Eligibility criteria for lung cancer screening in France: a modelling study
Menée en France à l'aide d'une revue de la littérature publiée jusqu'en août 2024 (36 études), des données d'une enquête nationale et d'une cohorte prospective ainsi que d'une modélisation simulant 14,8 millions de fumeurs ou anciens fumeurs, cette étude estime, en fonction de critères d'éligibilité, l'effet d'un programme de dépistage précoce de la maladie sur le nombre de décès par cancer du poumon
Evidence before this study : We performed a PubMed search for articles published in English up to August 1, 2024, including the terms ((lung cancer [MeSH Terms]) OR (lung neoplasm [MeSH Terms]) OR (lung neoplasms [MeSH Terms] OR “lung cancer”) AND ((cancer screening [MeSH Terms]) OR “screening”) AND ((france [MeSH Terms]) OR “France” OR “French”) AND (“criteria” OR “strategy” OR “eligible” OR “eligibility”) AND (“Low-Dose CT” OR “LDCT” OR “CT”). Among 36 papers identified, there were two pilot studies of lung cancer screening in France, and no study had comprehensively evaluated the potential health effects of lung cancer screening under different eligibility criteria in France.
Added value of this study : Our study estimated the potential national impact of lung cancer screening on lung cancer deaths in France. We simulated 14.8 million French individuals with a history of smoking using French national survey data and individual-level prospective cohort data. Our results demonstrated that 11,000–14,000 lung cancer deaths could be prevented over 5 years by screening 2.4–4.0 million individuals, depending on eligibility criteria. Compared with categorical eligibility criteria, a risk-based eligibility strategy may prevent more lung cancer deaths, but screen older individuals. In contrast, categorical criteria may select many individuals with low anticipated screening benefit. These results will support the design of the upcoming French national pilot programme of lung cancer screening. Moreover, the methodology of simulation and modeling in this study provides a framework that may be applied in other countries, particularly in Europe as national governments consider establishing lung cancer screening programmes.
Implications of all the available evidence : Lung cancer screening in France is in an early stage. This modeling study estimating the potential reductions in lung cancer deaths under different eligibility scenarios provides information for the design of the planned French national pilot and any potential future national lung cancer screening programme. The finding that risk-based eligibility may outperform categorical eligibility criteria in terms of screening efficiency should be examined in future, real-world data from lung cancer screening in France.
The Lancet Regional Health – Europe , article en libre accès, 2025