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Following the American National Lung Screening Trial results in 2011 a consortium of French experts met to edit a statement. Recent results of other randomized trials gave the opportunity for our group to meet again in order to edit updated guidelines. After literature review, we provide here a new update on lung cancer screening in France. Notably, in accordance with all international guidelines, the experts renew their recommendation in favor of individual screening for lung cancer in France as per the conditions laid out in this document. In addition, the experts recommend the very rapid organization and funding of prospective studies, which, if conclusive, will enable the deployment of lung cancer screening organized at the national level.

Introduction A study on lung cancer screening using low-dose computed tomography (DEP KP80) was conducted in the Somme department in northern France between May 2016 and December 2018. We conducted a cross-sectional survey of family physicians in that department to identify potential predictive factors for their participation in this pilot study. Methods A survey questionnaire was sent to the 545 general practitioners (GPs) of the Somme department. This survey rendered it possible to identify the investigators who were active in the DEP KP80 study. The questionnaire's content was focused on the socio-demographic conditions of GPs, their professional practices, and their medical practice situations. Results The response rate was 38% (206 completed questionnaires). Active investigators in DEP KP80 accounted for 55% (n = 113) of the GPs surveyed, and non-investigators for 45% (n = 93). Age, gender, or medical practice situation were not related to the active GPs’ participation in DEP KP80. A multivariate analysis revealed that two factors were correlated with active participation in organized screening: (1) prescription of nicotine replacement therapy; (2) smoking history of the GP. Conclusions Securing the active involvement of family physicians and of the French regional cancer screening coordination centers seems essential for the future organization of lung cancer screening on a regional or national level. Our results demonstrate that incorporating smoking cessation support structures into the program would maximize the mechanism's potential.

Lung cancer is the leading cause of cancer death worldwide. In recent years, screening using low-dose CT scan has shown a reduction in lung cancer-related mortality and in all-cause mortality. The DEP KP80 study was implemented in the French department of the Somme with the aim of investigating lung cancer screening in practice. The results of the first round showed a prevalence of 2.7% for lung cancer, with the majority at localized stages (77%). The primary objective of our study was to compare the stage at diagnosis of patients with lung cancer screened as part of DEP KP80 and those who were not screened. The secondary objectives were to describe the epidemiological characteristics of lung cancer in the French department of the Somme for the period in question and to compare survival rates in screened and unscreened patients.This retrospective cohort study compared from May 2016 to December 2017 the characteristics of patients with lung cancer screened as part of DEP KP80 and those who were not screened, using data from the Somme Cancer Registry.In total, 644 patients with lung cancer were included (18 in the screened group and 626 in the unscreened group). There was a significant inversion in the stage distribution at diagnosis, with a predominance of metastatic or locally advanced stages (69%) and a minority of early stages (31%) in unscreened patients, and a majority of early stages (77.8%) and a lower proportion of locally advanced or disseminated stages (22.2%) in screened patients (p 0.01). In the screened group, there was a significant improvement in survival, a higher rate of surgical resection, and a longer time interval between first contact and treatment initiation.Lung cancer screening by low-dose CT scan in the French department of the Somme showed an impact on stage at diagnosis, with a majority of early stages in screened patients, allowing for curative treatment with a significant improvement in survival.

MicroAbstract Lung cancer screening by LD CT scan demonstrated in prior studies a decrease in lung cancer mortality, as well as in overall mortality. The aim of our prospective multicentric study was to assess the implementation of three annual lung cancer screenings in a real-life setting in France. The results of the second round of our study showed the feasibility of this screening program in the general population and revealed that it would indeed be necessary to further optimise screening participation during the subsequent rounds by improving communication with the target population and the respective healthcare professionals. Summary Introduction: Over the last few years, lung cancer screening by low-dose CT scan has demonstrated a decrease in lung cancer mortality. While this method has been in use since 2013 in the United States of America, no European country has yet implemented a systematic screening program. We hereby report the results from the second round of screening from a French cohort study. Patients and Methods: DEP KP80 is a prospective study evaluating lung cancer screening by means of three low-dose computer tomography (CT) scans at 1-yr intervals in 1,307 participants, aged 55 to 74 years old, all smokers or former smokers, having quit within the last 15 years, with over 30 pack years. The results of the first round demonstrated it was possible to conduct effective screening in real-life situations. Results: Participation was lower in this second round than in the first (35.3% vs. 73.1%, p Conclusion: As with the first round, the results of this second round confirm the feasibility and efficacy of lung cancer screening. The lower participation rate for this second round is proof of the need to improve awareness among participants and healthcare professionals of the relevance of committing to an annual screening program.

