Lung cancer screening in France: soon to be generalized?

On February 1, 2022, the High Authority of Health (HAS) spoke out in a opinion in favor of a pilot program by the National Cancer Institute (INCA) aimed at setting up organized screening for lung cancer. “the lung cancer (also called bronchopulmonary cancer) is the cancer that causes the most deaths each year in France (more than 33,000). Often diagnosed at a late stage, it is also one of the cancers with the worst prognosis, with a 5-year survival rate of 20%.. In men aged 45 to 64, it is the leading cause of death from all causes. It is on the rise in women. Tobacco is responsible for eight out of ten lung cancers” recalls the HAS. What is the situation of lung cancer screening in France today ? How? ‘Or’ What diagnose this tumor? Through blood test? To scan ? X-ray?

Organized screening for lung cancer: what does the HAS say?

There is no organized screening for lung cancer so far in France because the HAS considered in 2016 that all the conditions were not met. Today, the analysis of new data leads the authority to update its opinion. In an Opinion dated February 1, 2022, the HAS spoke out in favor of a pilot program by the National Cancer Institute (INCA) aimed at documenting the prerequisites for setting up such screening: “The data studied shows that the scanner screening at low doses in people with high tobacco exposure leads to a reduction in specific mortality. This brings the HAS at […] encourage the implementation of real-life experiments, and in particular of a pilot program by CNIB.” Indeed, “with the implementation of systematic screening in populations highly exposed to tobacco, one could observe a significant reduction in mortality specific to this cancer, of the order of 5 lives saved for every 1000 people screened“ report the authors of clinical trials analyzed by the HAS. The HAS indicates that “The goal of cancer screening is to detect people which, in an apparently healthy population, have a higher risk of contracting a disease or health problem, so that a treatment or intervention can be more effective. If an abnormality is identified, additional examinations may be necessary to confirm the diagnosis or set up a follow-up.“HAS recommends that the following aspects can be defined before initiating the pilot program:

• The target population (eligibility criteria for the population exposed to a high risk of bronchopulmonary cancer, quantification of smoking among smokers or ex-smokers by sex and passive smoking if identifiable);
• The screening procedure : methods and algorithm (duration, frequency of screening, combination with smoking cessation, definition/management strategy of suspicious pulmonary nodules,) taking into account the total duration of repeated screening examinations over a lifetime.

What are the screening tests and examinations for lung cancer in France?

To identify lung cancer, several diagnostic tests are necessary. The screening test is a chest scan at low dose without injection, an imaging technique also called computed tomography. In the event of an anomaly, the diagnostic work-up would include the‘physical examinationadditional medical imaging (x-rays) or nuclear medicine examinations and a tumor biopsy.

“When the biopsy by fibroscopy is impossible, the medical team can proceed, under local anesthesia, to a sampling of the tumor or pleural fluid through the wall of the thorax or a sample of lymph nodes. Pathological analysis can also be performed on tissue removed during surgery“emphasizes theHealth Insurance in October 2021.

Can lung cancer be detected on an X-ray?

“A chest x-ray (face and profile) is a first step. Its performances are limited, its interest being to be easy to access, allowing a quick first orientation. Any suspicious image must lead to the realization of a chest scan as soon as possible.” recommend the HAS.

Any suspicious image must lead to the realization of a chest scan as soon as possible.

She adds that “the Imaging examinations, even normal ones, do not formally rule out the diagnosis. In the event of an anomaly on the chest X-ray or strong clinical suspicion of bronchopulmonary cancer despite a normal radiological assessment, a specialized consultation (pulmonologist, oncologist, thoracic surgeon) for diagnostic purposes must be organized as soon as possible.”

What is the INESSS calculator?

the calculator of the National Institute of Excellence in Health and Social Services (INESSS) of Quebec is a tool that calculates the percentage risk of developing lung cancer over 6 years according to criteria to fill in such as age, weight, family history or whether or not you are a smoker.

Sources:

“Lung cancer screening: the HAS recommends the start of a pilot program“; February 01, 2022, HAS.

“Symptoms and Diagnosis of Lung Cancer“, October 01, 2021, Health insurance, ameli.fr.

“Better detection of lung cancer through a blood test?“, July 16, 2018, Foundation against Cancer.

“Lung cancer screening”2017, Cancer Foundation