Each year in France, 3,000 cases of invasive cancer of the cervix are diagnosed and 1,100 patients die from it, Public Health France and the National Cancer Institute recall this week in a press release. However, according to the latest data published by the organization on the occasion of the European week for the prevention of this cancer, screening and vaccination coverage (which concerns both girls and boys since January 2021) are still too weak, even if they progress.
Thus, the screening rate for all women aged 25 to 65 is 59% (2018-2020 period), up one point compared to the 2017-2019 period, “far from the 70% recommended by the European Union”, emphasizes Public Health France, which deplores coverage “Insufficient at all ages and throughout the territory”. Several factors explain these shortcomings, according to Françoise Hamers, epidemiologist in the Cancer Unit and Anne-Sophie Barret, scientific project manager in the Respiratory Infections and Vaccination Unit of Public Health France.
Territories where screening fails
The lowest coverage, below 50%, “is observed in the overseas departments and regions, with the exception of Reunion, as well as in the Ile-de-France departments of Seine-Saint-Denis, Val d’ Oise and Val de Marne”, explain the National Cancer Institute and Public Health France in their joint publication.
As the map below shows, coverage is higher (>67%) in Rhône, Haute Garonne, Isère and Haut-Rhin, “these last two departments being the departments of France where a organized screening program has existed for many years. »
Organized screening that has real consequences on coverage. However “in France until recently, there was no organized screening program”, explains Françoise Hamers, epidemiologist doctor at the Cancer Unit of Public Health France. Consequently “only women who went to their doctor were screened”. Since 2018, a program has been in place to send invitations to all women in the target age group to get tested, but this is taking time.
The youngest are also screened more often than older women: the coverage is around 65% between 25 and 45 years old and then “declines significantly” from the age of 50 with a rate of 45% among women. 60-65 years old.
“The hypothesis is that from the menopause onwards, women see their gynecologist less or no longer at all”, points out Françoise Hamers. Among the other explanatory factors, “the distance from the healthcare system, and the socio-economic status which plays a big role. In Seine-Saint-Denis, for example, the coverage rate is very low. »
Vaccination coverage much lower than other countries, mistrust and ignorance in question
As for vaccination, which is recommended for girls but also for boys aged 11 to 14, it is again quite low, especially compared to other European countries. In 2020, it was estimated at 33% for the complete scheme at age 16 (+5 points compared to 2019).
In comparison, Portugal shows a rate of 87% for the complete scheme, and 80% in Sweden.
“We still have progress which is encouraging in 5 years”, notes Anne-Sophie Barret, scientific project manager at the Respiratory Infections and Vaccination Unit of Public Health France. If it is according to her “difficult to strictly compare the countries between them because vaccination is not organized in the same way (in Sweden, it is organized in schools)”, studies on the subject in France show that there is a lack of knowledge about vaccination among parents and among young women.
According to a health barometer conducted in 2016, “nearly half of young women between 18 and 24 were unaware of it, and more than 60% of parents had not been informed by their doctor”, underlines Anne-Sophie Barret . Among those who were informed, 54% considered that the vaccine could cause serious side effects, and a quarter that it was not effective. “So there is a real challenge in reaffirming the effectiveness of vaccines, which have a safety profile validated by the health authorities”, continues the project manager.
Vaccination of young boys, “an issue in the coming years”
Vaccination against HPV makes it possible, according to Public Health France, “to prevent genital HPV infections, which are the cause of approximately 90% of cancers of the cervix and the cause of other cancers of the genital and of the ENT sphere”, diseases that can affect both sexes, specifies Anne-Sophie Barret.
It has also been recommended for boys since 2021 and its deployment “is going to be an issue in the coming years”, because it is recognized that HPVs are transmitted in both sexes and that boys contribute to transmission.