is lymphoma cancer curable | Lung Cancer: A hope for early detection

Lung Cancer: A hope for early detection

Lung CANCER is a disease that is often fatal. Gravity is due to the fact that in the majority of cases, the damage is already very evolved when the diagnosis is carried. Systématiq screening tests...

Lung CANCER is a disease that is often fatal. Gravity is due to the fact that in the majority of cases, the damage is already very evolved when the diagnosis is carried. Routine screening of smokers with regular routine X-rays proved to be ineffective: when a tumor becomes visible on a lung radio, it is often already too late. With more than 28 000 new cases per year and 27 000 deaths, this disease, which concerns smokers in 90% of cases, is the first cancer in France, in order of frequency. Hence the idea, which has developed over the last few years, to use new imaging tools to try effective early detection and reduce mortality. The survey published today in the new England Journal of Medicine opens up new prospects for broadening such a diagnosis through a scan called spiral scanner that allows to visualize small lesions in the lungs.

The trial conducted under the auspices of Cornell University in New York was launched in 1993 and covers 31 567 people over 40 years of age, all at risk of lung cancer due to active smoking or occupational exposure to asbestos. They have benefited every year for ten years from a spiral scanner examination. The not necessarily cancerous nodules discovered during this examination were then subject to a specific protocol according to their size. For those measuring between 5 and 14 millimetres in diameter, a new scanner three months later is programmed to examine the evolution of the size. If it has grown, a biopsy is performed. If it is stable, the volunteer continues the annual screening. For those more than 15 millimetres in diameter, after antibiotic treatment, a new test is programmed, with biopsy if it persists. The difficulty of such screening is to avoid unsafe, non-risk-free interventions for small lesions that are not cancers.

Outstanding issues

After ten years, out of the 27 500 people who had actually been tested annually, 484 cases of lung cancer were diagnosed, of which 85% (412), the vast majority, were in stage 1, considered to be curable. It should be recalled that in the absence of screening only 10% of bronchial tumours are detected at this stage 1. The survival rate after 10 years for all of these patients is estimated at 80%. Of the 412 people with cancer Stage 1, 39 deaths related to the disease were observed during the surveillance period. "Spiral scan screening is able to detect lung cancer in stage 1 when it is still curable by surgery in a large proportion of people," conclude the authors. The cost of an examination is about 200 dollars and that of stage 1 lung tumour surgery is half lower than that of a later stage of the disease. We therefore consider that the efficacy/cost ratio of screening is very favourable. »

In an editorial published today also in the New England, Michael Hunger, of the Department of Diagnosis and Prevention of lung cancer of the Chase Centre (Philadelphia), explains in particular that if this study brings a lot of information Important, some issues remain unresolved. In particular, this expert questions the number of false positives (i.e., nodules diagnosed as cancer in the biopsy but not confirmed by surgery) that have not been recorded in the analysis and which must be taken into account in evaluating The risks of such screening.

For Prof. Antoine Flahault (head of the Public health Department of the Post Hospital, Paris), this work represents a certain advance and "shows that one has a potential key to improve the management of this cancer." But, he continues, to have a solid evaluation of this screening, randomized studies (Editor's note: With sample group) are necessary, with a control group to assess in the long term the mortality rate in those who are detected and those who do Have not been. »

Such randomized trials are underway in the United States. In any case, only one will not be enough to win the membership. In France, Prof. Flahault and his team have invested in an early screening project for lung cancer on 40 000 people, but at the moment they are struggling to find the necessary funding.