Background Cancer patients are thought to have an increased risk of developing severe Coronavirus Disease 2019 (COVID-19) infection and of dying from the disease. In this work, predictive factors for COVID-19 severity and mortality in cancer patients were investigated. Patients and Methods In this large nationwide retro-prospective cohort study, we collected data on patients with solid tumours and COVID-19 diagnosed between March 1 and June 11, 2020. The primary endpoint was all-cause mortality and COVID-19 severity, defined as admission to an intensive care unit (ICU) and/or mechanical ventilation and/or death, was one of the secondary endpoints. Results From April 4 to June 11, 2020, 1289 patients were analysed. The most frequent cancers were digestive and thoracic. Altogether, 424 (33%) patients had a severe form of COVID-19 and 370 (29%) patients died. In multivariate analysis, independent factors associated with death were male sex (odds ratio 1.73, 95%CI: 1.18-2.52), ECOG PS ≥ 2 (OR 3.23, 95%CI: 2.27-4.61), updated Charlson comorbidity index (OR 1.08, 95%CI: 1.01-1.16) and admission to ICU (OR 3.62, 95%CI 2.14-6.11). The same factors, age along with corticosteroids before COVID-19 diagnosis, and thoracic primary tumour site were independently associated with COVID-19 severity. None of the anticancer treatments administered within the previous 3 months had any effect on mortality or COVID-19 severity, except cytotoxic chemotherapy in the subgroup of patients with detectable SARS-CoV-2 by RT-PCR, which was associated with a slight increase of the risk of death (OR 1.53; 95%CI: 1.00-2.34; p = 0.05). A total of 431 (39%) patients had their systemic anticancer treatment interrupted or stopped following diagnosis of COVID-19. Conclusions Mortality and COVID-19 severity in cancer patients are high and are associated with general characteristics of patients. We found no deleterious effects of recent anticancer treatments, except for cytotoxic chemotherapy in the RT-PCR-confirmed subgroup of patients. In almost 40% of patients, the systemic anticancer therapy was interrupted or stopped after COVID-19 diagnosis., Highlights • A total of 1289 patients with solid tumours and COVID-19 were analysed. • Mortality and COVID-19 severity were mainly driven by patient general characteristics. • Overall, we found no deleterious effects of recent anticancer treatments on mortality. . • Systemic anticancer treatment was interrupted or stopped in 39% of patients.

Background Lung cancer mortality has been found to decrease significantly with low-dose (LD) computed tomographic (CT) screening among current or former smokers. However, such a screening program is not implemented in France. This study assessed the feasibility of a lung cancer screening program using LD CT scan in a French administrative territory. We report here the results of the first screening round. Patients and Methods DEP KP80 was a single-arm prospective study initiated in May 2016. Participants aged 55 to 74 years, current or former smokers of ≥ 30 pack-years, were recruited. An annual LD CT scan was scheduled. Our algorithms considered nodules 10 mm as positive; for intermediate nodules between 5 and 10 mm, 3-month CT scan with doubling time measurement was recommended. All general practitioners, pulmonologists, and radiologists from the Somme department were solicited to participate. Subjects were selected by general practitioners or pulmonologists who checked the inclusion criteria and prescribed the CT scan. Results Over a 2.5-year period, 1307 subjects were recruited. Screening was negative in 733 cases (77.2%), positive in 54 (5.7%), and indeterminate in 162 (17.1%). After the 3-month scans, 57 subjects screened positive: 26 patients exhibited 31 lung cancers (67.7% of stage 0 to I), of whom 76.9% underwent surgical resection, and 29 had no cancer (false-positive rate = 3.1%). The prevalence of lung cancer was 2.7%. Conclusion This study demonstrated the feasibility of organized lung cancer screening using LD CT scan within a real-life context in the general population.

