It is a major pollution which affects a large part of the French population, but for which the detection campaign remains very limited. Only 2,160 people have received reimbursement from health insurance for cadmium screening since this system was implemented in June. This heavy metal, classified as carcinogenic, has been the subject of several alerts launched in recent years by doctors as well as the French health authorities.
In 2021, the Esteban national biomonitoring study, conducted by Public Health France, revealed that 47.6% of the French population aged 18 to 60 exceeded the critical concentration threshold for cadmium in urine. Results confirmed last March by the publication of a report from the National Health Safety Agency (ANSES), reporting “worrying cadmium impregnation at all ages and from a very young age”.
Faced with these alerts, the Ministry of Health decided in June to open up the possibility of reimbursement for cadmium tests. The cost of screening, set at 27.50 euros, can thus be covered 60% by health insurance, the rest being the responsibility of complementary health insurance. But four months later, it appears that this system has been used very little. Between its entry into force on June 16 and September 28, the National Health Insurance Fund (Cnam) recorded 2,285 procedures reimbursed, including 1,539 by urine test and 746 by blood test. All of these tests concerned 2,160 people, according to a count communicated by the Cnam to franceinfo.
The refusal of doctors
“When we compare this figure to the number of private doctors in France [around 100,000], it remains low,” comments to franceinfo Doctor Pascal Meyvaert, coordinator of the health and environment working group of the National Conference of Regional Unions of Health Professionals.
Reimbursement of cadmium screening was a request from private doctors, authors of a letter sent in June 2025 to the government, in which they expressed "their great concern at the contamination of French people, particularly women and children". The toxic metal has been suspected since 2021 by Public Health France of “playing a role in the extremely worrying major increase in the incidence of pancreatic cancer”.
But Pascal Meyvaert today says he is unhappy with the way in which the screening reimbursement system was put in place. “I have not ordered any tests and I do not intend to do so,” he says. This representative of private doctors denounces the lack of reflection around the responses to be given to patients whose tests reveal cadmium levels that are too high. “The cart has been put before the horse,” judges this practitioner.
“The first step should have been to establish the action to be taken in the event of a positive dosage. What additional tests should be prescribed? What treatment should be proposed? This reflection was not carried out.”
Pascal Meyvaert, doctor
franceinfo
Added to this reluctance on the part of doctors is also the difficulty in identifying populations eligible for reimbursement for tests. The choice was in fact made to restrict this system to "people potentially overexposed to cadmium due to their place of residence", as specified in the decision of the National Union of Health Insurance Funds dated April 28. This is in line with the recommendations of an opinion delivered in 2024 by the High Authority for Health (HAS) which provides for a screening strategy targeted at people potentially overexposed to cadmium due to their environment, in particular soils. But the administration has not determined a list of affected areas.
No regulatory zoning
Contacted by franceinfo when the system came into force on June 16, neither Health Insurance, nor the Regional Health Agencies (ARS), nor the General Directorate of Health were able to provide a precise map of the eligible territories. “The areas identified at risk do not correspond to regulatory zoning. This is a logic of exposure situation and not an administrative division,” responds the office of the Minister of Health, Stéphanie Rist.
The Ministry of Health refers to a map showing the cadmium content in soils produced by researchers from the National Research Institute for Agriculture, Food and the Environment (Inrae) using data from the national soil quality monitoring program. But this modeling does not make it possible to distinguish the most exposed municipalities. “It is useful for identifying large-scale trends, but it does not allow a detailed reading at the municipal or plot scale and does not constitute an operational decision tool on its own,” explains the Ministry of Health.
Cadmium is naturally present in the soils of several French regions. And this map mainly represents the distribution of these areas. “It essentially shows natural contaminations of geological origin,” explains Thibault Sterckeman, research engineer at INRAE, at the Soil and Environment laboratory at the University of Lorraine. “When the substrate is limestone, we often have soils that are richer in cadmium. This is the case in Charente, in the Jura or even in the Paris basin. There are also mineralized areas rich in cadmium in the Cévennes,” lists the researcher.
Only rare places reveal contamination of human origin, generally linked to the industrial past of these territories. “The high concentrations in the Nord and Pas-de-Calais may result from the industry of the mining basin, but there is also chalk and limestone in this region,” explains Thibault Sterckeman.
The limitation of this map, however, lies in the way in which it was produced. This is a statistical modeling established from 2,200 samples taken between 2000 and 2009. "The result of these calculations makes it possible to highlight variations at the national or even sub-regional level, but at a more localized grid, the statistical uncertainty becomes too great", explains Nicolas Saby, geostatistician at Inrae.
As it stands, these data therefore do not make it possible to apply the thresholds set by the HAS to identify places of residence presenting a risk of overexposure to cadmium and justifying the prescription of screening for their population. Additional work has been launched by INRAE to clarify this question. But the conclusions are not expected before the end of 2026.
Polluted industrial sites
Beyond the regions naturally rich in cadmium due to their geology, the General Directorate of Health specifies that the "identified areas at risk" also include "territories having experienced historical or current anthropogenic contributions (former or current industrial activities, spreading)" and refers to the Ministry of Ecological Transition "for more details".
For its part, the Ministry of Ecology declares that the only information at its disposal is that published on its GeoRisks portal. Nearly 12,000 investigation files for sites and soils presenting proven or suspected pollution are referenced on this website, including 441 containing cadmium pollution, according to a Franceinfo count. Within this list, the Ministry of Ecology specifies that "the only lands formally recognized by the authorities as being polluted" are those which have been the subject of prefectural orders for information on soils (SIS) or restriction of use (SUP). We identified 164 of them.
For Doctor Pierre Souvet, a cardiologist by training and among the first to warn of the dangers of cadmium, "the choice to restrict reimbursements for tests based on place of residence amounts to limiting access only to people living near polluting industrial sites". “However, this does not correspond to the situation of French contamination, which is primarily linked to food,” he says.
Children overexposed
Reports from health authorities published in recent years point to a global problem of contamination through food. In its expert report published in March, ANSES assessed all possible sources of exposure to cadmium: food, smoking, industrial pollution, cosmetic products. Verdict: food is considered the main source of the toxic metal.
“The ingestion of food is the majority source of impregnation for the general French smoking and non-smoking population (which can reach a contribution of 98% for the general non-smoking population depending on age)”, concludes the health agency. Children are particularly exposed, with concentrations of cadmium in urine that exceed levels not to be exceeded in 100% of 2 to 3 year olds.
The foods identified as the main vectors are breakfast cereals, breads and dry bread products, pastries, pastries, sweet cakes and biscuits, pasta, rice and wheat as well as potatoes and certain vegetables. According to ANSES, the contamination of these foodstuffs is largely linked to the presence of cadmium in French agricultural soils, due in particular to the use of fertilizing materials, in particular phosphate mineral fertilizers with a high cadmium content.
In September 2025, private doctors presented to the Ministry of Health a model questionnaire based on patients' eating habits in order to identify people at risk for testing. But this request remained a dead letter. “We never heard back,” laments Doctor Pascal Meyvaert.
