Lung cancer: the High Authority for Health wishes to evaluate an experimental screening program

The French National Authority for Health (HAS) recommends implementing a pilot lung cancer screening program, supervised by the National Cancer Institute, before considering its possible large-scale extension.

The human cost of lung cancer remains very high

Lung cancer is the most deadly cancer in France, where it causes more than 33,000 deaths each year. The vast majority of lung cancers are diagnosed too late, at an inoperable stage, which explains a low five-year survival rate (less than 20%). In men aged 45 to 64, lung cancer is the leading cause of death. In women, the increase in the frequency of lung cancer is rapid, linked to the increase in their smoking over the past twenty years. The HAS rightly points out that tobacco is the cause of at least 80% of lung cancers.[1], and that preventing smoking is the best way to avoid these diseases and deaths.

Detecting lung cancer at an earlier stage to improve patients' chances of survival

The goal of a screening campaign is to diagnose a disease before it manifests itself through clinical signs, in a population that appears healthy but has a risk factor for developing the disease. Screening also allows for diagnosis at an earlier stage, allowing for the use of treatments that are still applicable at that stage and thus improving patient survival.

Evaluate the benefit-risk cost taking into account the risk of over-diagnosis

In 2016, the HAS considered that the conditions of quality, efficacy and safety for implementing a screening campaign were not met. Now, the public authority believes that screening for bronchopulmonary cancer by systematic low-dose chest CT in a population of smokers at high risk of developing this cancer could be effective, and could significantly reduce mortality from this cancer. However, the HAS specifies that these possible beneficial effects must be weighed against the harmful effects linked to over-diagnosis. Indeed, such screening exposes the observation of numerous non-cancerous radiological abnormalities (false positives), which require additional examinations that cause complications that are sometimes very severe and can also generate anxiety. At the same time, such screening only makes sense if it is accompanied by effective prospective and monitored management of the smoking of the screened subjects.

FT

[1] High Authority of Health, Lung cancer screening: HAS recommends the launch of a pilot program, 01/02/2022, (accessed 02/02/2022)