target reduction in mortality rate in our country.