Screening for different types of cancer

Breast cancer (cancer du sein)

Early detection of breast cancer vastly improves outcomes and provides for greater choice in treatment options, limiting treatment side-effects and after-effects. It is curable in nine cases out of ten if detected early.

 A yearly clinical examination is recommended for women after the age of 25, and a mammography screening is recommended every two years for women between the ages of 50 and 74. 

Women with a family history of breast cancer or demonstrating other risk factors (alcohol consumption, smoking, hormone treatments for menopause, etc.) are advised to inform their doctor of this and to follow regular screening as prescribed by their doctor. Around 80% of breast cancers develop after the age of 50. 

A nationwide screening campaign is in place for every woman aged 50 to 74, the age group most exposed to risk (the average age for diagnosis is 64). You should receive a voucher in the post every two years for a mammographie (mammogram).

 It must be used within six months. Sixty per cent of breast cancers are detected in the early stages thanks to this programme. The government has considered extending this to younger women but so far official advice for them is simply to have their breasts checked annually by a GP, gynaecologist or midwife. 

This cancer can also affect men, but this is rare. It is also advisable for women to check themselves regularly for any signs such as lumps, a change in the skin or in the nipple area. Screening appointments can be made with a centre de radiologie (x-ray centre) without the need to go via your GP.

 Take your previous mammogram with you, if you have one. You need your voucher letter and carte Vitale. Assurance Maladie covers the test and there is no upfront charge. The screening involves a mammogram, which takes about a quarter of an hour. The results will be analysed by the radiologist carrying out the test and are checked by a second doctor. 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 are reimbursed at 70%. 

Testing is 100% reimbursed for women of any age with a family history of the disease. Your GP can ask for a mammogram voucher from the health authority. A simple referral without a voucher may not be enough to get the test free; it will otherwise cost about €65 (reimbursed at 70%)

Colonic or rectal (cancer colorectal)

Colorectal cancer – cancer of the colon and rectum – is one of the most common cancers in France. The number of cases has remained stable for several years, but there has been a steady drop in mortality.

It affects more than 47,000 people each year and causes 17,000 deaths. In most cases, it comes from a benign tumour that slowly evolves and eventually becomes cancerous. A major risk factor for this cancer is excessive alcohol consumption. Others include smoking, a lack of physical exercise and being overweight as well as having a diet low in dietary fibre and rich in red or processed meat.

Colorectal cancer is easily detected with an immunological test. Screening for this type of cancer is recommended every two years. Colorectal cancer is curable in 90% of cases. Screening is available to people aged 50 to 74 every two years.

Your GP can provide a kit for taking a stool sample at home, which is sent in a pre-paid envelope to a testing centre. The standard €25 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 gastro-entérologue for a coloscopie (examination of the intestines with the use of an optical tube), which usually takes place in hospital.

If you have a personal or family history of colorectal problems, other measures may be advised. It is also possible to order a self-administered test online for home-delivery.

Gynaecological cancers

It is estimated that 90% of cervical cancers can be prevented by screening for precancerous lesions. Long-term outcomes for patients with cervical and ovarian cancers have improved significantly in recent years with a sharp decline in both incidence and mortality rates.

Vaccination against the human papillomavirus (HPV) is recommended as part of prevention against this type of cancer. HPV vaccines are reimbursed by social security at the rate of 65%. Your mutuelle may cover the rest.

Smear tests (frottis vaginal) to detect cervical cancer are recommended for women aged 25-65. The first two checks should be a year apart and then it is recommended that you should have a check every three years if the first two did not produce any abnormal results. Your GP or gynaecologist will refer you to a smear test clinic in a hospital or test centre.

A small cell sample is taken from the cervix and analysed by a specialist (un anatomopathologiste). This costs the price of a normal consultation plus an extra fee of around €20 which is all state-reimbursed at 70%. Women who have not had a test in the last three years are sent a letter allowing for a test which is 100% reimbursed.

Lung cancer (cancer du poumon) 

A large majority of lung cancers – around 80% – are attributable to tobacco. All types of smoking are considered to be equally harmful, and second-hand smoke is also a significant risk factor.

The prognosis tends to be poor – typically 20% survival rates after five years – due to the fact that these cancers are usually detected at an advanced stage, where treatment efficacy tends to be lower.

Lung cancer is diagnosed using a chest X-ray, a CT scan and a lung biopsy, following a clinical examination.

There has been some controversy over the usefulness of screening for this cancer – some doctors still think it should be done for those at risk only (eg. heavy smokers) – and the official view has been that screening is ineffective and unnecessary and there is no reliable way of detecting it at an early stage. The Haute Autorité de Santé said in 2022 that it welcomed the putting in place of ‘real life’ trials with a view to possible rolling out of the practice in future, especially to those in more vulnerable groups. Trials are underway in Paris, involving women aged 50-74 who smoke, or used to smoke, but do not currently have any cancer diagnosis.

Lung cancer used to be seen as a mainly male illness, but, while cases among men are stable, they are increasing among women. In 2023, there were 33,438 new cases among men and 19,339 among women.

For both genders, it is the most lethal of the cancers, but treatments have been improving. Surgery is the preferred treatment, but radiotherapy and medicines are also used.

Prostate cancer (cancer de la prostate) 

This is the most common cancer in men and there has been debate about whether there should be a screening campaign.

The Health Ministry says some forms of this cancer evolve very slowly and checking every man over 50 might mean some people taking a long exhausting treatment for a cancer that poses little threat.

Your GP might recommend a test if you are over 50. They will begin with a rectal examination and will refer you for a blood test which measures the amount of prostate-specific antigen (antigène prostatique spécifique) produced by the cells in the prostate gland. It is important to do both steps.

If the test shows a high level of PSA, you will be referred to a urologist (urologue). Only a biopsy, where tissue is taken from the prostate, will confirm whether there is cancer or not. A consultation will be about €50 (reimbursed at standard specialists' rates).

Treatment strategies for prostate cancer are adapted to the circumstances of individual patients. The factors taken into consideration by the doctor are the location of the cancer, its histological type (type of cancer cells), the stage and the level of the cancer. Different types of treatment are possible and include surgery, external radiotherapy, brachytherapy, hormone therapy, etc.

Prognosis for prostate cancer has improved in recent years, as approximately 90% of patients with this type of cancer can be cured.

Skin (cancer de la peau or mélanome)

The prevalence of skin cancer has increased since the 1980s, as a result of rising exposure to ultraviolet (UV) radiation through suntanning. Melanomas are the most common kind and there were 18,000 new melanoma cases in 2023 and around 2,000 people died from it, according to the latest figures from the Institut National du Cancer.

Screening involves a visual examination of spots and moles. People at risk are advised to self-examine their skin every three months, and to see a dermatologist once a year. The Institut National du Cancer says high-risk groups include people with delicate skin, a history of skin problems, who spend a lot of time outdoors or who have a family history of skin cancer.

Prevention advice include wearing a hat, using sunscreen, and avoiding spending too much time outside in the hottest hours. When examining your skin, be aware of any new lesions or brown spots changing in size, shape or appearance. When detected early, skin cancer has very good prognosis rates.

If you are worried, your GP can refer you to a dermatologist (dermatologue). You can also see one without referral, but will be less well reimbursed. The national dermatologist’s union, the SNDV, offers free check-ups on National Skin Cancer Awareness Day, usually in May or June.

Testicular cancer (cancer du testicule)

This represents only 1-2% 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 symptoms such as testicular swelling, inflammation or pain should contact their GP for a referral to a urologist.