Order of 10 March 2026 amending the Order of 16 January 2024 on organised cancer screening programmes

🔍💊 New regulatory framework for colorectal cancer screening: easier access to kits in pharmacies, with nurses or online, strengthened follow‑up of positive tests and mandatory accreditation of laboratories. A major step to reduce mortality from colorectal cancer.

Source :      📒 Arrêté du 10 mars 2026 modifiant l'arrêté du 16 janvier 2024 relatif aux programmes de dépistages organisés des cancers

 📜🔗LIEN 

1. ANALYTICAL SUMMARY

Context and challenges of organised screening

This ministerial order updates the specifications of the national organised colorectal cancer screening programme for people aged 50 to 74 at average risk. It covers the whole pathway: individual invitations by the health insurance funds every two years, distribution of immunochemical faecal occult blood test kits by health professionals (doctors, community pharmacists, registered nurses) or via online ordering, analysis by accredited medical laboratories and follow‑up of people with positive tests by the Regional Cancer Screening Coordination Centres (CRCDC). The document specifies eligibility criteria, excludes people at increased risk (personal or family history) who require colonoscopic surveillance, and defines reminder procedures to improve participation, currently 30.7% in 2024‑2025, well below the European benchmark of 45%.

Operational contributions for frontline actors

The order provides a detailed regulatory framework for all professionals involved: GPs, gynaecologists, gastroenterologists, pharmacists, nurses, medical biologists and CRCDC managers. It clarifies each actor’s role in assessing eligibility, informing about benefits and limitations of the test, ensuring traceability of kit delivery, analysing samples under strict accreditation standards (ISO 15189), and actively following up positive results to secure colonoscopy. The order sets precise timelines (results sent within 2 working days after receipt, data transfer to CRCDC within 48 hours), quality requirements (sensitivity 70%, specificity 96‑98%, configurable positivity threshold), and a secure, GDPR‑compliant information system for data sharing between laboratories, CRCDCs, physicians and screened individuals.

2. KEY POINTS OF THE DOCUMENT

1. Target population and strict eligibility criteria
Organised screening targets women and men aged 50 to 74 at average risk, i.e. with no symptoms, no personal history of adenoma, colorectal cancer or chronic inflammatory bowel disease, and no first‑degree family history of adenoma or colorectal cancer. People at increased risk (personal history of colorectal cancer, inflammatory bowel disease, family history of cancer or adenoma, polyposis, Lynch syndrome) are excluded from the programme and referred for colonoscopic surveillance or oncogenetic consultation. Individuals who have had a complete colonoscopy are ineligible for five years; those with CT colonography only or incomplete colonoscopy followed by CT colonography are ineligible for two years, subject to medical opinion.

2. Diversified access routes to screening kits
Eligible people receive a personal invitation from their health insurance fund every two years, encouraging them to pick up a kit from their doctor (GP, gynaecologist, gastroenterologist or physician at a health examination centre), from a community pharmacy, from a registered nurse or to order it directly online. Delivery by a doctor does not require a dedicated visit but is done during routine consultations. A structured reminder system is planned: two reminders within a maximum of 12 months, with a screening kit enclosed with the second reminder for people who participated in any of the previous three screening rounds. A text or email reminder is sent to individuals who ordered a kit online but did not return it to the laboratory within one month.

3. Central role of health professionals in risk assessment and information
The professional handing over the kit must assess the person’s risk level and eligibility, based on personal and family history. If the person is ineligible, the doctor proposes alternative screening or surveillance (referral to a gastroenterologist or oncogenetic consultation), whereas pharmacists and nurses refer to the GP. The professional explains the benefits and limitations of screening, possible follow‑up steps and what to do if the test is positive. They ensure that the person understands how to use the kit and send the sample, check correct identification on pre‑printed labels (name, date of birth, unique health insurance identifier) and can help complete the form if needed. During subsequent consultations, they again raise the issue with patients who have not yet done the test.

