OBJECTIVE:Despite their established clinical benefits, breast cancer screening examinations expose women to ionizing radiation (IR) and call for vigilance regarding protocols and practices. This study estimates the population attributable risk (PAR) of radiation-induced breast cancer in France in 2019 that is attributable to past exposure to IR through screening performed in women aged 40 to 74 years old. METHODS:Breast cancer screening practices were reconstituted for the period 1980 to 2019. Records of recent years were built based on French National Health Data System. An estimation was made for earlier years based on the available literature and expert knowledge. Women diagnosed with a history of breast cancer before mammography were excluded. Absorbed glandular doses to the breast were modeled based on existing literature and reports on French practices. Excess breast cancer cases were estimated using 2 radiation-risk models (Biologic Effects of Ionizing Radiation VII and the International Commission on Radiological Protection). RESULTS:Of roughly 55 000 new breast cancer cases diagnosed in 2019 in women at least 40 years old, we estimate that approximately 27 might be attributable to past exposures to IR associated with breast cancer screening between the ages of 50 and 74 years. This leads to a PAR of 0.048%. In addition, about 16 cases might be attributable to screening between ages 40 and 49 years, with a PAR of approximately 0.030%. CONCLUSION:The contribution of breast cancer screening to the breast cancer burden in France is limited. Efforts to limit the dose delivered to the breast must continue.

Introduction Lung cancer screening using low-dose computed tomography (LDCT) is being experimented in France. Based on the terms of a French pilot program, we estimated the risk of radiation-induced cancer for six cancer sites exposed to ionizing radiation during LDCT. Materials and methods Three groups were considered according to smoking behavior. Baseline cancer risks in smokers were computed based on available data and literature. Radiation-induced risks of cancer following repeated LDCT from age 50 until loss of eligibility to screening, were estimated based on two reference radiation-risks models, assuming a complete adherence to the program, and a volume computed tomography dose index (CTDIvol) of 0·8 mGy. A benefit-risk ratio was estimated considering 5-year cancer mortality in France, and screening lung cancer specific mortality decrease, as reported in literature. Results We estimated a lifetime attributable risk of 16 radiation-induced cancers per 100,000 screened women (7 in men, respectively), including 9 (3) lung cancers, and 2 (0) breast cancers, leading to 10 (5) deaths. Compared to 232 (162) expected lung cancer deaths prevented, this leads to an estimated ratio of 23 (32). Because smoking cessation improve survival rates and decrease lung cancer incidence rates, ceasing groups face lower benefit-risk ratios: it is close to 1 in individuals weaned 15 years before screening inclusion. Conclusion Our results show that the number of radiation-induced cancers following repeated LDCT remains low compared to prevented deaths, as long as weaning is recent. It underlines the importance of efforts to reduce the dose to ensure that all enrolled individuals face a favorable ratio.

BACKGROUND AND OBJECTIVES:The objective of this study is to assess spatial and socioeconomic disparities in cervical cancer screening (CCS) coverage in France before the implementation of the national organized screening program. MATERIALS AND METHODS:This ecological study analyzed CCS coverage among 17.2 million women aged 25-65 years residing in ∼35,000 municipalities in mainland France from January 2016 to June 2019. Screening coverage was estimated using universal health insurance data. Socioeconomic deprivation was measured using the French Deprivation Index (FDep), and access to care was assessed using the Access to General Practitioner (AGP) index. Descriptive spatial analyses and a generalized hierarchical binomial model were used to examine the impact of deprivation and healthcare provision on screening participation, while accounting for geographic variability. RESULTS:Screening coverage varied widely across departments (47.5%-68.0%) and within departments, with a strong social gradient (62.5% in the least deprived quintile vs. 52.4% in the most deprived). FDep explained 34.1% of municipal variations in screening, but a significant portion remained unexplained (random effect: 21 percentage points). The AGP index was weakly associated with participation (+2.2 percentage points between the 90th and 10th percentiles. The screening gap related to deprivation (11.3 percentage points) was smaller than the unexplained variability (15.6). CONCLUSION:Our study highlights significant spatial and social disparities in CCS participation before the national program rollout. While organized screening programs were associated with higher participation, inequalities persisted. Addressing these disparities requires targeted interventions and structural changes in the CCS programme. Future evaluations will be essential to determine whether the national CCS program reduces these disparities and improves screening equity.

