In around thirty years, the number of new cases of cancer has almost doubled in mainland France, a more marked increase among women due in particular to an increase in smoking. For 2023, the number of new cancers is estimated at 433,136 cases, indicates a report published on Tuesday July 4 by Public Health France, the National Cancer Institute (Inca), the Francim cancer registry network and the biostatistics service. – bioinformatics of the Hospices Civils de Lyon (HCL). “Between 1990 and 2023, the number of new cases of cancer doubled, with a 98% increase in cancers in men and 104% in women, all locations combined”, according to this study appeared in SpF’s weekly epidemiological bulletin. This total evolution must however be put into perspective because it goes hand in hand with the increase in the French population and its ageing.
The increase in the incidence of cancers is indeed linked to a large extent to the demographic evolution of France, but also to an increase in the risk linked to behaviors and lifestyles, note the researchers. Among women, demographic changes explain only half of the increase in new cancers, much less than among men. If, in men, the most frequent cancers have seen their incidence drop or stabilize between 1990 and 2023, it is the opposite for women. “For men, there are a lot of rather favorable evolutions, except for skin melanoma, pancreatic and kidney cancers which continue to increase. For women, the evolutions are unfavorable for more localizations”, has summed up Dr. Florence Molinié, president of Francim, during a press conference. On the difference in incidence between men and women, “the major factor is tobacco consumption, which has increased from certain generations of women after those of men”, she pointed out.
Thus, in women, the incidence of cancers induced in part by tobacco (lip-mouth-pharynx, esophagus or lung) “increases considerably”, while it decreases in men, points out the study. “It’s a staggered incidence, specifies to L’Express Professor Marie Wislez, pulmonologist at Cochin Hospital. Today, many patients who develop lung cancer started smoking in the 1960s and 1970s with the emancipation of women and the arrival of cigarettes in their habits. They are now reaching an age where pathologies are developing.” Conversely, since the 1970s, male smoking has been declining, explains epidemiologist Valérie Olié on Public Health France.
“There is a big signal of attention on mortality from lung cancer in women, which, in the next two to three years, will exceed mortality from breast cancer”, underlined Pr Norbert Ifrah, president of the Inca, during a press conference. If tobacco is the first risk factor, other causes can also be taken into account in the development of female lung cancer adds Marie Wislez: “Passive smoking can play a role, for example, but also, perhaps, specific causes to the sociology and biology of women, which until now have been less studied.The risks associated with traditionally feminine professions and activities and the role of hormones are avenues to be explored for research.Lung cancer in women n do not always have the same particularities as those of men and they are potentially not exposed to the same carcinogens.”
Complex screening
The complexity of diagnosis for bronchopulmonary cancers is also highlighted in the “Panorama des cancers” report. Since the symptoms are suggestive of many different diseases, this disease is often diagnosed late and requires extensive and invasive tests such as biopsies (removal of a piece of lung tissue). Unfortunately, only an early diagnosis allows curative surgery (curing cancer by removing the tumor) maximizing the chances of remission.
To remedy this flaw in the screening process, the National Cancer Institute presents in its overview a “pilot program” aimed at smokers and former smokers. It aims in particular to set up organized screening, such as breast cancer for example. “Mass, organized, high-throughput screening would make it possible to detect lung cancer before the appearance of symptoms and therefore at an earlier stage, with better chances of recovery. We are currently conducting discussions with several actors in the fight against cancer to set the precise criteria and the organizational methods: an age group, for example between 50 and 74 years old, the quantity of tobacco smoked, since when… and of course associating a proposal for smoking cessation” , list Marie Wislez. These systematic screenings could concern millions of eligible smokers or former smokers.
Another aspect of this program is to make this screening more bearable for patients while remaining effective. The “low dose” chest scanner (STFD) would make it possible to detect suspicious images early and without invasive examination, explains the Inca in its report. “It is not so much this scanner technology that is innovative but the way of reading the images, in volume rather than in size, and comparing their evolution”, nuance Marie Wislez. New and more reliable expertise in the reading of scanners which will require the training of healthcare professionals and the appropriate image analysis computer tools. Thanks to these developments, early detection should allow a “significant reduction in specific mortality from lung cancer”, assures Florie Fillol, Inca prevention project manager.