4. Technical and quality requirements for medical laboratories
Only medical laboratories accredited to ISO 15189 by COFRAC or an equivalent European body and selected through a national public tender led by the National Health Insurance Fund (CNAM) may perform the analyses. They use a quantitative immunochemical faecal occult blood test based on a single self‑sample, with an adjustable positivity threshold (in France typically 150 ng Hb/ml, approx. 30 µg Hb/g of faeces). Expected performance is 70% sensitivity, 96‑98% specificity, positive predictive value at least 8‑10% for cancers and 40% for cancers plus advanced adenomas, with an overall positivity rate between 3% and 6%. Laboratories must respect strict timelines: analysis within 7 days after sampling, dispatch of results within 2 working days after receipt, transfer of data to CRCDCs within 48 working hours in a secure electronic format.

5. Strengthened follow‑up of people with positive results by CRCDCs
CRCDCs monitor all screened individuals according to a national guideline developed by the French National Cancer Institute (INCa). For people with a positive result (3.3% of tests in 2024‑2025), CRCDCs actively check whether colonoscopy has been performed, via the physician receiving the results, gastroenterologists or directly with the person. Reminder letters are sent to patients with uninvestigated positive tests in the year following the result, after consulting the identified physician. All contacts (letters, phone calls) are systematically logged. If after two years no follow‑up data can be obtained despite multiple reminders, monitoring is stopped but the person is reinvited in the next round. Colonoscopy refusals are specifically documented to avoid unnecessary reminders, while undecided persons are still encouraged by their doctors, supported by a final reminder sent by the CRCDC.

3. ACTIONABLE PATHWAYS FOR LOCAL ACTORS

1. Systematically assess screening eligibility during routine consultations
General practitioners, gynaecologists and other physicians can systematically ask patients aged 50 to 74 about personal and family history of colorectal cancer, adenomas or inflammatory bowel disease, to distinguish average‑risk individuals eligible for organised screening from higher‑risk patients needing specialised surveillance. They should use the list of eligible patients provided by health insurance to target discussions during consultations and opportunistic visits. This proactive approach can help raise the participation rate, currently 30.7%, still well below the 45% European target.

2. Train pharmacists and nurses in first‑line counselling and referral
Provide dedicated training for community pharmacists and registered nurses on eligibility assessment, correct use of the kit, key messages on benefits and limitations of the test, and referral to GPs when eligibility is uncertain or when risk is increased. These frontline professionals, authorised to distribute kits since 2022, are crucial for improving access to screening, especially for people without a regular doctor or with limited access to primary care. CRCDCs can supply them with kits and organise local training and awareness sessions.

3. Develop targeted communication to low‑participation groups
CRCDCs, in partnership with Regional Health Agencies (ARS) and health insurance, can design tailored campaigns for groups with low participation: men, people in precarious situations, residents of deprived neighbourhoods, and people with low health literacy. Use varied formats (short videos showing how to use the kit, testimonials, outreach stands in community venues, collaborations with patient associations), with simple messages about test effectiveness (detects 70% of cancers, more cancers and advanced adenomas than the previous test) and ease of use (single sample, pre‑paid return envelope). Always highlight new access routes (pharmacy, nurse, online order).

4. Strengthen follow‑up of positive tests via gastroenterology networks
CRCDCs can formalise agreements with local networks of gastroenterologists (hospital and private) to improve documentation of colonoscopies undertaken after positive tests and reduce loss to follow‑up. Use standardised reporting templates (INCa colonoscopy and pathology forms) to feed CRCDC information systems. Organise coordination meetings between CRCDCs, GPs and gastroenterologists to identify local barriers (waiting times, patient reluctance, comorbidities) and design tailored solutions (fast‑track slots, specific support for vulnerable patients).

5. Improve traceability and interoperability of information systems
Laboratories and CRCDCs must ensure that their IT systems comply with national INCa specifications for automated, secure data exchange (test results, kit delivery channels, follow‑up after positive tests). They should verify that data transfers meet current standards (structured electronic formats, compliant barcodes or data matrix codes, GDPR and French data protection law requirements). Staff need training in using these tools, and regular data quality checks are required to avoid misidentification and duplicates. This traceability is essential for programme evaluation and regional management by ARSs