SCREENING FOR COLORECTAL-CANCER IN FRANCE - EXPERIENCE IN 165,000 PEOPLE IN THE DEPARTMENT OF CALVADOS

Objectives. - Screening for colorectal cancer is a major public health problem in France as in most developed countries. Several controlled trials are on-going in Europe. The aim of the study was to determine r equirements for success of mass-screening for colorectal cancer in Fra nce. Methods. - A mass-screening program has been conducted between Ap ril 1991 and June 1994 in the depart ment of Calvados for 164,364 peop le aged 45-74 years. The screening test was first proposed by general practitioners and occupational doctors during appointments. Secondly, a postal invitation to obtain the test, free of charge, by doctor or c hemist, was sent. Results. - Global participation rate was 43.4 %; 40. 2 % of tests were distributed during the first phase, 47.1 % during th e second phase and 12.7 % were distributed by a private health institu te. Participation was higher for females (47.1 %) than males (39.2 %) and for urban districts (46.5 %) than rural districts (24.4 %). In cas e of positive rest, colonoscopy has been more frequently achieved in u rban districts and when test has been distributed by a physician. Posi tivity rate was 2.8 %. Positive predictive value was 8.0 % for a cance r and 13.5 % for an adenoma larger than 1 cm. Because both positivity rate and positive predictive value were higher for males than females and increased with age, rate of cancer or large adenoma screened was a lmost three times higher for males than females and markedly increased with age. Conclusions. - In France, different recruitment methods hav e to be used to reach a satisfactory participation to a mass-screening campaign. Such a program requires involvement of general practitioner s and close coordination between practitioners and health care insuran ce agencies.