A cancer too often detected too late
Lung cancer is the leading cause of cancer mortality in France: nearly 30,900 deaths per year, with approximately 53,000 new cases diagnosed annually.
Its prognosis remains particularly bleak: the 5-year net survival rate is only 20%, largely because 73% of cases are detected at an advanced stage, when symptoms finally appear.
However, at this stage, therapeutic options are significantly limited.
Early detection is a radical game-changer. The Cochrane meta-analysis demonstrated this: low-dose CT screening reduces lung cancer-specific mortality by 20%.
This is precisely the ambition of the IMPULSION program.
IMPULSION: From Nice to the Whole of France
The IMPULSION program (IMPlémentation du dépistage du cancer PULmonaire en populatiON) has been officially launched nationwide by the Ministry of Health, following several years of preparation and local experimentation.
IHU RespirERA is one of its founding pillars.
Under the direction of Pr Charles-Hugo Marquette, the IHU has pioneered the development of this innovative approach, alongside the project's national coordinators, Pr Marie-Pierre Revel (AP-HP) and Pr Sébastien Couraud (Hospices Civils de Lyon).
The program benefits from the support of a consortium of 29 partner organizations, reflecting an unprecedented collective commitment from the French medical and scientific community.
"Currently, we are detecting a new case of lung cancer every 10 to 15 days. Without screening, these patients would have arrived in our departments in three to five years, with the disease at a much more advanced stage."
– Pr Charles-Hugo Marquette, IHU RespirERA
If IHU RespirERA was chosen as one of the pillars of the national program, it is the result of several years of fieldwork, organizational innovation, and conclusive results.
In two years of local experimentation, 900 people have been screened in Nice, with eloquent results: where cancer is usually discovered too late, the Riviera teams are now succeeding in detecting it at a so-called "infra-centimetric" stage (tumors of barely a few millimeters, still operable and curable).
A comprehensive approach, well beyond a simple scan
What distinguishes IMPULSION is its holistic vision of pulmonary health. The proposed pathway is not limited to cancer detection; it systematically combines three complementary dimensions:
🔬 Low-dose chest CT scans form the core of the program.
Each participant undergoes two scans one year apart, and then every two years. Radiation exposure is minimized while still enabling the early detection of lesions, including tumors of just a few millimeters that are barely visible. Eligible patients can receive a scan within approximately one week, compared to several weeks or even months in a traditional healthcare pathway.
🌬️ Spirometry (breath measurement) completes this respiratory assessment.
It notably enables the detection of frequent but often unrecognized conditions, such as COPD (chronic obstructive pulmonary disease): approximately 15% of those screened present an undiagnosed COPD, and one third present emphysema.
🚭 Smoking cessation support is integrated from the very start.
And for good reason: smoking is responsible for nearly 80% of diagnosed lung cancers. Combining screening and smoking cessation reduces the risk of lung cancer death by 38% (NLST study). A tobacco cessation consultation is therefore systematically offered to active smokers or those who quit less than 15 years ago, ideally before the first scan.
The key role of healthcare professionals
General practitioners and healthcare professionals play a central role in the success of the program. They are the ones who, on a daily basis, identify eligible patients and guide them toward the protocol.
Inclusion can take place in several ways: during a medical consultation, at certain health examination centers of the National Health Insurance (Assurance Maladie), via the digital platform, or by telephone.
The attending physician is systematically kept informed of their patient's participation and receives the reports of the screening scans.
The 4 steps of the screening pathway
1 – Identification and invitation: Eligible patients are identified during medical consultations, via the depistage-cancer-poumon.fr platform, by phone at 34 33, or through community outreach initiatives targeting populations furthest from the healthcare system.
2 – Inclusion visit: Verification of eligibility, comprehensive information regarding the program, and collection of informed consent. It is at this stage that the tobacco cessation consultation is offered to smokers.
3 – Referral for the scan: Performing the low-dose chest CT scan in a partner radiology center. The interpretation is independently performed by two specialized radiologists.
4 – Follow-up: Receipt of reports and organization of care in the event of a positive result, in coordination with the attending physician.
Am I eligible?
The program is aimed at individuals meeting the following criteria:
- Age: between 50 and 74 years old
- Smoking status: active smoker or ex-smoker who quit less than 15 years ago
- Cumulative consumption: at least 20 pack-years (for instance, 1 pack/day for 20 years), with thresholds adapted according to the duration and method of consumption
- Social Security affiliation
- Absence of medical contraindications
On the reimbursement side: low-dose CT scans are covered at 100% by the French Health Insurance (*Assurance Maladie*). Inclusion and tobacco cessation consultations are reimbursed under standard conditions.
A progressive national rollout
Starting today, 5 pilot regions, including the Sud region, are launching the initial phase of the program. The objective: to recruit 20,000 voluntary participants over 18 to 24 months nationwide, including 1,600 in the Sud region alone.
If the expected results are confirmed, IMPULSION could serve as a model for a large-scale rollout by 2030, as part of the ten-year cancer control strategy (2021-2030) led by the INCa (French National Cancer Institute).
To participate or to learn more
📞 National toll-free number: 34 33
🌐 Dedicated website: www.depistage-cancer-poumon.fr
📧 IHU RespirERA Contact: impulsion@chu-nice.fr
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