2023-06-09 01:03:00
Faced with the higher than expected rate of lung cancer in women just one year following the launch of their study, the investigators of the Cascade study want to accelerate the movement. The French team coordinated by the AP-HP encourages general practitioners to send them eligible patients, i.e. without symptoms but at risk, having smoked at least 20 pack-years, still active smokers or weaned since under 15 years old.
The primary objective of the Cascade study (for lung cancer in French women by low-dose CT scan) is to test the contribution of artificial intelligence (AI) to lung cancer screening by low-dose CT scan, in a population of female smokers or ex-smokers. What is the most appropriate mode of reading the results: single or double reading? With or without AI assistance?
Nevertheless, “Our study does not just analyze the different methods of reading screening », insists Prof. Marie-Pierre Revel, head of the radiology department at Cochin Hospital (AP-HP), the main investigator of the study.
The Cascade program also aims to screen for other tobacco-related pathologies, such as coronary disease, emphysema and osteoporosis. « We will also produce data on factors essential to women’s health: bone mineral density, adherence to substitution treatments, the psychological impact of screening, etc. she specifies.
In terms of lung cancer screening, women have so far remained under-represented in large international studies. In the Nelson* randomized trial, which demonstrated the benefit of screening current and former smokers using low-dose CT scans, only 2,594 women (half having had a CT scan) were included compared to 13,195 men. (1).
In one year, the Cascade study has already included 1,300 women, 85% of whom are active smokers, and should eventually include 2,400 who will all benefit from a scanner, i.e. double the number of women in the study. Nelson.
Between 2 and 3% positive screening
The investigators expected a positivity rate of 1%. Of the approximately 1,300 women recruited, the positive screening rate (following expert review and confirmation of diagnosis) was two to three times higher than what was observed among men in the Nelson study, from the 2 to 3% once morest 0.9%. One participant presents with asymptomatic cancer for every 30 women screened.
“At the same level of smoking, the literature already told us that female smokers had a higher risk than male smokers of developing lung cancer, explains Professor Revel. But it’s another thing to be able to observe it in real life. » As early as 1996, a study by the US National Cancer Institute (NCI) had indeed demonstrated that female smokers were 1.2 to 1.7 times more likely to develop lung cancer than male smokers (2).
In 50 years, lung cancer in women has gone from almost negligible to the leading cause of cancer death in women, ahead of breast cancer. “We are witnessing the consequences of the increase in smoking among women since the 1970s”, sums up Professor Revel. According to data from the addiction prevention network, while smoking decreased overall in France between 2019 and 2021, it continued to increase in the female population, with 23% of French women smoking daily in 2021, i.e. + 2% compared to 2019.
As recommended by the National Cancer Institute (Inca) and the High Authority for Health (HAS), smokers entering the study are offered smoking cessation assistance. The study also shows that this aid is accepted by 75% of active smokers.
Before the big national experiment
In Europe, the Solace program should in future provide a “toolbox” to Member States in order to set up their respective screening programmes. In France, since February 2022, the HAS has requested the implementation of a national pilot program for the organized screening of lung cancer among smokers and former smokers. A working group, to which Professor Revel belongs, is currently hard at work. Cascade data should feed the reflections.
In order to speed up recruitment, the promoters of Cascade want to encourage general practitioners to send patients meeting the inclusion criteria to be screened by specially trained participating radiologists in the cities of Paris, Rennes and Béthune (call 06 15 06 58 35 or send an e-mail to cascade.cch@aphp.fr).
(1) H. de Koning et al, NEJM, 2020. DOI: 10.1056/NEJMoa1911793
(2) EA Zang et al, J Natl Cancer Inst, 1996. doi: 10.1093/jnci/88.3-4.183
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