P62.01 PREVALUNG: Evaluation of Lung Cancer Prevalence in Patients With Smocking-associated Atherosclerotic Cardiovascular Diseases

Abstract

Listen

Translate article

Lung cancer is the leading cause of cancer related death in France and Worldwide. Lung cancer screening based on low dose thoracic computed tomography (low dose CT) in patients selected on age and lifelong tobacco consumption has proven to improve lung cancer related mortality. However, the definition and identification of patients eligible for lung cancer screening is a challenge that may limit lung cancer screening program implementation. Epidemiological data shows that 30 to 40% of patients with lung cancer present a history of cardiovascular disease, mainly atheromatous diseases such as peripheral arterial diseases and coronary artery stenoses. We hypothesized that patients with history of smoking who developed atheromatous disease could represent a population at high risk to develop lung cancer. Our main objective was to evaluate the prevalence of lung cancer among patients with atherosclerotic disease and history of tobacco consumption. Our second objective was to evaluate the lung cancer screening program implemented to measure the prevalence. We implemented a monocentric prospective epidemiological study to evaluate the prevalence of lung cancer among 500 patients with inclusion criteria i.e age 45-75 years old, history of at least 10 years of daily tobacco consumption preceding the onset of an atherosclerotic disease. Principal exclusion criteria were history of active carcinoma < 5 years, symptoms of lung cancer, follow-up for lung nodules and grade IV dyspnea. Patients with inclusion criteria are referred for an inclusion visit (V0) with a thoracic surgeon by adult cardiologists, vascular surgeons and adult cardiac surgeons in charge of the patient. After information and inclusion, a low dose CT scan is scheduled within 7 months and a smoking cessation visit is proposed in case of active smoking. Blood and gut microbiota samples are harvested the day of the low dose CT. Positive low-dose CT are discussed weekly at the multidisciplinary thoracic oncologic staff meeting and managed accordingly to the current European and national recommendations. A clinical follow-up is scheduled by phone at 3, 6 and 12 months after the low-dose CT to evaluate oncologic and cardiovascular events. Between November 2019 and April 2021 we included 487 of the 500 patients scheduled, 330 low dose CT were completed, 7 localized primary lung cancer were resected by minimally invasive lobectomy, 1 patient was treated by radiation alone without pathological proof for a lung nodule, 1 patient was related with systemic therapy for a stage IV primary lung cancer and 2 patients are waiting for surgical resection for clinically localized lung cancers. The implementation of a lung cancer screening program dedicated to patients followed-up for tobacco related atherosclerotic diseases is feasible and will allow to evaluate both lung cancer prevalence and short-term benefits of lung cancer screening in this population.