The number of new cases of breast cancer has increased significantly since the 1980s in France and its incidence is currently among the highest in Europe. However, mortality and survival improved and survival in France is above the average for European countries. Organized screening in France may have contributed to this and has reduced social inequalities in survival. However, after reaching a peak of around 50 %, participation has been declining since 2012 while the use of mammograms outside of scheduled screening is high and at an earlier age than recommended.

Le nombre de nouveaux cas de cancer du sein a beaucoup augmenté depuis les années 1980 en France et son incidence est à ce jour parmi les plus hautes d’Europe. La mortalité et la survie se sont cependant beaucoup améliorées et la survie en France est au-dessus de la moyenne des pays européens. Le dépistage organisé français a pu y contribuer, tout en réduisant les inégalités sociales de survie. Cependant, après avoir atteint un pic autour de 50 %, la participation à ce dépistage baisse depuis 2012 alors que le recours à des mammographies hors programme est important et précoce.

The incidence of early-onset breast cancer (EOBC) has recently been shown to be increasing over time in the US and the UK. Using national cancer registries data including 229,352 BC cases, we show that the incidence rate of EOBC in France increased steadily from 1990 to 2023, rising from 16.1 (95 % CI: 14.7-17.8) to 26.3 (95 % CI: 20.7-33.3) and from 98.7 (95 % CI: 93.8-103.7) to 131.2 (95 % CI: 115.8-148.7) per 100,000 person-years in women aged 30 and 40 years, respectively. This population-based study confirms that the incidence of EOBC is increasing over time in Western countries. Further research is needed to explain this trend, which may have implications for prevention and screening strategies.

This essay describes the author's experience with learning about building trust with every patient and family interaction through literature.

BACKGROUND:The SHAMISEN (Nuclear Emergency Situations - Improvement of Medical And Health Surveillance) European project was conducted in 2015-2017 to review the lessons learned from the experience of past nuclear accidents and develop recommendations for preparedness and health surveillance of populations affected by a nuclear accident. Using a toolkit approach, Tsuda et al. recently published a critical review of the article by Cléro et al. derived from the SHAMISEN project on thyroid cancer screening after nuclear accident. MAIN BODY:We address the main points of criticism of our publication on the SHAMISEN European project. CONCLUSION:We disagree with some of the arguments and criticisms mentioned by Tsuda et al. We continue to support the conclusions and recommendations of the SHAMISEN consortium, including the recommendation not to launch a mass thyroid cancer screening after a nuclear accident, but rather to make it available (with appropriate information counselling) to those who request it.

OBJECTIVE:In France, the national breast cancer screening programme (NBCSP), targeting women aged 50-74 years was rolled out nationwide in 2004. It aims at reducing breast cancer mortality. In addition to the NBCSP, the use of opportunistic screening is permitted in France. The objective of this study is to estimate both opportunistic use and overall coverage rates of breast cancer screening, among women 40-84 years of age, in France.METHODS:The French medico-administrative health data system (SNDS) was used to identify women performing an opportunistic or organised mammography screening in France in 2016-2017.RESULTS:The two-yearly opportunistic mammography screening is 18 % among women aged 40-84; it is 11 % among women aged 50-74, i.e., the target age range for organised screening, 36 % among women aged 40-49 and 13 % among women aged 75-84. The overall two-yearly screening coverage is 48 % for all women aged 40-84; it is 60 % among women aged 50-74, 36 % among women 40-49 and 16 % for those aged 75-84. Geographical variations in screening are lessened when the two screening strategies are considered, as they balance each other.CONCLUSION:Although coverage in the NBCSP is around 50 % in France, more than one third of the women make use of opportunistic screening within and outside the target age range. Organized screening appears to improve equity of access to mammography screening service. The lack of data on opportunistic screening practices hinders the evaluation of French screening practices as a whole.

