why we need to go further in screening

why we need to go further in screening
why we need to go further in screening


  • A first trial conducted in the United Kingdom with people at risk of developing lung cancer highlights the positive effects of early detection on disease management and mortality.
  • In France, no systematic screening for lung cancer has yet been organized, the High Authority for Health arguing in particular that imaging generates too many false positives.

With 33,117 deaths estimated in 2018 in France, lung cancer today remains the leading cause of cancer death in the country. In 2018, 31,231 men and 15,132 women were diagnosed with lung cancer after being screened individually. However, to better manage this disease and especially to limit mortality, it is urgent to systematize screening by computed tomography (LDCT), in particular among people at high risk.

This is shown by the results of the UK Lung Screening Trial (UKLS), the UK’s first CT-scan lung cancer screening trial. Presented at the International Association for the Study of Lung Cancer 2021 global conference and published in the Lancet Regional Health Europe, they provide new proof of the value of making more efforts in screening for lung cancer.

Get tested to reduce mortality

The trial was based on evaluating people aged 50 to 75 who were at risk of developing lung cancer over five years using the LLP risk score. From October 2011 to February 2013, researchers randomly allocated 4,055 high-risk participants between a single invitation to LDCT screening and no screening (usual care). They then collected data on lung cancer cases and deaths up to February 29, 2020 through a link to national registries, for an average of seven years.

The results are edifying. In the first group of 1,987 participants screened, 86 lung cancers were diagnosed. In the second group without screening of 1,981 patients, 75 cancers were diagnosed. 30 lung cancer deaths were reported in the screening group, and 46 in the control group. The benefit in terms of lung cancer mortality was most strikingly observed in years 3 to 6 after randomization. Overall, LDCT screening is associated with a 16% reduction in lung cancer.

For Professor John Field, from the University of Liverpool, these results “provide the necessary impetus to establish a long-term lung cancer screening or lung health program integrating LDCT screening in the UK and to encourage European countries to launch their own programs. lung cancer and surgery save lives “.

“These findings add to international evidence that low-dose CT screening reduces the risk of death from lung cancer,” abounds in Professor Stephen Duffy of Queen Mary University and the essay’s principal statistician. They also show that this screening can work in the UK. The low dose CT scan may be added to the arsenal of potential lung cancer fighting tools. “

And in France ?

Although screening is a major issue for lung cancer, which is often detected at an advanced stage, France does not yet practice systematic organized screening. In 2016, the High Authority for Health (HAS) concluded that “the conditions are not currently in place for this screening to be possible and useful”.

To justify its decision, the HAS argued in particular that lung cancer is “difficult to detect at an early stage because of its rapidity of development”. “It is not clear that there is a sufficiently long period – between when an abnormality is detectable on imaging and the onset of the first symptoms – to conduct screening.”. She also explained that “the chest scanner generates too many false positives (up to 90% of abnormalities found on the scanner turn out to be non-cancerous after examination) and remains irradiating even at low doses”.

Things could change in the next few years, explained to Why Doctor Professor Christos Chouaid, pulmonologist and lung cancer specialist at the intercommunal hospital center of Créteil, who pleads for an extension of screening organized by low-speed scanner to over 50s. . Emmanuel Macron’s speech last February to present his ten-year cancer strategy has also put the fight against lung cancer and its screening at the center of the 4th Cancer Plan. “I think this is the time to set up experiments, which may vary according to the contexts, regions and situations”, explains Professor Chouaid, who wishes “treatment at the same time as lung cancer screening based on tobacco risk”. “That is to say to be able on the occasion of these lung cancer screenings to offer comprehensive patient care to offer active smokers a smoking cessation, which remains the action of public health most effective. “

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