Behavior of general physicians about lung cancer screening in a French region hosting a pilot study

Introduction: Lung cancer is the leading cause of cancer-related death in France and has a 5-year survival rate of 20%. Recent prospective randomized controlled trials revealed that lung cancer-specific mortality decreased in patients who underwent screening using low-dose chest computed tomography (low-dose CT). The DEP KP80 pilot study conducted in 2016 showed that an organized lung cancer screening campaign involving general practitioners was feasible.

Material and method: We conducted a descriptive observational study of screening practices by sending a self-reported questionnaire to 1013 general practitioners practicing in the Hauts-de-France region. Our study's primary aim was to investigate the knowledge and practices of general practitioners in the Hauts-de-France region of France regarding lung cancer screening using low-dose CT. The secondary endpoint was to compare practices between general practitioners in the Somme department who had experience of experimental screening and their colleagues in the rest of the region.

Results: The response rate was 18.8% (190 completed questionnaires). Even though 69.5% of the physicians were unaware of the potential benefits of organized low-dose CT screening for lung cancer, 76% proposed screening tests for individual patients. Despite its proven ineffectiveness, chest radiography was still the most widely recommended screening modality. Half of the physicians stated that they had already prescribed chest CT to screen for lung cancer. Additionally, only 36.3% proposed chest CT screening for patients aged over 50 years with a history of more than 30 pack-years. The physicians working in the Somme department (61% had participated in the DEP KP80 pilot study) were more aware of low-dose CT as a screening modality, and offered it significantly more than their colleagues in the other departments (61.1% vs 13.4% p<0.01). All the physicians were in favor of an organized screening program.

Conclusion: More than a third of general practitioners in the Hauts-de-France region offered for lung cancer screening using chest CT, although only 18% specified low-dose CT. Before an organized screening program can be set up, good practice guidelines must be made available about lung cancer screening.