Background Since 2004, an organised screening programme (OS) for breast cancer has been in place for 50-74 years women who are not at an increased risk. Despite this, 17% of cancers diagnosed within 24 months following an OS mammogram are interval cancers (IC), diagnosed even though the OS had not reported cancer. After identifying IC from the French administrative healthcare database (SNDS), our objective was to describe the care pathways of women with IC in 2016. Materials and Methods The IC identification algorithm is based on breast imaging tests conducted in the 24 months prior to diagnosis and on the compatibility of their timeline with ACR3 lesion follow-up (BIRADS guidelines). The care pathways of 3 groups were compared: women with IC, diagnosed through the OS, and diagnosed outside the OS programme (personalised screening or based on clinical signs, PSCS group). Results Respectively, 12,965 (46%), 3433 (12%), and 11,761 women (42%) were classified in the OS, IC and PSCS groups, i.e. 20.9% IC cases among the women taking part in the OS programme. The women from the IC group presented with more forms with lymph node or metastatic involvement than those of the OS group. Their pathways were more complex than in the OS group: at an equivalent stage, more total mastectomies and more adjuvant or neoadjuvant chemotherapy regimens. Conclusion The care pathways of women with IC are intermediate with respect to those of the OS or PSCS group.Cases of IC probably include several cancer prognosis profiles.

Exposure of the thyroid gland to ionizing radiation at a young age is the main recognized risk factor for differentiated thyroid cancer. After the Chernobyl and Fukushima nuclear accidents, thyroid cancer screening was implemented mainly for children, leading to case over-diagnosis as seen in South Korea after the implementation of opportunistic screening (where subjects are recruited at healthcare sites). The aim of cancer screening is to reduce morbidity and mortality, but screening can also cause negative effects on health (with unnecessary treatment if over-diagnosis) and on quality of life. This paper from the SHAMISEN special issue (Nuclear Emergency Situations - Improvement of Medical And Health Surveillance) presents the principles of cancer screening, the lessons learned from thyroid cancer screening, as well as the knowledge on thyroid cancer incidence after exposure to iodine-131. The SHAMISEN Consortium recommends to envisage systematic health screening after a nuclear accident, only when appropriately justified, i.e. ensuring that screening will do more good than harm. Based on the experience of the Fukushima screening, the consortium does not recommend mass or population-based thyroid cancer screening, as the negative psychological and physical effects are likely to outweigh any possible benefit in affected populations; thyroid health monitoring should however be made available to persons who request it (regardless of whether they are at increased risk or not), accompanied with appropriate information and support.

Although medical ionizing radiation (IR) has clear clinical benefits, it is an established carcinogen. Our study estimates the number of new cancer cases in France in 2015 attributable to IR exposure from medical procedures. Exposures from external (X‐rays, CT scans, interventional radiology) and internal (nuclear medicine) sources were considered. We used 2007 national frequencies of diagnostic examinations by sex and age to estimate the lifetime organ dose exposure adjusted for changes in the use of such procedures over time. The Biological Effects of Ionizing Radiation VII risk models were used to estimate the corresponding excess cancer risk, assuming an average latency period of 10 years. Additionally, we used cancer incidence data from the French Cancer Registries Network. Of the 346,000 estimated new cancer cases in adults in France in 2015, 2300 cases (940 among men and 1360 among women) were attributable to diagnostic IR, representing 0.7% of all new cancer cases (0.5% for men and 0.9% for women). The leading cancers attributable to medical IR were female breast (n = 560 cases), lung (n = 500 cases) and colon (n = 290 cases) cancers. Compared to other risk factors, the contribution of medical IR to the cancer burden is small, and the benefits largely outweigh its harms. However, some of these IR‐associated cancer cases may be preventable through dose optimization of and enhanced justification for diagnostic examinations.

