The latest figures published by INCa estimate the number of deaths attributable to it at just over 30,000, or almost 20% of total mortality due to cancer. If mortality from lung cancer is evolving in an encouraging manner in men, around – 3%/year per year in France over the 2011-21 decade, it is conversely increasing in a worrying manner in women + 0.5%/ year.
The chances of survival vary drastically depending on the stage at which the disease is diagnosed. More than 9 out of 10 patients are still alive 5 years after the diagnosis of localized cancer. On the other hand, this statistic is less than 10% for metastatic stages.
Low dose, high impact
While being able to make a diagnosis as early as possible is therefore essential, the late appearance of symptoms of the disease means that it is rarely identified at an early stage. In this context, the establishment of a screening program* organized is a crucial issue because it can make it possible to detect lung cancer at a stage where treatment will be much more effective with a possible cure.
Today there is an effective technique for detecting lung cancer at an early stage: low-dose chest CT*. The results of several large-scale studies (NLST in the United States, Nelson and Mild in Europe) and a Cochrane meta-analysis* show that its use makes it possible to obtain a 20% reduction in lung cancer mortality in a high-risk population, smokers or former smokers over the age of 50 with very significant exposure to tobacco.
Big questions
The availability of an appropriate diagnostic tool is, however, far from being sufficient for the implementation of an organized screening program. Many other subjects relating to public health, safety (overdiagnosis, overtreatment, etc.), the medico-economic impact of the implemented program, its acceptability as well as ethical and societal questions come into play. account. The question of the best coordination of the screening program with an incentive and support system for smoking cessation also constitutes a crucial question. And, as such, results obtained in the United Kingdom show that integrating screening with effective smoking cessation interventions could effectively encourage smoking cessation among motivated high-risk smokers.
Program et horizon
Initiated by the High Authority for Health and managed by the INCa, the “Lung cancer screening” pilot program must answer the questions previously mentioned. Part of the Action “Evaluate the feasibility of an organized screening program for lung cancers” of the ten-year strategy to combat cancer, it should enable research to be carried out on a scale of several regions and over several years, the results of which will answer “ …to questions remaining unanswered, by getting closer to real exercise situations in the field. » INCa also specifies that the promoter of this research must propose an organization associating city and hospital and that this organization must “ …ensure simple access and optimal territorial coverage, in order to limit inequalities. »
The results of this work could lead to an effective deployment of organized lung cancer screening in France by 2030-35.
