Le dépistage individuel du cancer broncho-pulmonaire en pratique. Perspectives sur les propositions du groupe de travail pluridisciplinaire de l’Intergroupe francophone de cancérologie thoracique, de la Société d’imagerie thoracique et du Groupe d’oncologie de langue française

Perceptions and feelings of a French sample regarding lung cancer screening

INTRODUCTION

This study investigated the perceptions and feelings of a French sample about the possible introduction of lung cancer screening.

METHODS

A total of 146 individuals, aged between 19- and 64-years, participated in this study conducted between November 2020 and January 2021. Participants were divided into three groups according to their smoking status: (i) active smokers (G1); former smokers (G2); and non-smokers (G3). Each individual completed an online questionnaire evaluating their perceptions and feelings about lung cancer, screening and scans.

RESULTS

Overall, a higher percentage of former smokers (47%) indicated a greater willingness to participate in lung cancer screening compared to active smokers (19%) and non-smokers (32%). Active smokers and former smokers reported anxiety about the development of lung cancer. Active smokers who wished to participate in screening reported a greater motivation to reduce their tobacco consumption. The perception of lung cancer risk had less influence than age and socio-economic category on the participation in screening. Finally, stigma did not appear to be a barrier to undergoing screening.

CONCLUSION

Active and former smokers were generally optimistic about screening; however, active smokers showed less inclination to participate in screening compared to former smokers and non-smokers. Three main factors appeared to influence this participation: the perception of the risk of developing cancer, age and socio-economic category.

Intergroupe francophone de cancérologie thoracique, Société de pneumologie de langue française, and Société d'imagerie thoracique statement paper on lung cancer screening

Following the American National Lung Screening Trial results in 2011 a consortium of French experts met to edit a statement. Recent results of other randomized trials gave the opportunity for our group to meet again in order to edit updated guidelines. After literature review, we provide here a new update on lung cancer screening in France. Notably, in accordance with all international guidelines, the experts renew their recommendation in favor of individual screening for lung cancer in France as per the conditions laid out in this document. In addition, the experts recommend the very rapid organization and funding of prospective studies, which, if conclusive, will enable the deployment of lung cancer screening organized at the national level.

[Smoking cessation and lung cancer screening]

Several studies have shown that lung cancer screening, using annual low-dose computed tomography (CT) scan in a targeted population of smokers and ex-smokers reduces overall and lung cancer specific mortality rates. This form of screening strategy is not currently established for use in France by the French High Authority for Health. Quitting smoking is the most important measure in reducing mortality from lung cancer. The maximum benefit in reducing mortality from lung cancer should be seen through an effective combination of smoking cessation intervention and chest CT screening to identify early, curable disease. However, current data to guide clinicians in the choice of smoking cessation interventions in this specific context are limited due to the small number of randomized studies that have been carried out. The optimal approach to smoking cessation during lung cancer screening needs to be clarified by new studies comparing different motivation strategies, establishing the ideal moment to propose stopping smoking and the most effective therapies to use.

[Lung screening]

The NLST study found in more than 53,000 (former-) heavy smokers that annual screening with low-dose CT-scan (LDCT) reduced lung cancer mortality and overall mortality by 20% and 6.7% respectively. However, several potential harms of such screening strategy were underlined: over-diagnosis bias, irradiation risk, and the high rate of false-positive results that could lead to futile invasive (and potentially harmful) exams, to impact quality of life, to increase patient's anxiety and costs. All these concerns were largely debated in several recent publications. Most of them concluded in a risk/benefit ratio favoring screening strategy by LDCT. Conversely, most of American academic societies currently recommend LDCT-based lung cancer screening. In France, a taskforce edited a common statement recommending screening smokers or ex-smokers, from 55 to 75years old who have smoked at least 30packs/year. The taskforce also underlined the need for clinical trials aiming to translate screening strategy to the French setting. However, the French Health Authority recently claimed that lung cancer screening was not relevant in the current setting.

[Script concordance test for knowledge assessment of lung cancer screening]

BACKGROUND

Annual screening for lung cancer using low-dose CT-scans is associated with decreased mortality. A survey conducted in Rhône-Alpes area in France found that clinicians need education and information on this topic. Script concordance tests (SCT) are a tool for assessing clinical reasoning in situations of uncertainty. They have not previously been used in France in the context of continuing medical education.

METHOD

We created a questionnaire with 5 multiple-choice questions (MCQ) and two SCT scenarios. The questionnaire was sent to all clinicians and residents who are members of French-Speaking Respiratory Society or the French Young Pulmonologist Association.

RESULTS

One hundred and ninety answers were analyzed. Seventy percent stated that decreasing mortality was the best criterion for assessing the effectiveness of a cancer screening policy, and 75% that low-dose CT scan was the best test to achieve this in lung cancer screening. Forty-five percent knew the eligibility criteria of the population, and 62% that low-dose CT scan should be performed annually. Participation in tumor boards and certification in oncology were significantly associated with a better score at MCQ and SCT. SCT and MCQ scores were significantly correlated (Spearman's Rho 0.339; P<0.0001).

CONCLUSION

SCT are feasible by electronic survey and seem relevant. Improving knowledge of clinicians on lung cancer screening is still critical.