Lung cancer is one of the most common cancers in France but also the deadliest with 52,777 new cases in 2023 and 33,100 deaths estimated in 2018. While the trend is towards a slight decline in men, the number of cases has exploded among women, + 4.3% per year.
Often diagnosed at a late stage, when no curative treatment is yet possible, it is one of the cancers with the worst prognosis with a survival rate of 17% at 5 years. “The 5-year survival is only 4% for detection at stage IV of this cancer, the stage at which it is today diagnosed in 40% to 55% of cases,” reported the High Authority of Health in 2022.
In this context, early detection would improve patients’ chances of survival by offering them curative treatments.
But unlike colorectal cancers, breast cancers and cervical cancers, there is no organized screening program for lung cancer in France. This is particularly regretted by the “Together we lungs” collective, made up of professionals (oncologists, radiologists, thoracic surgeons) and patient associations.
On this Friday, May 31, World No Tobacco Day, the collective is putting the spotlight on lung cancer screening in France, where 25% of adults smoke daily (7 points more than the European average) while tobacco is responsible for eight out of ten lung cancers.
The low dose scanner
Organized lung cancer screening was excluded by the HAS in 2016, which reversed this opinion in 2022. It then recommended the launch of a pilot program under the aegis of the National Cancer Institute, INCa. Several studies, including two major ones, have highlighted the benefits of screening using low-dose CT, an injection-free imaging technique, also called CT scanning.
The first, the American NLST study in 2011, showed a 20% reduction in mortality compared to chest radiography. Then the NELSON study, published in 2020 and carried out in Belgium and the Netherlands, showed, thanks to early detection, a reduction in mortality of 24% in men and 48% in women.
Thus, several techniques are currently being studied, in particular low-dose scanning, a method on which the INCa pilot study (Cascade Study) is based. Much less irradiating than the classic scanner, it also allows “to detect early cancerous nodules more precisely and more reliably than x-rays”, advances the collective “Together we lungs”.
The Cascade study involves 2,400 women aged 50 to 74, smokers or ex-smokers (for less than 15 years) without chest symptoms. The use of artificial intelligence to support the expertise of professionals to detect nodules on scanner images is tested in this study.
Analysis of volatile organic compounds
The European Pathacov project is testing the analysis of volatile organic compounds contained in breath for the early diagnosis of bronchopulmonary cancers, a non-invasive technique which could be carried out outside hospitals and laboratories.
“VOCs are organic compounds resulting from cellular metabolism and detectable in exhaled air. Their nature varies when a pathology appears or under the influence of pharmacological treatment. explains the project website.
Liquid biopsy
Performed on a sample of blood, saliva or urine, this technique makes it possible to detect biological markers of lung cancer from the cells, DNA or micro-RNA of the tumor circulating in the body. Minimally invasive, this technique could make it possible to detect several cancers at the same time.
Organized since 2013 in the United States, the idea of organized lung cancer screening among heavy smokers is progressing in many countries. In Europe, Croatia, a pioneer in this area, launched its program in 2020, followed by the United Kingdom in 2022. In France, around fifteen programs are underway.
