Search

Risk factors and prevention of lung cancer. In France, lung cancer is the leading cause of death from cancer with more than 30,000 deaths per year. The vast majority (85%) of lung cancer are due to tobacco and the duration of smoking has a greater impact than the amount smoked. Passive smoking increases the risk of lung cancer and is responsible for around 25% of lung cancers in non-smokers in France. The risk of lung cancer linked to cannabis smoke hasn't been demonstrated, but is suspected. Other carcinogens found in certain workplaces, such as asbestos, or in the environment, such as radon in granite soils and urban air pollution, increase the risk of lung cancer. The maximum benefit on lung cancer mortality reduction should be obtained by combining smoking cessation and lung cancer screening by chest CT. Lung cancer screening has shown its effectiveness, but is currently not recommended in France. Measures to promote smoking cessation are known and include public health measures to de-normalize tobacco (neutral packaging, ban on advertising, significant increase in its price) and treatments that have been shown to be effective in smoking cessation: nicotine replacement therapy, varenicline and cognitive behavioral therapy.Facteurs de risque et prévention des cancers du poumon. En France, le cancer du poumon est la première cause de mortalité par cancer, avec plus de 30 000 décès par an. La très grande majorité (85 %) des cancers du poumon sont dus au tabac. La durée du tabagisme a un impact plus important que la quantité fumée. Le tabagisme passif augmente aussi le risque de cancer du poumon et serait responsable d’environ 25 % des cancers du non-fumeur en France. Le risque de cancer du poumon lié à la fumée de cannabis n’est à ce jour pas démontré mais est suspecté. D’autres cancérogènes trouvés dans certains lieux de travail, tels que l’amiante, ou dans l’environnement, tel que le radon des sols granitiques, et la pollution de l’air des villes peuvent augmenter le risque de cancer du poumon. Le bénéfice maximal sur la réduction de la mortalité par cancer du poumon pourrait être observé par le sevrage tabagique et le dépistage par scanner thoracique. Le dépistage a montré son efficacité, mais n’est pas à ce jour recommandé en France. Les mesures pour favoriser le sevrage tabagique comportent les mesures de santé publique pour dénormaliser le tabac (paquet neutre, interdiction de la publicité, augmentation importante de son prix) et les traitements qui ont démontré leur efficacité dans le sevrage tabagique : la substitution nicotinique, la varénicline et les thérapies cognitives et comportementales.

The combination of surgery with chemotherapy is the standard of care in stage II-IIIa surgical non small cell lung cancer. The survival benefit of chemotherapy corresponds to 4 to 8%. This benefit has been proved mainly by postoperative chemotherapy trials. When the positive results were published, most preoperative chemotherapy trials were closed. Nevertheless, the same survival benefit could be expected in preoperative chemotherapy trials. Furthermore preoperative chemotherapy has advantages: compliance of chemotherapy is excellent and tumor chemosensibility can be estimated. As the sequence of chemotherapy and surgery is not yet established, the French recommendations of the SOR (Standards, Options and Recommendations) suggest either pre or postoperative chemotherapy.