Introduction DEP KP80 est une etude prospective multicentrique debutee en mai 2016 dans le departement de la Somme evaluant la faisabilite d’un depistage organise du cancer du poumon par scanner thoracique faiblement irradiant chez les sujets a risque: fumeurs ou anciens fumeurs âges de 55 a 74 ans avec un tabagisme superieur a 30 paquets/annees, actifs ou sevres depuis moins de 15 ans. Nous rapportons ici les resultats du deuxieme tour de scanner (T1). Methodes Deux cent dix huit medecins generalistes, 17 pneumologues et 28 radiologues ont participe a cette etude departementale et 1342 sujets ont ete recrutes. Le protocole comprenait un scanner faiblement irradiant annuel pendant 3 ans associe a une incitation au sevrage tabagique. Les inclusions se sont terminees en decembre 2018. Les resultats du premier scanner (T0) ont permis de conclure a la faisabilite en vie reelle de la mise en place d’un tel depistage [1] . Le taux de participation a ce premier tour de scanner etait de 73 % (n = 942 scanners realises), la prevalence de cancer du poumon de 2.7 % avec 77 % de stade I, II traites chirurgicalement. Le taux de faux positif etait de 3.1 %. Les 856 participants ayant eu un depistage negatif a T0 ont ete invites par l’association departementale de depistage des cancers (ADEMA80) a participer au deuxieme tour de scanner (T1). Resultats Trois cent vingt quatre scanners T1 ont ete realises soit un taux d’adhesion de 38 % (n = 324/856). Dans 92.2 % le depistage etait negatif (n = 299), dans 3.7 % il etait indetermine (n = 12) et dans 4 % positif (n = 13). Il n’y a pas eu de cancers d’intervalle. L’incidence du cancer du poumon etait de 1.54 % (n = 5 dont 2 stades IB, 1 stade IA, 1 Stade IIIA et 1 CPC localise). Les traitements ont consiste en lobectomies (n = 3), pneumonectomie completee d’une radio-chimiotherapie (n = 1) et association radio-chimiotherapie (n = 1). La valeur predictive positive etait de 38 % et le taux de faux positifs de 2.46 % (n = 8/324). Conclusion Cette etude pilote confirme avec les resultats de ce deuxieme tour de scanner la faisabilite et l’efficacite du depistage annuel du cancer du poumon par TDM faiblement irradiant et la necessite d’optimiser le taux de participation.

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 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.

Objectif de l’etude : l’etude tente de demontrer que la personnalite dependante est un facteur de risque majeur dans la depression du post-partum.Methode : une serie de questionnaires est remise a une population de parturientes. Ces questionnaires identifient le risque de presenter une depression du post-partum et une personnalite dependante.Resultats : il existe une association statistiquement significative entre les scores a l’EPDS (Edinburgh Postnatal Depression Scale) et les scores au QPD (Dependent Personality Questionnaire) (p ou = a 13, il y a 15,63 fois plus d’EPDS > ou = a 11 (de 2,7 a 42%).Conclusion : si le QPD etait realise avant la grossesse ou au debut de celle-ci, cela permettrait d’identifier une population vulnerable a la depression du post-partum.

The effect of supplying either nitrate or ammonium on nitrate reductase activity (NRA) was investigated in Brassica napus seedlings. In roots, nitrate reductase activity (NRA) increased as a function of nitrate content in tissues and decreased when ammonium was the sole nitrogen source. Conversely, in the shoots (comprising the cotyledons and hypocotyl), NRA was shown to be independent of nitrate content. Moreover, when ammonium was supplied as the sole nitrogen source, NRA in the shoots was surprisingly higher than under nitrate supply and increased as a function of the tissue ammonium content. Under 15 mM of exogenous ammonium, the NRA was up to 2.5-fold higher than under nitrate supply after 6 d of culture. The NR mRNA accumulation under ammonium nutrition was 2-fold higher than under nitrate supply. The activation state of NR in shoots was especially high compared with roots: from nearly 80% under nitrate supply it reached 94% under ammonium. This high NR activation state under ammonium supply could be the consequence of the slight acidification observed in the shoot tissue. The effect of ammonium on NRA was only observed in cotyledons and when more than 3 mM ammonium was supplied. No such NRA increase was evident in the roots or in foliar discs. Addition of 1 mM nitrate under ammonium nutrition halved NRA and decreased the ammonium content in shoots. Thus, this unusual NRA was restricted to seedling cotyledons when nitrate was lacking in the nitrogen source.

Winter oilseed rape was grown under two nitrogen fertilisation conditions. The N1-plants and N5-plants were respectively supplied with 4.5 g N per plant (N-limiting condition) and 22.5 g N per plant (non-N-limiting condition). Growth parameters and nitrate reducing capacity were monitored at five sampling stages interspersed with ammonium nitrate applications. N5-plants showed a higher growth rate producing more leaves and stems, early flower and silique formation and delayed leaf senescence. They also contained more nitrate and a higher nitrate reductase activity (NRA) especially in leaves which represented the main site of nitrate reduction before flowering. However, stems and siliques contributed to NRA especially in nitrogen-limited plants that lost their leaves early. This present study outlines the importance of siliques as individual sinks reducing nitrate essentially in the pod walls. The soluble protein content decreased in senescing leaves which was indicative of the reallocation of proteinic nitrogen towards stems and siliques. In non-limiting conditions, other nitrogen compounds of leaves may account for such a reallocation. Hence, the timing of leaf fall could contribute to the low nitrogen recovery in rapeseed.

