France restricts free cadmium screening despite doctors’ warnings
Experts say criteria for patient inclusion is too narrow
The substance has been linked to a number of illnesses including pancreatic cancer, osteoporosis, kidney disease and heart problems
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Restrictions placed on free cadmium screening tests have drawn criticism from doctors who say criteria for patient inclusion is too narrow.
Cadmium, a toxic metal, has been linked to a number of illnesses including pancreatic cancer, osteoporosis, kidney disease and heart problems.
It is officially classified as carcinogenic and harmful to reproductive health.
Health body Santé publique France estimates nearly one in two adults in France have cadmium levels above the recommended threshold, with around 15% of children also overexposed.
While it is naturally present in the soil in a number of areas in France – including Champagne, Charente and Jura – greater concern surrounds its presence in imported mineral phosphate fertilisers used in the cultivation of cereals, potatoes and vegetables.
Around 7,000 sites of industrial contamination have also been identified, spread all over the country, and it is found in cigarette smoke.
From this summer, screening tests will be made available at a cost of €27.50.
Depending on conditions, this will be refunded at 60% by state health insurance body Assurance Maladie, with the remaining 40% covered by top-up mutuelle insurance if the person has one.
Further information about how tests can be accessed will be available at a later date.
State reimbursement will only be available to “people potentially overexposed to cadmium due to their place of residence,” or if they work in industries at risk of cadmium exposure, the government has clarified.
Medical experts argue that the lack of wider reimbursement will restrict uptake and provide only limited benefits.
The health authority Anses is calling for collective action to lower the amount of cadmium in food generally by reducing the amount found in fertilisers, especially by limiting imported phosphate from North Africa, which is high in the metal.
Doctors want more screening
It says that between 23% and 27% of children exceed the dietary exposure thresholds, compared to 1.4% to 1.7% of adults.
“What the Anses study showed is that the biggest source of contamination is from food which has been grown using fertiliser containing cadmium,” Dr Pascal Mayvaert, coordinator for the Santé Environnementale group of GPs, told The Connexion.
“But the restrictions on who can prescribe the tests mean that they will only be free when the contamination comes from industrial activity, which is a very small part of overall cadmium exposure.”
He said doctors wanted a system under which the tests could be prescribed nationally if a questionnaire completed by the doctor and patient suggested that high cadmium levels might be contributing to health problems.
Dr Mayvaert said that although some cadmium is expelled from the body through urine, not all of it is eliminated, and what remains becomes lodged in a person’s organs and bones for life.
“We know that having healthy levels of iron in the body stops cadmium from becoming lodged in the body, so if we know there is a problem we can act to boost the iron levels, as well as giving dietary advice,” he said. “That is why having a test is useful.”
A bill to limit the risks of cadmium exposure is also set to be reviewed in early June.
Currently, France allows up to 90mg/kg of cadmium in fertiliser, higher than the EU’s recommended limit of 60mg/kg.
The government said it will reduce the limit to 60mg/kg by 2027, 40mg/kg by 2030, and 20mg/kg by 2038.
“It is a very long timetable for something which can cause big health problems,” said Dr Mayvaert.
