Proportion of lung cancer patients eligible for screening in France: Data from the KBP-2020-CPHG study

Lung cancer remains the leading cause of cancer-related mortality worldwide. Screening with low-dose CT reduces lung cancer mortality. France implemented a pilot lung cancer screening program in may 2026 targeting individuals at high risk based on age and smoking history. We estimated the proportion of patients with lung cancer who would have been eligible for screening under different eligibility criteria.

We analysed data from the KBP-2020-CPHG cohort, including 8999 patients with newly diagnosed lung cancer enrolled in 82 French non-academic hospitals in 2020. Five screening eligibility models were evaluated: the French pilot program criteria (Model 1a) and an age-extended version (Model 1b); criteria derived from the NELSON trial (Model 2); and two simplified models based on smoking exposure using pack-years (Model 3) or smoking duration (Model 4). Eligibility proportions were calculated among patients with complete data.

Among 6015 patients analysed, 49.9% met the current French pilot screening criteria (Model 1a). The main reasons for ineligibility were lower smoking intensity (39.9%) and age ≥ 75 years (24.0%). Extending the upper age limit to 79 years increased eligibility to 54.3%. NELSON-based criteria identified 48.4% of patients as eligible. Simplified criteria based on ≥ 20 pack-years and ≥ 20 years of smoking identified 55.2% and 59.0% of patients, respectively.

Under current French eligibility criteria, about half of patients with lung cancer would have been eligible for screening. Broader or simplified smoking-related criteria could increase the proportion of lung cancers detectable through screening and should be considered in population-based screening programs.