What is lung cancer screening ?

While chest X-rays have never shown their usefulness for lung cancer screening, a US study whose results were published in 2011 demonstrated that low-dose non-contrast chest CT scanning can detect lung cancer at an earlier stage and reduce the risk of lung cancer mortality by more than 20% in high-risk individuals.

In this study, high-risk individuals were those over 55 years old who had smoked at least one pack a day for 30 years and smokers who may have quit for less than 15 years.

A large European study whose results were published in 2020 confirmed the results of the American study, suggesting that the benefit was even greater in women than in men with a 10-year mortality reduction of 24% in men and 33% in women.

In the USA, screening is recommended for individuals over 50 years old who smoke or have smoked at least one pack a day for 20 years or two packs a day for 10 years and who continue to smoke or have quit for less than 15 years.

In France, screening is currently individualized. It is gradually being implemented nationwide for individuals heavily exposed to smoking. It mainly concerns individuals over 50 years old who have smoked more than one pack a day for 35 years, even though there is no threshold beyond which smoking is dangerous.

For these individuals, a low-dose CT scan is performed annually. Most often, pulmonologists take care of these high-risk individuals. For these individuals, they accompany screening with an attempt to quit smoking since adherence to a screening process should not be considered by the smoker as a "license to continue smoking.".

To perform this screening, the radiologist also plays a crucial role. They must be equipped with a low-dose radiation scanner often coupled with an image processing software. This software can detect small nodules that need to be monitored even if they are often benign. Some nodules will require intervention.

For this monitoring or for possible intervention, the pulmonologist and the radiologist work in cooperation with surgeons, interventional radiologists, or radiotherapists who can operate on a nodule, intervene to remove it, or irradiate it.

Interview with Doctor Bertrand Mennecier