Lung cancer: For the first time in history, its disappearance is within our reach

It is the number one cancer, the deadliest. Lung cancer alone is the cause of approximately 5% of deaths in France, ie nearly 33,000 deaths per year. These symptoms are often mild. Since the lungs lack painful nerve endings, the tumor is only noticeable if it spreads. Shortness of breath, lung infection? Cancer is detected late in 85% of cases. Metastases.

It’s even more glaring since the Covid-19 crisis. Everywhere in France, oncology services are seeing the return of patients whose treatments have been delayed, canceled, victims of the cessation of the care pathway during confinement. It was unfortunately planned. The Gustave Roussy Institute expects excess cancer mortality of 2.5% per year by 2025, or 4,000 deaths per year.

And yet, it is not a fatality. For the first time in our history, we can affirm that the virtual disappearance of lung cancer is within our reach. As we have done collectively in the fight against AIDS, the triptych “prevention, detection, treatment” can drastically reduce the number of cases, while progress in immunotherapy is already allowing a spectacular improvement in the vital prognosis of the stages advances. We, health professionals, pulmonologists, addictologists, surgeons, or medical imaging specialists, therefore call collectively to make lung cancer our next Great National Cause.

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The unfailing involvement of public authorities is essential to our success. Since February, the High Authority for Health (HAS) has also chosen its side. According to its analyses, low-dose CT screening in people with high tobacco exposure reduces mortality. It therefore calls for pilot programs to be set up so as not to delay access to these screening methods.

A major issue in women’s health

Jacques Brel, Pierre Desproges, Johnny Hallyday… Behind these men who gave the disease a face, lung cancer has actually become a major issue in women’s health. The results of the French KBP-2020 study, a world reference taken up by The Lancet, shows a drastic worsening of the situation: while women accounted for 16% of lung cancers diagnosed in 2000, they were 24.3% in 2010, 34.6% in 2020. And the peak has not been reached. In Sweden, the number of new lung cancers in women is already equal to that of men.

The CASCADE program, led by the APHP since the beginning of the year, tackles the subject head-on. In addition to calling on women aged 50 to 74 to come and get screened voluntarily (see how to participate) to assess the practicalities, it is testing in real conditions the contribution of artificial intelligence to medical imaging to facilitate the detection of cancerous nodules. High-quality, rapid and efficient imaging is indeed essential to guarantee good screening for everyone, despite the additional number of patients to be treated, or the place of residence.

Objective generation without tobacco 2030

Screening and prevention must go hand in hand: 90% of lung cancers are linked to smoking! And its ravages go far beyond that. Infarction, arteritis, respiratory failure, chronic bronchitis… Associated diseases cause between 100,000 and 200,000 deaths per year.

Screening should be an opportunity to offer a quit solution to all smokers, and to make possible the objective of a tobacco-free generation by 2030. However, this is far from certain. The means are lacking, and we must continue to encourage tools to help people quit smoking. Behind the fashion for “puffs”, rightly denounced, we must not lose sight of the essential: nicotine is not carcinogenic, contrary to what the majority of French people think.

Prevention policies should apply to everyone. All over the world, the less you have a diploma, the more modest you are, the more you smoke. The proportion of smokers is twice as high among BEP holders as those with Bac+2. They must be targeted directly, and in the regions more than in Paris. We must denormalize the cigarette, but without feeling guilty. You have to accompany smokers, as many times as necessary, when they want to “quit”.

Many countries are ahead of France. The United Kingdom, the United States, and Italy have already democratized early detection, and it is time to follow in their footsteps. Not out of national pride, but because tens of thousands of lives are at stake.

Signatories: Pr Marie Pierre-Revel (Head of the Radiology Department at Cochin Hospital), Dr Nicolas Bonnet, (Director of RESPADD (1st national addiction prevention network with 850 establishments)), Pr Marie Wislez (Pneumologist, Head of the Center Expert in thoracic oncology from Cochin Hospital), Dr David Boulate (thoracic surgeon, Hôpital Nord de Marseille), Dr Gaspard d’Assignies, Antoine Jomier, Florence Moreau (co-founders of Incepto, specialist in AI applied to medical imaging).