Poor prognosis, diagnosis too late, management that leaves much to be desired … In the United Kingdom, a third of patients die 90 days after being diagnosed with lung cancer.
One in three Britons die within three months of being diagnosed with lung cancer. This is the result of a large study published in the journal Thorax, produced from the files of 20,142 patients. It confirms the UK’s bad reputation in this area. These results raise a broader issue, which also concerns France: that of the rapid detection of tumors, via early diagnosis but also screening.
Unequal in the face of cancer
30% of lung cancers result in death within 90 days of diagnosis, 10% within 30 days. These figures are much lower than in the rest of Europe, underline the authors of this study. “The management of cancerous pathologies is much less good than in the rest of the countries, in particular France”, confirms the Prof. Christos Chouaid, professor of pulmonology at the intercommunal hospital of Créteil (Val-de-Marne). “In lung cancer, fewer patients are operated on – that is to say diagnosed at an early stage – more of them die or have complications related to the surgery, because the centers are less specialized than in France. When we look at the management of patients who have metastases, fewer of them have access to chemotherapy and innovative drugs. “
This study highlights several risk factors for early death. Some are predictable: men are 17% more likely to die within 90 days, octogenarian patients have an increased risk of 80%, smokers 43%. Others are more surprising: the patients who entered the health system via their general practitioner, and who have carried out numerous chest x-rays, are more likely to die within three months of the diagnosis. The main reason for this is that x-rays are very poor at detecting tumors at an early stage.
Listen to Prof. Christos Chouaid, professor of pulmonology: ” We do a first x-ray, we have an anomaly, we put the patient on antibiotics. We see him again two months later and we lost time. “
Early diagnosis or screening?
In France either, the prognosis for lung cancer is not good. At 5 years, only 14% of patients survive. The first part of the problem is the lack of organized screening. However, when screening by CT scan is established, one in two cancers is diagnosed at an early stage, compared to 15% to date. Applied to patients at risk, aged 55 to 74, smokers or former smokers – weaned for less than 15 years and having smoked 30 packs per year – it reduces mortality by 20%.
Listen to Prof. Bernard Milleron, former president of the ITTC (1): ” I strongly advocate for the generalization of the scanner according to American recommendations. Health authorities are in the process of considering studies are included in the Cancer Plan. “
The other problematic aspect is the reference diagnostic examination, the x-ray. It should be systematically supplemented by a CT scan or endoscopy. This is still not the case and it hinders “early diagnosis”, that is, the detection of tumors when they are still at stage I.
A pessimistic view
It is not only imaging techniques that hamper early diagnosis, the ignorance of lung cancer as well. For example, only 62% of smokers and 21% of former smokers consider themselves at risk of lung cancer, even though they are the first to be affected by this disease.
Listen to Prof. Bernard Milleron, former president of the ITTC: ” The patient has little knowledge of the symptoms and his risk of lung cancer. The population is also quite pessimistic. “
“General practitioners also have a fairly negative view of lung cancer”, continues the Prof. Milleron. He denounces a lack of information among these professionals, yet located on the front line. “They rarely see lung cancer, often think the disease is symptomatic. And less than one in two is aware of the existence of the scanner as a screening technique, ”explains the specialist. The combination of these two elements therefore favors a late diagnosis.
The “central role” of the general practitioner
Lung cancer is found at a metastatic stage and is associated with 5% survival at 5 years. It is 90% when diagnosed at an early stage. General practitioners are on the front line to improve results: “They see less than one lung cancer per year, but they see a lot of smokers over the age of 45”, underlines the Prof. Chouaid. He believes that as soon as symptoms appear or evolve in this population, more in-depth examinations should be carried out.
Listen to Prof. Christos Chouaid, professor of pulmonology: ” General practitioners have a central role in being vigilant and in smoking cessation. “
There remain the 15% of lung cancers that are not linked to tobacco. They most often affect profiles that do not match that of the typical patient (man, smoker or ex-smoker, over 45): they are women, young people, who have never smoked… In this configuration, impossible to set up a screening, or even to diagnose the disease early.
(1) IFCT: Francophone Intergroup of Thoracic Cardiology.
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