In young planttets of chicory (Cichorium intybus L. var Witloof) nitrate reduction is mainly localized in roots. Following root excision, nitrate reductase activity rapidly decreased. This inhibition was first induced by phosphorylation of NR, followed by the decrease of NR-protein and NR-mRNA contents (Vuylsteker et al., 1997). Addition of 10" M BAP re-induced NRA in excised roots after 2 d, in vivo NRA reaching 10-fold the level of controls on day 5. This increase of NRA was related to enhanced NR-protein and NR-mRNA contents. After 4 d, BAP increased 16-fold the NR-protein and 3.5-fold the NR-mRNA levels, respectively. In vitro NRA measured in the presence of EDTA was 5.6-fold higher in BAP-treated roots than in control roots confirming the in vivo measurements. The high discrepancy between the NR-protein level and NRA shows that limiting factors other than the NR-protein content affected NRA reactivation. With 10" M NAA, in vivo NRA was enhanced seven times on day 5 and in vitro NRA was increased only 2.5 times. Enhancement of the NR-protein was more restricted with NAA than with BAP. Besides a poor effect at the transcriptional level, NAA may control NRA by a phosphorylation mechanism underscored by higher sensitivity of in vitro NRA to magnesium. Resumption of NRA in the presence of either BAP or NAA occurred simultaneously to the increase of the dry weight and was probably driven by increasing needs of reduced nitrogen to support regrowth.

International audience; Nitrate transporters are important for nitrogen acquisition by plants and in algae some require two gene products, NRT2 and NAR2, for function. The NRT2 family was already described and the recent identification of a family of the NAR2-type genes in higher plants showed that there was a homologue in Arabidopsis, AtNAR2.1. Using heterologous expression in yeast and oocytes we showed that the two Arabidopsis AtNRT2.1 and AtNAR2.1 proteins interacted to give a functional high affinity nitrate transport system (HATS). The gene knock out mutant atnar2.1-1 is deficient specifically for HATS activity and the resulting growth phenotype on low nitrate concentration is more severe than for the atnrt2.1-1 knock out mutant. Physiological characterisation of the plant N status and gene expression revealed a pattern that was characteristic of severe nitrogen deficiency. Consistent with the down regulation of AtNRT2.1 expression, the atnar2.1-1 plants also displayed the same phenotype as atnrt2.1 mutants in lateral root (LR) response to low nitrate supply. Using atnar2.1-1 plants constitutively expressing the NpNRT2.1 gene, we now show a specific role for AtNAR2.1 in LR response to low nitrate supply. AtNAR2.1 is also involved in the repression of LR initiation in response to high ratios of sucrose to nitrogen in the medium. Therefore the two component system itself is likely to be involved in the signaling pathway integrating nutritional cues for LR architecture regulation. Using a green fluorescent protein-NRT2.1 protein fusion we show the essential role of AtNAR2.1 for the presence of AtNRT2.1 to the plasma membrane.

e18552 Background: In the last few years, new drugs and strategies have emerged in the management of lung cancer (LC). ESCAP-2011-CPHG, promoted by the French College of General Hospital Respirator...

The identification of a family of NAR2-type genes in higher plants showed that there was a homolog in Arabidopsis (Arabidopsis thaliana), AtNAR2.1. These genes encode part of a two-component nitrate high-affinity transport system (HATS). As the Arabidopsis NRT2 gene family of nitrate transporters has been characterized, we tested the idea that AtNAR2.1 and AtNRT2.1 are partners in a two-component HATS. Results using the yeast split-ubiquitin system and Xenopus oocyte expression showed that the two proteins interacted to give a functional HATS. The growth and nitrogen (N) physiology of two Arabidopsis gene knockout mutants, atnrt2.1-1 and atnar2.1-1, one for each partner protein, were compared. Both types of plants had lost HATS activity at 0.2 mm nitrate, but the effect was more severe in atnar2.1-1 plants. The relationship between plant N status and nitrate transporter expression revealed a pattern that was characteristic of N deficiency that was again stronger in atnar2.1-1. Plants resulting from a cross between both mutants (atnrt2.1-1 × atnar2.1-1) showed a phenotype like that of the atnar2.1-1 mutant when grown in 0.5 mm nitrate. Lateral root assays also revealed growth differences between the two mutants, confirming that atnar2.1-1 had a stronger phenotype. To show that the impaired HATS did not result from the decreased expression of AtNRT2.1, we tested if constitutive root expression of a tobacco (Nicotiana plumbaginifolia) gene, NpNRT2.1, previously been shown to complement atnrt2.1-1, can restore HATS to the atnar2.1-1 mutant. These plants did not recover wild-type nitrate HATS. Taken together, these results show that AtNAR2.1 is essential for HATS of nitrate in Arabidopsis.

