NEW research in the USA has raised hopes that one day doctors might be able to track the presence of cancer with a simple blood test.
However until then each type of cancer has its own separate method of screening - and its own medical jargon and costs.
In France there are routine screening campaigns for four of the most common types of cancer: breast, prostate, cervical and bowel.
These are offered free to certain age groups.
The four cancers are well-suited for early screening: they grow slowly and symptoms can take a while to appear. Screening means potential problems can be picked up at a very early stage, greatly increasing the chances of successful treatment.
If you fall outside of the target group but still want to be checked, or if your test comes back positive and you need further checks you will have to pay for consultations and claim back the cost.
With all of these tests, you should remember to bring proof of identity, a carte vitale, complementary health assurance card if you have one and blood group card.
It is a good idea to ask your doctor to include a blood grouping with the first test because you will need your blood group card if you ever need to go into hospital for an operation.
Breast cancer (cancer du sein)
A free nationwide screening campaign is in place for every woman aged 50 to 74 – the age group most exposed to the risk of breast cancer. You should receive a voucher from the local health service every two years offering a mammogram (mammographie). It must be claimed within six months.
Appointments are made directly with a local centre de radiologie without the need to go via your GP. You will be given a list of nearby centres that are agréé (conform to agreed standards on training and equipment). Take your previous mammogram with you for easy comparison.
Arranged this way, the Assurance Maladie meets the full cost of the test and there is no unfront charge.
If you are under 50 and have a family history of breast cancer, you might still be able to get a free check. Your GP (médecin généraliste or médecin traitant) can ask for a mammogram voucher from the local health authority.
A simple referral without a voucher might not be enough to get the test free – it will cost about €65 (reimbursed at 70%) otherwise.
The screenings are checked thoroughly by a second expert within 15 days. The Institut National du Cancer says 8% of cases are picked up at this second stage. If a problem is detected, you will be referred to a specialist for an ultrasound (échographie mammaire, about €42) or MRI scan (IRM mammaire) which costs about €70. Both of these are reimbursed at 70%.
Bowel cancer (cancer colorectal)
A free test is available to all men and women aged 50 to 74 every two years – a total of 16 million people. Your GP will provide a kit for taking a faeces sample at home, which is then sent in a pre-paid envelope to the local testing centre (centre de lecture) to check for blood.
The standard €22 cost of the GP’s consultation is reimbursed at 70%.
You and your doctor will both receive a copy of the results. If an anomaly is detected, you will be referred to a gastroenterologist (gasto-entérologue) for a colonoscopy (coloscopie).
This usually takes place in hospital, under general anaesthetic and requires you to turn up à jeun (without eating, drinking or smoking beforehand). This makes early morning tests ideal.
The colonoscopy will cost up to €180, plus €18 for the hospital stay. Again, all of this is reimbursed by the Assurance Maladie at 70%.
Cervical cancer (cancer du col de l’utérus)
A smear test (frottis vaginal) is offered free to all women from 25 to 65, and is recommended even for those who have been vaccinated against HPV (human papillomavirus, called papillomavirus in French). The first two checks should be a year apart, and then every three years if they produced no abnormal results.
Unlike the screening for breast cancer and bowel cancer, there is no major national campaign to send out smear test vouchers. Your GP or gynaecologist will refer you to a smear test clinic in either a hospital or medical test centre (laboratoire d’analyses médicales). A small cell sample is taken from the uterus and analysed by a specialist (un anatomo-pathologiste).
Prostate cancer (cancer de la prostate)
This is the most common cancer in men, with about 65,000 new cases a year. There has been much debate in recent years about whether there should be a nationwide screening campaign for prostate cancer. The Health Ministry says some forms of prostate cancer evolve very slowly and checking every man over the age of 50 might mean that some people end up taking a long and exhausting course of treatment for a cancer that poses them little threat.
Your GP might recommend a prostate cancer test if you are over 50. They will begin with a rectal examination (toucher rectal) and will then refer you for a blood test which measures the amount of prostate-specific antigen (PSA, or antigène prostatique spécifique) produced by the cells in the prostate gland – these levels are an indicator of whether there are problems. It is important to do both steps of the screening, as sometimes one method misses a suspect sign that the other one finds. If the test shows a high level of PSA you will be referred to a urologist (urologue) for further checks. Only a biopsy, where tissue is taken from the prostate for examination, will confirm whether there is cancer or not. A urologist consultation will cost about e50, and e30 of it is reimbursed by the Assurance Maladie (70% of the €44 base tariff).
Skin cancer (cancer de la peau or mélanome)
It is not possible to screen for this in advance – but skin cancer can be treated early if action is taken when a potential symptom arises. If you are worried about a mole, your GP can refer you to a dermatologist (dermatologue) for further checks, priced €44 and reimbursed at 70%.
The Institut National du Cancer recommends that high-risk groups (people who spend a lot of time outdoors or have a family history of skin cancer) get checked once a year.
The national dermatologists union, the SND, offers free check-ups to everyone on National Skin Cancer Awareness Day, which this year is on May 27. Specialist check-up centres will be set up around the country. A full list is due to be published at www.syndicatdermatos.org towards the end of April.
Testicular cancer (cancer du testicule)
This represents only 2% of cancers in men, but is the most common cancer among 15 to 35-year-olds. There is no national screening programme, but anyone presenting certain symptoms such as testicular swelling, inflammation or pain should contact their GP for a referral to a urologist.
Lung cancer (cancer du poumon)
This kills about 20,000 people each year, but there is no way of detecting this at an early stage – thorax examinations pick up the cancer at a developed stage and are not suitable for a widespread screening campaign.
-- Cancer Support France is a charity dedicated to helping English speakers affected by the disease. It has a network of English-speaking support groups around the regions of France offering advice, hospital visits and translation assistance for anyone dealing with cancer, their relatives and carers. You can contact them on 05 45 89 30 05. See also www.cancersupportfrance.info
Find out more online
Assurance Maladie website. Click “Je suis assuré” and “Soins et remboursements” for details of the reimbursement rates of different consultations. You can also log in to your personal account to check the progress of claims.
Find a medical lab, urologist, gastro-enterologist or other cancer screening expert near you on the official Assurance Maladie directory. Includes full list of prices charged.
Official site from the Institut National du Cancer has lots of information (in French) about how to avoid, detect and treat most of the major types of cancer