Mass screening for lung cancer: “We need the green light from the authorities”

In an interview with the Quotidien du médecin published on November 12, Professor Marie Wislez, who works in the pulmonology department of Cochin Hospital in Paris, launched a new appeal to health authorities in favor of the implementation of mass and organized screening for lung cancer in France, based on the results of a study published in January 2020.

Attributable in 90% of cases to smoking, lung cancer is currently the most deadly cancer in France, where it is responsible for more than 30,000 deaths per year [1]. Despite this, there is still no organized and massive screening for this cancer in France today, even though such a system is already in place in three Anglo-Saxon countries in particular: the United States, Canada and Australia [2]. In the first of the three, lung cancer screening is recommended and covered from the age of 55 [3].

The American NLST study did not convince the High Authority for Health

For at least ten years, calls from doctors to the health authorities for the creation of a mass screening system for lung cancer in France have been increasing, particularly since the publication in 2011 of the results of a major American study, the NLST (National Lung Screening Trial), in the New England Journal of Medicine [4]. Conducted on 53,000 individuals, this study demonstrated "a reduction in lung cancer mortality of 20 % in smokers or former smokers (for less than fifteen years), screened every year by a low-dose scanner" [5].

Following the publication of this study, several learned societies contacted the High Authority for Health (HAS), "the public body responsible for making recommendations and assessments in health matters" [6], to defend the implementation of mass screening for lung cancer in France. In 2016, in a press kit entitled Lung cancer: conditions not met for screening among smokers, the HAS had however issued an unfavorable opinion regarding this request, arguing that "there [were] too many risks and disadvantages associated with this screening for very uncertain benefits" [7].

A new Dutch-Belgian study could change the game

However, the final results of the Dutch-Belgian Nelson study published in the New England Journal of Medicine in January 2020 may well change the minds of the French health authorities. As part of this study, 13,195 men and 2,594 women aged 50 to 74, smokers and former smokers, were regularly screened by CT scan over a period of ten years, while other people, forming a control group, were not screened over the same time interval. In the interview she gave to the Quotidien du médecin, Professor Marie Wislez indicates that the data provided by this study show among the regularly screened subjects "a decrease in mortality of 24 % in men and 33 % in women at ten years" [8].

In addition to confirming the results of the NLST study, the Nelson study innovates compared to it in its methodology. Indeed, in the Dutch-Belgian study, "The positivity of the scanner is based on the volume of the nodule [9] and its doubling speed and not on its diameter" [10], a parameter that was taken into account by the NLST study. This innovation made it possible to significantly reduce the number of scans falsely considered positive: the Nelson study shows a false positive rate of only 1 %, compared to 24 % for the NLST study.

According to Professor Wislez, this clear decrease could convince the High Authority for Health to reverse its unfavorable opinion issued in 2016: "This was justified by the NLST study (which caused numerous false positives and therefore unnecessary surgeries, and increased morbidity and mortality [11] and of a higher cost) is no longer relevant with the Nelson study" [12]. "At the moment, we are lacking the green light from the authorities to implement this screening," continues the onco-pulmonologist, who points out that "in other European countries, there are feasibility studies and initiatives."

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[1] Lung cancer: conditions not met for screening among smokers, has-sante.fr (May 19, 2016, consulted November 17, 2020). [2] Sandrine Cabut, Advocacy for lung cancer screening, Le Monde (November 21, 2018, consulted November 17, 2020). [3] Cancer screening by scanner confirms its effectiveness in high-risk subjects, The Doctor's Daily (March 30, 2020, consulted November 17, 2020). [4] Sandrine Cabut, Advocacy for lung cancer screening, Le Monde (November 21, 2018, consulted November 17, 2020). [5] Anne Prigent, Should there be organized screening for lung cancer?, Le Figaro (October 14, 2018, consulted November 17, 2020). [6] Ibid. [7] Lung cancer: conditions not met for screening among smokers, has-sante.fr (May 19, 2016, consulted November 17, 2020). [8] Professor Marie Wislez: “The conditions for mass cancer screening will soon be met”, The Doctor's Daily (November 12, 2020, consulted November 17, 2020). [9] "Small, hard, well-defined, ball-shaped tumor, swelling.", Encyclopædia Universalis (accessed November 17, 2020). [10] Cancer screening by scanner confirms its effectiveness in high-risk subjects, The Doctor's Daily (March 30, 2020, consulted November 17, 2020). [11] “Mortality due to diseases, death rate for a given disease.”, Encyclopædia Universalis (accessed November 17, 2020). [12] Professor Marie Wislez: “The conditions for mass cancer screening will soon be met”, The Doctor's Daily (November 12, 2020, consulted November 17, 2020). DNF - For a Zero Tobacco World |