Breast cancer screening in women aged 50-74 years: is there room for improvement?

Regular mammography screening has been available in France, free of charge, for all women aged 50-74 years since 2005. Two nationwide surveys [EDIFICE 1 (507 women interviewed; age 50-74 years) and EDIFICE 2 (488 women)] recently collected data on individuals' access to cancer screening procedures. Two further surveys interviewed 600 general practitioners (GPs) each to determine their attitudes towards screening in general and screening for breast cancer in particular.

Large population survey: strengths and limits. Methodology of the EDIFICE survey.

In France, mass screening for breast and colon cancer issupported by the French National Cancer Institute (INCa). In these nationwide screening campaigns, individuals aged between 50 and 74 years receive a personalized letter inviting them for a screening examination every 2 years. Prostate cancer screening is, however, still controversial and has not been included in the INCa recommendations so far.

Cancer screening: reaching the limits or terra incognita? Lessons from the EDIFICE surveys.

The main lessons from the EDIFICE surveys can be summed up in five points. (i) Evidence talks but very quietly: cancer-screening practices in the French general population do not match scientific evidence; (ii) Give time to time: the rate of appropriation of screening behaviour is slow; (iii) Where there is a will there is a way: the organization of screening decreases inequalities for cancer screening; (iv) Do not aim only at the target: although monitoring of adhesion and compliance for the targeted population is mandatory, monitoring the utilization of screening resources, particularly in countries such as France that have no financial constraints (screening outside the official range is still almost fully reimbursed) is also useful; and (v) Trees do not reach the sky: we have observed a ceiling effect for breast cancer with 90-95% of women who have had a mammogram in their lifetime and 80-85% of women from the targeted population who had a mammogram within the previous 2 years. For colorectal cancer, even with the longstanding programme, the ceiling level observed in France is close to 60%.

Impact of general practitioners' sex and age on systematic recommendation for cancer screening.

Characteristics of primary-care providers have been associated with their patients' participation in breast cancer screening. A nationwide observational survey, 'EDIFICE', was conducted by telephone from December 2007 to January 2008 on a representative sample of 600 general practitioners (GPs) working in France, to investigate how a GP's characteristics may influence patient participation in screening for breast, colorectal and prostate cancer. For breast cancer screening, systematic recommendation was associated with female physicians [odds ratio (OR) =1.

Impact of awareness of cancer among acquaintances on cancer screening attendance.

Two nationwide observational surveys were carried out in France in 2005 and 2008 with the aim of assessing the impact on attitudes towards cancer screening of a positive history of cancer among a person's close circle of acquaintances (relatives, friends or colleagues). In 2005, 67% (993/1482) of people interviewed reported having someone in their close circle of acquaintances affected by cancer and in 2008, the rate was 80% (1158/1454). In 2008, having someone within a person's close circle of acquaintances affected by cancer did not increase the rate of screening for breast cancer (already high at >80%).

Screening for prostate cancer: growth without control.

In France, no official recommendations for or against systematic screening for prostate cancer have been issued yet. Therefore, individuals' choices with regard to screening or non-screening, and general practitioners' (GPs) recommendations for or against systematic screening should reflect personal preferences. Four nationwide observational studies (surveys) were conducted in France, two in 2005 and two in 2008, on a representative sample of participants aged between 40 and 75 years and a representative sample of GPs.

Organized colorectal cancer screening programmes: how to optimize efficiency in the general population.

In France, free faecal occult blood testing is offered to individuals aged between 50 and 74 years every 2 years as a method of screening for colorectal cancer (CRC). To assess how a proposed organized programme of CRC screening would be perceived among a representative sample of individuals living in France, aged between 40 and 75 years, and by a representative sample of general practitioners, two nationwide observational telephone surveys were carried out in 2005 (EDIFICE 1; 1601 individuals) and 2008 (EDIFICE 2; 1801 individuals). In 2008, 38% of individuals aged between 50 and 74 years reported undergoing screening for CRC; this corresponded to a statistically significant 13% increase in CRC screening rate compared with 2005 (P=0.

Mammography utilization in women aged 40-49 years: the French EDIFICE survey.

In France, mammography screening is offered to women aged between 50 and 74 years. EDIFICE, the iterative nationwide survey, collected data on a national level about consumers utilization of available cancer screening procedures. This analysis compared data from a subset of 241 women aged between 40 and 50 years with that of 488 women aged between 50 and 74 years.

Uptake of breast cancer screening in women aged over 75 years: a controversy to come?

In France, the age range for organized screening for breast cancer is 50-74 years. From a layperson's perspective, the public health message focusing on a specific target population may be difficult to understand. The aim of this study is to assess how women aged over 75 years deal with this absence of screening recommendations for their age group.

Impact of organised programs on colorectal cancer screening.

Purpose: Colorectal cancer (CRC) screening has been shown to decrease CRC mortality. Organised mass screening programs are being implemented in France. Its perception in the general population and by general practitioners is not well known.

Cancer screening in France: subjects' and physicians' attitudes.

Objective: Since screening for cancer has been advocated, funded, and promoted in France, it is important to evaluate the attitudes of subjects in the general population and general practitioners (GPs) toward cancer screening strategies.

Methods: EDIFICE is a nationwide opinion poll that was carried out by telephone among a representative sample of 1,504 subjects living in France and aged between 40 and 75 years and among a representative sample of 600 GPs. The questionnaire administered to subjects queried about previous screening for cancer.

The European rare diseases therapeutic initiative.

For many rare diseases, doctors have nothing to offer in the way of specific treatments to alter the disease. A new public- private partnership aims to address this problem.