This is an expected and essential step in the deployment of organized lung cancer screening which has been achieved. The National Cancer Institute (Inca) announced on January 23 the launch of a pilot program which should include the first patients from the summer. In total, this project, planned to last at least three years, will screen 20,000 smokers or former smokers (for less than 15 years), aged 50 to 74, with a cumulative tobacco consumption of at least 20 pack-years.
In France, with more than 30,000 deaths each year, lung cancers are among the “deadliest”recalled Professor Norbert Ifrah, president of the Inca, during a press conference. 5-year survival currently does not exceed 20%, because almost three-quarters of cases are diagnosed at an advanced stage. There “early detection” cases “offers real chances of recovery”giving screening a “major interest for public health”he insists.
This pilot project, which foreshadows large-scale screening, is the culmination of a long journey. Several studies have already demonstrated the benefits of lung cancer screening using low-dose CT. Early detection of tumors can reduce mortality by 20 to 25%. But it was only in 2022, after the publication of the results of the European Nelson study, that the High Authority for Health gave its approval to the implementation of organized screening experiments like which is practiced for breast, cervical and colorectal cancers.
A consortium and 29 partner structures
To identify actors capable of carrying out such an experiment, Inca issued a call for applications in July 2024. And it is a consortium, called “Impulsion”, which was selected by an international jury. It is jointly coordinated by Professor Marie-Pierre Revel at the AP-HP and Professor Sébastien Couraud at the Hospices Civils de Lyon (HCL) and brings together 29 partner structures. It will receive funding of 6 million euros, a budget “up to the challenge”judge the Prince Ifrah.
In other organized screenings, the only participation criterion being age, the target population is easily identifiable. In the case of lung cancer, adding the criterion of current or former smoking adds complexity. Identification will be facilitated by the mobilization of general practitioners, advanced practice nurses (APNs), pharmacists, midwives, pulmonologists, addictologists and even radiologists.
-Concretely, a low-dose chest scan, coupled with a smoking cessation course, will be offered to the target population. The examination must be carried out twice, one year apart, then every two years. Health Insurance will cover 100% of the scans. Several methods of inviting screening will be tested, with particular attention to populations furthest from care. The ambition is to define the most relevant modalities with a view to generalization.
ARS in support of local organization
The organization will be set up in conjunction with regional health agencies (ARS), certainly starting in the promoters’ regions: Île-de-France and Auvergne Rhône-Alpes. Where a device is in place, “we don’t disorganize”assures Professor Ifrah. The results obtained by programs already installed, such as that of Foch hospital, will be taken into account. “The generalization work will be enriched by all the projects”explains the president of the Inca.
Beyond the terms of invitation to screening, the pilot program must make it possible to define the optimal conditions of implementation: duration, frequency, number of shots to be taken, place of AI in reading images, use of a low dose or at a very low dose, impact on the provision of care, etc. To anticipate the influx of patients, the French Society of Radiology has been training specialists for 2 years in performing the scanner and reading it.
The results of the pilot study will serve as a basis for setting up organized screening. “We can hope for generalization even before 2030”a deadline initially brought forward for national deployment, indicated Professor Ifrah.