The PII signal transducing protein is involved in carbon/nitrogen (C/N) sensing in bacteria and cyanobacteria. In higher plants the function of the PII homolog GLB1 is not known. GLB1 transcripts were found in all plant organs tested, while in Arabidopsis leaves GLB1 expression and PII protein levels were not significantly affected by either the day/night cycle or N-nutrition. Its putative regulatory role in plants has been studied by analysing Arabidopsis thaliana T-DNA insertion lines in the GLB1 gene. These PII mutants showed an 80% (PIIV1 mutant) and 100% (PIIS2 mutant) reduced AtGLB1 transcript level and no detectable PII protein. They did not display an altered growth or developmental phenotype when grown under non-limiting conditions suggesting that the PII protein does not play a crucial role in plants. However, in vitro grown PII mutants did show a higher sensitivity to nitrite (NO (2) (-) ) compared to the wild-type plants. This observation is reminiscent of the role of PII in the regulation of NO (2) (-) metabolism in cyanobacteria. Furthermore, when grown hydroponically, the PII mutants displayed a slight increase in carbohydrate (starch and sugars) levels in response to N starvation and a slight decrease in the levels of ammonium (NH (4) (+) ) and amino acids (mainly Gln) in response to NH (4) (+) resupply. Although the phenotypic changes are rather small in the mutant lines, these data support the hypothesis of a subtle involvement of the PII protein in the regulation of some steps of primary C and N metabolism.

International audience; Genomic projects heavily depend on genome annotations and are limited by the current deficiencies in the published predictions of gene structure and function. It follows that, improved annotation will allow better data mining of genomes, and more secure planning and design of experiments. The purpose of the GeneFarm project is to obtain homogeneous, reliable, documented and traceable annotations for Arabidopsis nuclear genes and gene products, and to enter them into an added-value database. This re-annotation project is being performed exhaustively on every member of each gene family. Performing a family-wide annotation makes the task easier and more efficient than a gene-by-gene approach since many features obtained for one gene can be extrapolated to some or all the other genes of a family. A complete annotation procedure based on the most efficient prediction tools available is being used by 16 partner laboratories, each contributing annotated families from its field of expertise. A database, named GeneFarm, and an associated user-friendly interface to query the annotations have been developed. More than 3000 genes distributed over 300 families have been annotated and are available at http://genoplante-info.infobiogen.fr/Genefarm/. Furthermore, collaboration with the Swiss Institute of Bioinformatics is underway to integrate the GeneFarm data into the protein knowledgebase Swiss-Prot.Genomic projects heavily depend on genome annotations and are limited by the current deficiencies in the published predictions of gene structure and function. It follows that, improved annotation will allow better data mining of genomes, and more secure planning and design of experiments. The purpose of the GeneFarm project is to obtain homogeneous, reliable, documented and traceable annotations for Arabidopsis nuclear genes and gene products, and to enter them into an added-value database. This re-annotation project is being performed exhaustively on every member of each gene family. Performing a family-wide annotation makes the task easier and more efficient than a gene-by-gene approach since many features obtained for one gene can be extrapolated to some or all the other genes of a family. A complete annotation procedure based on the most efficient prediction tools available is being used by 16 partner laboratories, each contributing annotated families from its field of expertise. A database, named GeneFarm, and an associated user-friendly interface to query the annotations have been developed. More than 3000 genes distributed over 300 families have been annotated and are available at http://genoplante-info.infobiogen.fr/Genefarm/. Furthermore, collaboration with the Swiss Institute of Bioinformatics is underway to integrate the GeneFarm data into the protein knowledgebase Swiss-Prot.

1582 Background: In 2010, the French College of General Hospital Respiratory Physicians performed a prospective multicenter epidemiological study to describe the baseline characteristics and manage...

