high incidence but survival rate among the best in Europe

Here is one of the most striking paradoxes of the cancer figures: the French are sicker even though they are treated better than elsewhere. A recent study, published in the very influential medical journal The Lancet, placed France at the top of the countries with the highest number of patients: 389.4 per 100,000 inhabitants, the second highest rate in the world. This confirms a European study from 2024.

However, these alarmist figures should not mask France’s good overall results in the fight against the disease. The five-year survival rate for the most common cancers (breast, lung, prostate, colon) is one of the best in the world. “In France, living a long time with stabilized cancer concerns more and more patients,” says Professor Jean-Yves Blay, president of Unicancer..

Very low mortality

Better yet: if this pathology remains the leading cause of death in France, cancer mortality is one of the lowest there with 227 deaths per 100,000 inhabitants, compared to 242 on average in Europe (1). Here we are before this famous paradox: “The French are more affected, but they survive better than elsewhere,” summarizes Dr Claire Morgand, director of science observation, data and evaluation at the National Cancer Institute (Inca).

How then can we explain these seemingly worrying data? First of all, the phenomenon does not only concern France. The study of Lancet notes that between 1990 and 2023, the number of cases more than doubled worldwide, and deaths increased by 74%. Then, the authors of this meta-analysis produced incidence rates – number of patients per 1000 people in a given country – standardized in order to be able to compare countries. Even if they neutralized the effect of age, biases remain. However, France is a country with an older population than elsewhere.

Risky behavior

This ranking is also explained by the lack of reliable data: France does not yet have a national register for reporting cases. Although a law passed on June 30 provides for the creation of a centralized register, the implementing decree has remained in limbo, due to government instability. Cases are reported very differently depending on the region. “The figures are only reliable for 20 to 30% of the territory,” specifies Professor Fabien Calvo, doctor and researcher (2). The rest is the subject of extrapolations, using calculation methods which can make the comparisons inconsistent.

In addition, this data constitutes a fairly old photograph. With the delays in the appearance of the disease and the collection of data, “they measure cases due to an environment which may have evolved over ten years”, specifies Professor Fabien Calvo. Thus, the recent drop in smoking, announced on October 15, has not yet been taken into account.

However, this high incidence specific to France can be explained by different factors. First of all, there remain behaviors that favor the appearance of cancer. “Almost half of cancers could be avoided by adopting healthy lifestyle habits,” emphasizes Dr Claire Morgand.

Tobacco, for example, is responsible for 20% of new cases each year. However, France has 25.3% daily smokers, compared to 18.8% in Europe or 13% in the United States. Same observation for alcohol, the second preventable risk factor, particularly for the most common cancers. “If daily consumption decreases, significant one-off alcohol consumption increases,” specifies Dr Sophie Beau-père, general delegate of Unicancer.

Insufficient screening in France

If the French are not very good at prevention, they are not doing better at screening, as the European Cancer Organization noted in May. Thus, the percentage of women participating in the breast cancer screening campaign has never exceeded 52% since its launch in 2004, compared to 80% in Portugal, Finland or Denmark. Only 34% of French people participate in colorectal cancer screening. Several reasons explain this resistance: health insurance, which covers care (excluding excess amounts) via long-term illness status, leads the French to focus on treatments rather than prevention, even free.

“The lack of screening has a direct impact on the severity of cancers, because discovered later, they are more aggressive,” underlines Dr Jean-Yves Blay. We must also take into account a certain distrust of scientific injunctions. Another explanatory factor: the provision of care. France has 1.52 oncologists per 100,000 inhabitants, three times less than in Estonia (3.76 on average in the European Union)… But these limits should not make us forget the successes. France is among the best performing countries in terms of treatment and care. Five-year survival rates reach 89% for breast cancer and 92% for prostate cancer, among the best in Europe.

The advantage of research

This progress can be explained by proactive and innovative public policies. Since the general cancer conference in 1998, the country has adopted a coordinated policy to fight the disease. Since 2003, three successive cancer plans, followed by the ten-year strategy to combat cancer 2021-2030, have coordinated prevention, the organization of care and research, and have created a unifying body: the National Cancer Institute.

It is also thanks to the first cancer plan that cancer centers supported by research teams were created. Their performances are also another French asset. French oncologists are discovering treatments, but also new ways of supporting patients, as demonstrated by the congress of European oncologists meeting in Berlin from October 17 to 21. In France, we have sick people, but also ideas for treating them.

1) European Cancer Organization 2022, 2024.

2) Author of Better understand cancers ; Ed. Kero, 284 p., €19.90.