Until now, France has never implemented organized screening for lung cancer. The Haute Autorité de Santé has just come out in favor of experimenting with screening for lung cancer in people at risk. Focus on this new position.
Lung cancer screening: late diagnosis
Lung cancer (or bronchopulmonary cancer) represents the deadliest cancer on our territory : more than 33,000 French people die from it each year. It must be said that it is unfortunately often the subject of a late diagnosis, and that its 5-year survival rate is only 4% for detection at stage IV of this cancer. The leading cause of death in men aged 45 to 64, it is increasing sharply in the female population. This disease might however be avoidable since tobacco is the cause in 80% of cases.
Until now, France has never implemented organized screening for lung cancer. In a 2016 opinion, the High Authority for Health considered that all the conditions of quality, efficacy and safety were not met for such a project. This is without taking into account the publication of new data according to which screening by low-dose scanner in people heavily exposed to tobacco would allow a reduction in mortality from this cancer.
In this context, the body has just reviewed its opinion and is now in favor of setting up a real-life screening experiment for people at risk.
The benefits of screening in people at risk
The screening examination consists of an imaging technique called computed tomography. It’s actually a low-dose, injection-free chest CT scan. The purpose of such screening ? Early detection of people who are at higher risk of contracting lung cancer so that the treatments or interventions put in place prove to be more effective.
To know ! If an abnormality is identified, additional examinations as well as a biopsy of the tumor may be necessary to confirm the diagnosis or set up a follow-up.
According to the HAS, the implementation of systematic screening in populations highly exposed to tobacco might thus allow “a significant reduction in the specific mortality of this cancer, of the order of 5 lives saved for 1000 people screened (depending on the screening methods)”.
These initial results thus support the idea that the chances of recovery from lung cancer detected early would be much better than in the event of detection at an advanced stage. However, the Haute Autorité de Santé would like to point out that these encouraging results remain to be confirmed due to the high heterogeneity of the results and study protocols.
Towards generalized screening of people at risk?
While some French pulmonologists have been supporting for several years the interest of organized screening like that already in force in the United States, this type of strategy nevertheless presents risks in terms of public health. Among these risks, that of overdiagnosis, ie the diagnosis of cancerous lesions that are not very progressive or of lesions that would never have become symptomatic, or even the diagnosis of false positives. Overdiagnosis is indeed the cause of anxiety, additional examinations, and sometimes cumbersome and useless treatments for patients.
Therefore, are we heading in France towards generalized screening for lung cancer in people at risk? “The state of knowledge is still incomplete for the implementation of a systematic and organized screening program for bronchopulmonary cancer in France”, declared the High Authority of Health.
For the time being, the body recommends that the National Cancer Institute set up a pilot program as well as additional studies. Because many elements remain to be defined such as the target population, the modalities of the screening procedure, the effectiveness, safety and acceptability of screening, the organizational and economic impacts, etc. The main objective will therefore consist in obtaining essential elements of response for a possible large-scale deployment of an organized, effective and safe screening program.
Déborah L., Doctor of Pharmacy
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