Contexte : le cancer du poumon reste un problème majeur de santé publique par son incidence et sa mortalité. Son principal facteur de risque est connu, le tabagisme. La possibilité d’un dépistage par scanner thoracique faiblement irradiant chez les sujets à risque a fait l’objet de plusieurs études à travers le monde, une réduction de la mortalité chez les sujets dépistés a été démontrée. A la suite de ces résultats, l’étude DEP KP80 a été mise en place dans le but d’expérimenter ce dépistage dans le département de la Somme. Il a été retrouvé une prévalence de 2,7% de cancers pulmonaires, avec une majorité de stades I ou II (77%). Méthode : il s’agit d’une étude rétrospective menée à partir des données du Registre du Cancer de la Somme, sur les patients ayant présenté un cancer pulmonaire diagnostiqué entre mai 2016 et décembre 2017. Afin d’évaluer l’impact et l’intérêt du dépistage, nous avons comparé les caractéristiques du groupe des patients dépistés au groupe des patients non dépistés. Résultats : au total 644 patients ont été inclus. Parmi les résultats obtenus, on note une inversion significative de la répartition des stades (classification TNM 8ème édition) au diagnostic entre les deux groupes, avec chez les patients non dépistés une prédominance de stades disséminés ou localement avancés (69%) et une minorité de stades précoces (31,0%), contrairement aux patients dépistés chez lesquels on retrouvait une majorité de stades précoces (77,8%) et une plus faible proportion de stades localement avancés (22,2%). Cet effet était directement répercuté sur la survie, avec une différence significative entre les deux groupes. On notait également des différences significatives entre les deux groupes concernant l’âge, l’histologie, les traitements, et les délais de prise en charge. Conclusion : le dépistage du cancer du poumon par scanner faiblement irradiant a montré dans le département de la Somme, après comparaison avec les patients non dépistés, un impact sur le stade au diagnostic, avec une majorité de stades précoces permettant un traitement curatif, majoritairement par chirurgie, ce qui est un facteur pronostique majeur, avec un net bénéfice sur la survie des patients dépistés.

Une campagne de dépistage du cancer du poumon par scanner faible dose est mise en place dans la Somme depuis mai 2016. Notre étude avait pour objectif principal de connaître les motivations et les réticences des médecins généralistes à participer à ce dépistage. L'objectif secondaire était de déterminer les facteurs motivants et limitants des patients à adhérer à ce dépistage. Une enquête qualitative par entretiens semi-dirigés a été réalisée auprès de 15 médecins généralistes de la Somme. Pour les médecins généralistes, le dépistage fait partie intégrante de la prise en charge des cancers notamment du cancer du poumon car il permet la détection de stades précoces rendant possible un traitement efficace et une guérison. C'est le rôle du médecin généraliste de proposer le dépistage, qui est nécessaire en raison de la prévalence du tabagisme et du cancer broncho-pulmonaire dans leur pratique quotidienne. Le dépistage est de plus un moyen de sensibilisation contre le tabagisme. Il est complémentaire à la prévention primaire. Le manque d'intérêt des patients pour se rendre chez leur médecin traitant uniquement dans le cadre de la prévention et du dépistage et le manque de temps des médecins généralistes pour aborder le sujet durant leurs consultations étaient les principaux freins à sa mise en place. Les problèmes de faux-positifs, de risque d'irradiation et de risque de surdiagnostic ont aussi été évoqués séparément par trois praticiens. Pour la plupart des médecins généralistes, le scanner restait une technique appropriée. Néanmoins, pour les patients, le scanner était une source d'inquiétude tout comme la tolérance d'examens plus invasifs. Le faible niveau socio-économique et la distance par rapports aux centres d'imagerie étaient également des facteurs limitants. Cependant, les informations données par leur médecin traitant concernant les avantages du dépistage restaient le principal levier pour leur participation. Un tiers des médecins interrogés nous ont suggérés l'idée d'une campagne d'informations auprès des patients afin d'améliorer leur adhésion. L'information des patients permettrait également aux médecins généralistes d'aborder le sujet du dépistage plus facilement car les patients pourraient consulter pour cet unique motif. Pour rappel, le taux d'adhésion des patients était de 76% dans le cadre de l'étude dans la Somme. Cette étude a mis en évidence la considération des médecins généralistes de la Somme pour la pratique d'un dépistage du cancer du poumon par tomodensitométrie à faible dose malgré la publication récente de recommandations HAS à ce sujet.