From randomized trials to the clinic: is it time to implement individual lung-cancer screening in clinical practice? A multidisciplinary statement from French experts on behalf of the French intergroup (IFCT) and the groupe d'Oncologie de langue francaise (GOLF).

BACKGROUND: Despite advances in cancer therapy, mortality is still high except in early-stage tumors, and screening remains a challenge. The randomized National Lung Screening Trial (NLST), comparing annual low-dose computed tomography (LDCT) and chest X-rays, revealed a 20% decrease in lung-cancer-specific mortality. These results raised numerous questions. The French intergroup for thoracic oncology and the French-speaking oncology group convened an expert group to provide a coherent outlook on screening modalities in France. METHODS: A literature review was carried out and transmitted to the expert group, which was divided into three workshops to tackle specific questions, with responses presented in a plenary session. A writing committee drafted this article. RESULTS: The multidisciplinary group favored individual screening in France, when carried out as outlined in this article and after informing subjects of the benefits and risks. The target population involves subjects aged 55-74 years, who are smokers or have a 30 pack-year smoking history. Subjects should be informed about the benefits of quitting. Screening should involve LDCT scanning with specific modalities. Criteria for CT positivity and management algorithms for positive examinations are given. CONCLUSIONS: Individual screening requires rigorous assessment and precise research in order to potentially develop a lung-cancer screening policy.

[Profile of active investigators involved in a clinical trial in general medical practice]. / Profil des investigateurs actifs au cours d'un essai clinique en médecine générale.

INTRODUCTION: Depiscan was the pilot phase of a large trial to evaluate low dose computed tomography as a screening method for lung cancer (GranDepiscan). The goal of the study presented in this manuscript was to predict the activity of general practitioners (GPs) involved as investigators in a clinical trial. METHODS: A questionnaire about GP's socio-demographic characteristics, initial involvement and perception of difficulties was sent to 189 GPs volunteers after enrollment into the Depiscan trial was complete. RESULTS: Among the 97 respondents, 61 were active investigators. Age lower than 50 years and presence during the initiation visit were significantly associated with the participation of investigators. Two other factors at the limit of significance were: the status and the type of initiation visit. The following factors: gender, type of practice, membership of a medical society, parallel activity in the public sector and knowledge of the referring pulmonary oncologist were not associated with the level of recruitment, as well as the difficulties mentioned by the investigators. CONCLUSIONS: These results will help for selection of investigators for future clinical trials in general medical practice, particularly for the GranDépiscan trial.