The good news is that cancer mortality rates have been steadily declining in France: With 136.8 deaths per 100,000 people in 2023, compared to 184.7 in 1990, the trend reflects significant advances in medical care. France is one of the European countries with the lowest cancer mortality rate, which is a testament to the effectiveness of our healthcare system, especially given that the number of cancer cases has surged. That is the bad news: France is now ranked among the countries with the highest cancer incidence rates worldwide, with the number of cases continuing to rise sharply.
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A study published in September in the journal The Lancet ranks France at the very top, with 389.4 cancer cases per 100,000 people. This first-place rank is alarming, all the more so because the reasons behind it are still largely unexplained.
Admittedly, these rankings should be interpreted with caution. Another study, produced by a World Health Organization agency based in Lyon, ranked France ninth for cancer incidence worldwide. Differences between the data sources and methodologies used may explain this discrepancy. Nevertheless, France’s poor standing has raised questions, and it calls for explanations that are difficult to provide at present.
Worrying first place
The distinctive features of France’s cancer data collection system are among the factors that need to be examined. Until now, the system has relied on partial local registries, which inexplicably exclude both densely populated urban areas and Seveso sites (which contain potentially dangerous industrial substances). A national cancer registry is officially planned, thanks to a law passed in June, but it is not yet operational, as recent government turmoil has prevented the necessary implementing decree from being published.
The idea that France’s high cancer incidence rates could be explained by the country having more effective cancer screening does not hold up, since the French population is not particularly diligent in participating in screening campaigns when compared to other developed countries.
Tobacco and alcohol, long-identified risk factors, would seem to explain part of the situation in France, especially the rise in cancer among women. The smoking rate among French women (23%) is the highest in Europe. Alcohol consumption also remains well above the European Union average. The number of cancer cases linked to lack of physical activity and those related to hormones, in particular from contraceptive pills, also calls for further studies into possible French-specific factors.
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A dermatologist examines a patient’s moles in Quimper, western France, on May 22, 2019. FRED TANNEAU / AFP
The same applies to comparative research on cancers linked to unintentional exposure to pollutants via people’s environments and diets. French people have been shown to have particularly high levels of exposure to cadmium (a carcinogen found in many fertilizers) and pesticides (of which France is among the world’s largest users), but the connection between this and higher cancer exposure rates remains unclear.
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Even though it is worth viewing with caution, France’s unfortunate first place in The Lancet’s study should serve as a wake-up call. It is unacceptable for a developed country like France to be unaware of all the causes behind unusually high cancer incidence rates. All the relevant scientific bodies, particularly the National Cancer Institute (INC), should be mobilized to conduct a large-scale epidemiological study covering all factors that could be associated with this illness, which is the leading cause of death and everyone’s concern.
Translation of an original article published in French on lemonde.fr; the publisher may only be liable for the French version.