Lung cancer is likely to become a real “pandemic” in a few years’ time in women, currently invited in France to be screened as part of an experiment, before a possible generalization. “Lung cancer is no longer a disease of men”: this is the main finding of a study presented in January at the congress of French-language pneumology.
Carried out every ten years since 2000, it measures the evolution of these cancers treated and diagnosed in non-university centers in France. “What we saw in 2020 was a very clear increase in the female contingent in lung cancer,” explains his coordinator, pulmonologist Didier Debieuvre (head of department, GHRMSA-Mulhouse). “We went from 16% of women [parmi les personnes] lung cancer in 2000 to 24.3% in 2010 and 34.6% in 2020”.
The fear of a “real pandemic”
In the under 50s, parity has almost been reached since 41.1% of patients are now women. In question, the development of female smoking from the 1960s, tobacco being the cause of these cancers in more than 87% of cases in the general population and 75% in women. If, in the United States, lung cancer has already become the first cause of death by cancer in women, “we expect this to be the case in France shortly”, warns Dr Debieuvre, who fears a “real pandemic”.
However, these cancers remain diagnosed too late, very often at the metastatic stage (58% of cases), which considerably reduces the chances of survival. Several studies have demonstrated the benefits of CT screening. In the United States, the increase in the early detection of lung cancer since 2014 has saved around 10,100 lives, underlines a study published this Wednesday in the British medical journal. In France, this cancer is not covered by organized screening, as is the case with breast, colon or uterine cancer, which is systematically offered to an entire target population.
The health authorities essentially fear a risk of “overdiagnosis”: identifying tumors that do not evolve into cancer and therefore imposing heavy and unnecessary treatments. They have recently opened the way to a possible generalization. In an opinion issued in February, the High Authority for Health (HAS) encouraged “the implementation of real-life experiments before considering the deployment of a large-scale organized screening program”.
In this context, the Assistance Publique-Hôpitaux de Paris (AP-HP) has just launched a pilot study (entitled “Cascade”) which consists of inviting 2,400 smokers or ex-smokers, aged 50 to 74, to detect. They must be from Paris, Rennes, Grenoble or Béthune, and not show symptoms of the disease because it is a question of prevention. “For two years, they will be offered three low-dose radiation scanners and medical follow-up,” explains Marie-Pierre Revel, head of service at Cochin hospital, which oversees this project.
“In France as in Spain, the epidemiological situation among women is extremely worrying with an increase in the mortality rate due to this cancer of 3% every year”, she insists, justifying the choice of an exclusively female target. . Several studies have shown that CT can detect small, incipient tumours, very early on, considerably reducing the risk of death. In women, it would be reduced by 59% eight years after the start of screening.
The objective is therefore not so much to demonstrate the interest of screening, but rather to determine what could be the modalities of a more massive device, if it were decided. “One of the questions concerns the reading of scanners: can it be done by a single radiologist, trained and assisted by artificial intelligence software? “, illustrates for example Marie-Pierre Revel. So far, some 500 women have come forward to participate in the screening. This invitation is also an opportunity to offer “help with weaning”. We must manage to “detrivialize the fact of smoking”, concludes Marie-Pierre Revel.