Low participation in organized colorectal cancer screening in France: underlying ethical issues
Open accessAbstract
International studies have shown a significant reduction in colorectal cancer (CRC) mortality following the implementation of organized screening programs, given a sufficient participation rate and adequate follow-up. The French national CRC screening program has been generalized since 2008 and targets 18 million men and women aged 50–74 years. Despite broad recommendations, the participation rate remains low (29.8%), questioning the efficiency of the program. A panel of experts was appointed by the French National Cancer Institute to critically examine the place of autonomy and efficiency in CRC screening and propose recommendations. In this paper, we explore the ethical significance of a public health intervention that falls short of its objectives owing to low take-up by the population targeted. First, we analyze the reasons for the low CRC screening participation. Second, we examine the models that can be proposed for public health actions, reconciling respect for the individual and the collective good. Our expert panel explored possible ways to enhance take-up of CRC screening within the bounds of individual autonomy, adapting awareness campaigns, and new educational approaches that take into account knowledge and analysis of sociocultural hurdles. Although public health actions must be universal, target actions should nonetheless be developed for nonparticipating population subgroups.
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- Authors
- Moutel, G., Duchange, N., Lièvre, A., Orgerie, M. B., Jullian, O., Sancho-Garnier, H., & Darquy, S.
- Affiliations
- Inserm (FR)
- Centre Hospitalier Universitaire de Tours (FR)
- Institut National du Cancer (FR)
- JDB Prevention-Cancer Foundation, Fontenay-lès-Briis
- Université de Bordeaux (FR)
- Corresponding author
- Darquy, Sylviane
- Venue
- European Journal of Cancer Prevention
- Published
- 2019-01
- Volume
- 28
- Issue
- 1
- Pages
- 27-32
- ISSN
- 0959-8278 (ISSN-L)
- OpenAlex
- W2913475320
- Cited by
- 24
- References
- 44
- Citations by year
- 2025: 3 · 2024: 2 · 2023: 4 · 2022: 3 · 2021: 5 · 2020: 4 · 2019: 3
- FWCI
- 0.84
- Type
- journal article
- Language
- en
- Open access
- green
- inserm.hal.science
- Licence
- other-oa
- Locations
- European Journal of Cancer Prevention (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion, other-oa)
- HAL (submittedVersion)
- Oskar-Bordeaux (Universite de Bordeaux) (submittedVersion)
- Funders
- Institut National de la Santé et de la Recherche Médicale
- Centre National de la Recherche Scientifique
- Institut National Du Cancer
- Université Paris-Est Créteil Val-de-Marne
- Institut de Veille Sanitaire
- Université de Franche-Comté
- National Cancer Institute
- Topics
- Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ethics and bioethics in healthcare
- Keywords
- colorectal cancer screening, screening uptake, organized screening programs, individual autonomy, public health ethics, public awareness campaigns, socio-cultural barriers, expert panel recommendations
- MeSH terms
- Female, France, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Patient Participation, Socioeconomic Factors, Colorectal Neoplasms, Personal Autonomy, Early Detection of Cancer
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