Preliminary results of a french pilot trial of lung cancer screening by low dose CT scan in the department of the Somme (DKP80)

Abstract

Lung cancer screening is controversial in France, especially since the negative report of the French Nationnal Authority for Health (HAS) and despite the results of large-scale international studies, particularly the NLST study showing a 20% decrease in specific mortality and in general mortality 6.7%.

DKP80 is a single-arm, prospective study started in May 2016. The inclusion criteria are those of the NLST study. An annual low dose CT scan is scheduled. 2 rounds are planned, 1500 participants are expected. Our algorithms considered as negative <5mm nodules, as positive> 10mm nodules and recommended a 3-month CT for nodules between 5 and 10 mm with measurement of the doubling time. Smoking cessation encouragement is part of the protocol.

This study is managed by the departmental cancer screening agency (ADEMA80).

All general practitioners, pulmonologists and radiologists from Somme were solicited by mail to participate in this study.

218 general practitioners, 17 pneumologists and 28 radiologists accepted to participate in this study. 998 subjects were recruited in 20 months and 663 scans were performed representing a participation rate of 66%. Screening was negative in 608 cases (92%), positive in 42 (6.3%) and indeterminate in 13 (1.9%).

17 cancers were detected. There were 10 adenocarcinomas,2 squamous cell carcinomas, 1 carcinoid tumor, 2 small cell carcinomas and 2 unknown. There were 9 Stage IA (53%).

The lung cancer detection rate is 2.5% and the Positive Predictive Value is 40%.

This study demonstrates the feasibility and effectiveness at a regional level of organized and structured screening of lung cancer by low dose CT scan in France.