Background: Cancer is a major cause of premature illness and death in France. To quantify how cancer prevention could reduce the burden, we present estimates of the contribution of lifestyle and environmental risk factors to cancer incidence in France in 2015, comparing these with other high-income countries. Method: Prevalences of, and relative risks for tobacco smoking, alcohol consumption, inadequate diet, overweight and obesity, physical inactivity, exogenous hormones, suboptimal breastfeeding, infectious agents, ionising radiation, air pollution, ultraviolet exposure, occupational exposures, arsenic in drinking water and indoor benzene were obtained to estimate the population attributable fraction (PAF) and the number of attributable cancers by the cancer site and sex. Results: In 2015, 41% (or 142,000 of 346,000) of all new cancers diagnosed in France could be attributed to the aforementioned risk factors. The numbers and PAF were slightly higher in men than in women (84,000 versus 58,000 cases and 44% versus 37%, respectively). Smoking (PAF: 20%), alcohol consumption (PAF: 8%), dietary factors (PAF: 5%) and excess weight (PAF: 5%) were the most important factors. Infections and occupational exposures each contributed to an additional 4% of the cancer cases in 2015. Conclusion: Today, two-fifths of cancers in France are attributable to preventable risk factors. The variations in the key amenable factors responsible in France relative to other economically similar countries highlight the need for tailored approaches to cancer education and prevention. Reducing smoking and alcohol consumption and the adoption of healthier diet and body weight remain important targets to reduce the increasing number of new cancer patients in France in the decades to follow. (C) 2018 Published by Elsevier Ltd.

Basu et al. published an excellent report on the implementation and organisation of cancer screening in the European Union member states as of 2016.1 However, the article contains a few inaccuracies on the French organized cancer screening programmes, which we would like to rectify while also providing some clarifications and further information on these programmes. Colorectal cancer screening is nationwide and not regional as indicated in the report.1 France was indeed among the first countries to implement a population-based organized colorectal cancer screening programme,2 which was fully rolled out nationwide by 2009. In 2015, the immunochemical test (FIT) replaced the conventional guaiac faecal occult blood test (gFOBT), based on the evidence generated in one pilot district, Calvados, that FIT is superior to gFOBT.3 A population-based nationwide cervical cancer screening programme was launched end 2016. Rollout is ongoing. The organizational model is based on that of a pilot intervention implemented in selected geographic areas during 2010–2014.4 Invitations exclude women who have been screened opportunistically in the past 3 years but all screenings – opportunistic and invitational – are integrated into the screening programme monitoring and evaluation system. Screening is cytology-based but a shift to primary HPV testing is foreseen in the future.5 The population-based breast cancer screening programme co-exists with substantial use of opportunistic screening and, as in some other countries, is subject to a vibrant debate. A public consultation was carried out in 2015–2016 to seek opinions from the public, health professionals, scientists and other stakeholders on breast cancer screening.6 The consultation report recommended to either end the organized breast cancer screening programme or to reform it radically, including by providing women with information to enable them to make their own decision about breast cancer screening, developing research on the natural history of breast cancer and improving screening evaluation. Based on these recommendations, the Ministry of Health published an action plan to revamp the programme.7

The purpose of the study was to estimate the number of new breast cancer cases in France in 2015 attributable to breastfeeding for durations below recommendations (at least 6 months per child), and cases prevented through historical breastfeeding. As a secondary analysis, the corresponding numbers for ovarian cancer were estimated.

The objective was to quantify the relationship between deprivation and national breast cancer screening programme (NBCSP) participation at an ecological level in mainland France. Data from 4,805,390 women-living in 36,209 municipalities within 95 departments-participating in the 2013-2014 NBCSP were analysed using the French Deprivation Index (FDep). FDep population quintiles by municipality were computed to describe NBCSP participation according to deprivation. To better examine the relationship between continuous value of deprivation index and participation rates at the municipality level, we built a generalized linear mixed model. Geographical variations in participation rates were marked. The national standardized participation rate was higher in the intermediate quintiles (55%), 45% for the least deprived one and 52% for the most deprived one. Using our model, we also obtained an inverted U-curve for the relationship between NBCSP participation and municipality deprivation: participation was lower for both the least and most deprived municipalities. This relationship was also observed for each of the two subpopulations-urban municipalities and rural ones-considered separately. Introducing the FDep in the model reduced slightly the unexplained variations in participation rates between departments and between municipalities (with a proportional change in variance of 14% and 12% respectively). We highlight major disparities in departmental participation rates and FDep/participation profiles. However, deprivation appears to have only little influence on geographical variation in participation rates. There is a need to further understand the factors affecting geographical variation in participation rates, in particular the use of opportunistic screening.

