This paper evaluates the impact of the National Breast Cancer Screening Program (NBCSP), implemented in France in 2004 and targeting women aged 50-74, on breast cancer mortality. While previous research has explored the socioeconomic and behavioural determinants influencing participation in the screening program, gaps remain in understanding how population-based screening affects breast cancer mortality.

This study uses CépiDc mortality data (2005-2021) for women aged 25-74 across 13 French regions, alongside regional screening participation rates from Santé Publique and socioeconomic covariates from INSEE, and identifies disparities in mortality and participation trends. A parametric Fuzzy Regression Discontinuity Design (RDD) is employed to assess the screening effect around the age eligibility threshold, addressing imperfect compliance by instrumenting actual participation on eligibility. 

Findings indicate that sub-optimal participation reduces the program’s full potential impact on mortality to approximately half of its intent-to-treat. The study also finds that increased availability of treatment facilities and Regional cancer screening coordination centres correlates with lower mortality rates. Robustness checks using non-parametric approaches confirm these findings. 

This paper provides important policy implications to encourage screening uptake and improve health outcomes.