Tobacco is currently the largest risk factor for cancers of the lung, lip/oral cavity/pharynx (LOCP) and esophagus. Variations in tobacco consumption over time have led to changes in cancer incidence in the general population. Data on the incidence of cancers at these sites in adults aged 20-44 years old are scarce. Our objective was to provide estimates of incidence trends for these cancers in France among this age group over the last 30 years. Observed incidence data over the period 1982-2010 for the 20-44 age group were provided from six cancer registries (eight for esophagus) covering approximately 6% of the French population. Age-period-cohort models were used on the observed period, and estimates of cancer incidence for France in 2012 were provided on the basis of short-term predictions. In men, a sharp decline was observed over time for LOCP and esophageal cancers, while lung cancer saw only a slight decline. In women, a large increase was seen in lung cancer incidence, while LOCP cancer incidence did not vary significantly. Smoking behaviors among adults aged 20-44 impact incidence trends in cancers of the lung, LOCP and esophagus, although other factors are involved, particularly in LOCP and esophageal cancers. Our results highlight the importance of preventative efforts which particularly target women aged 20-44. Efforts to curb tobacco smoking in men should also be pursued.

Background: District-level cancer incidence estimation is an important issue in countries without a national cancer registry. This study aims to both evaluate the validity of district-level estimations in France for 24 cancer sites, using health insurance data (ALD demands – Affection de Longue Durée) and to provide estimations when considered valid. Incidence is estimated at a district-level by applying the ratio between the number of first ALD demands and incident cases (ALD/I ratio), observed in those districts with cancer registries, to the number of first ALD demands available in all districts. These district-level estimations are valid if the ratio does not vary greatly across the districts or if variations remain moderate compared with variations in incidence rates. Methods: Validation was performed in the districts covered by cancer registries over the period 2000–2005. The district variability of the ALD/I ratio was studied, adjusted for age (mixed-effects Poisson model), and compared with the district variability in incidence rate. The epidemiological context is also considered in addition to statistical analyses. Results: District-level estimation using the ALD/I ratio was considered valid for eight cancer sites out of the 24 studied (lip–oral cavity–pharynx, oesophagus, stomach, colon–rectum, lung, breast, ovary and testis) and incidence maps were provided for these cancer sites. Conclusion: Estimating cancer incidence at a sub-national level remains a difficult task without a national registry and there are few studies on this topic. Our validation approach may be applied in other countries, using health insurance or hospital discharge data as correlate of incidence.

French uterine cancer recordings in death certificates include 60% of "uterine cancer, Not Otherwise Specified (NOS)"; this hampers the estimation of mortalities from cervix and corpus uteri cancers. The aims of this work were to study the reliability of uterine cancer recordings in death certificates using a case matching with cancer registries and estimate age-specific proportions of deaths from cervix and corpus uteri cancers among all uterine cancer deaths by a statistical approach that uses incidence and survival data. Deaths from uterine cancer between 1989 and 2001 were extracted from the French National database of causes of death and case-to-case matched to women diagnosed with uterine cancer between 1989 and 1997 in 8 cancer registries. Registry data were considered as "gold-standard". Among the 1825 matched deaths, cancer registries recorded 830 cervix and 995 corpus uteri cancers. In death certificates, 5% and 40% of "true" cervix cancers were respectively coded "corpus" and "uterus, NOS" and 5% and 59% of "true" corpus cancers respectively coded "cervix" and "uterus, NOS". Miscoding cervix cancers was more frequent at advanced ages at death and in deaths at home or in small urban areas. Miscoding corpus cancers was more frequent in deaths at home or in small urban areas. From the statistical method, the estimated proportion of deaths from cervix cancer among all uterine cancer deaths was higher than 95% in women aged 30-40 years old but declined to 35% in women older than 70 years. The study clarifies the reason for poor encoding of uterus cancer mortality and refines the estimation of mortalities from cervix and corpus uteri cancers allowing future studies on the efficacy of cervical cancer screening.

Epidemiological studies in nuclear industry workers can produce relevant information to better appreciate the health risks related to chronic external exposure to low doses of ionizing radiation (IR). This work examined the relations between exposure to IR and mortality in workers at the French Electricity Company (EDF), followed up to year 2003.