Program 14 : Cancer Screening

Program 14 : Cancer Screening



Pr Antoine KHALIL, is a teaching professor of radiology, at Université Paris Cité, specialized in interventional and thoracic radiology. He chairs the radiology department of Hôpital Bichat – Claude Bernard Paris, AP-HP.Nord and is the refering radiologist of the thoracic oncology multidisciplinary board. He authored or co-authored more than 120 peer-reviewed articles with a specific focus in bronchial arterial emboization,  low-dose CT lung cancer screening and lung nodule management (transthoracic lung biopsy).

Pr Cédric DE BAZELAIRE, is a teaching professor of radiology, at Université Paris Cité, specialized in breast imaging and breast interventional radiography. He currently chairs the radiology unit of the integrated multidiciplinary breast cancer department (Senopole) at Hôpital Saint-Louis, AP-HP.Nord, where hundreds of women (800 to 900) are explored every year for screening mammography -detected breast lesions or nodules.

Pr Frédéric PRAT, is a teaching professor of gastroenterology and hepatology at Paris Cité University and chief of the endoscopy unit at Beaujon hospital, Assistance Publique-Paris hospitals. His translational research focuses on minimally invasive therapeutic applications of high intensity ultrasound and other physical agents to biliopancreatic cancer. Clinical interest and publications cover a wide range of interventional and diagnostic endoscopy topics, from GERD and Barrett’s esophagus to cholelithiasis and pancreatic diseases, with a particular focus on ERCP, EUS and mucosal resection techniques, including innovative endoscopic devices.

P14 - Cancer Screening

Specialists Assistants Practioners – PH / Oncology Board Certified:

  • 3 (thorax)
  • 4.5 (digestive)
  • 3 (breast)
  • 3 (cervix) FTE

Assistant head of clinic:

  • 2 (thorax)
  • 1 (digestive)
  • 2 (breast)
  • 1 (cervix)

New patients 2019:

  • 70 new patients referred for lung nodule, yearly and 158 CT-guided needle biopsies yearly
  • 158 (mammography screening) + 852 radio-guided core needle biopsies (echo-, mammography- or MRI-guided);
  • 100-150 patients referred for colonoscopy each year because of a positive fecal blood test yearly, and 50 patients with inherited genetic condition (Lynch syndrome)
  • 789 patients referred yearly  for suspect cervix cytology and 202 patients with abnormal cytology referred for colposcopy

> 98% outpatient activity


Cancer Care

In the French health system, primary cancer screening is mainly performed outside of public hospitals and organized by the national health system, with dedicated screening structures in each French department (ADECA75 in Paris). The patients are contacted via an annual notification.


The three nationally reimbursed cancer screening programs detect:

  • Breast cancer: bi-annual mammography from 50 to 74 years old performed by specialized radiologists
  • Colorectal cancer: bi-annual fecal immunological blood test from 50 to 74 years old, performed by general practitioners. For patients with a positive fecal blood test, a medical consultation is scheduled within 2 weeks and a colonoscopy is performed within a maximum of 4 weeks.
  • Cervical cancer: via cervical cytology every 1 to 3 years (depending on age and cytological first result), performed by gynecologists or general practitioners for women between 25 and 30 years old. After the age of 30, high-risk (HR) HPV testing is performed every 5 years (if negative) until the age of 65. If HR HPV is identified, cervical cytology is performed. Women with abnormal cytology should be referred for colposcopy and those with normal cytology re-tested for HR HPV 12 months later.


Lung cancer screening is not yet reimbursed at the national level, but is the subject of regional implementation. This examination can be performed as an individual opportunistic screening, for asymptomatic high-risk smokers aged between 50 and 74 years, via annual low-dose chest computed tomography (CT) scanner.


Skin cancer (mainly melanoma) screening by annual clinical skin examination of the whole body and dermatoscopy is mainly managed by dermatologists, in an opportunistic way, since this examination is not nationally organized or reimbursed. Patients are only referred in case of difficult-to-interpret skin lesion or open cancers, when further explorations are needed, systemic treatments or follow-up. The dermatology department in Saint Louis Hospital provides videodermoscopy and confocal microscope monitoring of high-risk patients.


Skin cancer in Organ Transplant Recipients (OTR): systematic skin screening of OTR is organized in the dermatology department of Bichat and Saint Louis Hospitals. Baseline skin and mucosal check-up are performed before transplantation (heart, lung or kidney transplantation) and an annual dermatologic follow-up is initiated after. In Beaujon Hospital, the same circuit has been set up for patients with hepatic transplantation. This follow-up enables early identification and treatment of skin cancers in this at-risk population.


As soon as a potential abnormality is detected in at-risk subjects, whether they needa multidisciplinary advice for more invasive exploration or radiological follow-up (for lung cancer), a colonoscopy (for colorectal cancer), a radio-guided breast cytological sampling (for breast cancer),  a colposcopy with cervical biopsy (for uterine cervix neoplasia suspected on a cytological Papanicolaou suspect smear), or a larger, deeper skin biopsy or resection (for melanocytic lesion), the subjects are directed towards specialized departments of the Cancer Institute AP-HP Nord:


  • Gastroenterology and colonoscopy departments from Louis Mourier, Beaujon, Bichat and Saint-Louis Hospitals: for colonoscopy and possibly colorectal lesions biopsies. Three colonoscopy units exist (one in each hospital) representing the highest colonoscopy activity of AP-HP with large colorectal surgery departments in each of the three hospitals. Moreover, the Saint-Louis oncogenetics department coordinates the Lynch clinical pathway for patients and families including colonoscopy follow-up as well as gynecological examinations.

A few figures:

  • Patients followed on site for cancer: a colonoscopy is performed at 1 year then every 5 years if normal, or 3 years after if new polyps have been detected (approximately 10 per week or 500 per year)
  • Patient cohort with inflammatory bowel disease (IBD): after 10 years of evolution chromo-endoscopy is performed every 3 to 5 years, except in patients with the exception of associated sclerosing cholangitis or low-grade dysplasia for whom a chromoendoscopy is scheduled every year. The IBD patient cohort is composed of around 2000 patients.
  • Patient cohort with Lynch syndrome: chromo-colonoscopy every 2 years. The Lynch patient cohort is composed of approximately 50 patients.


  • Radiology and breast diseases departments from Saint-Louis and Lariboisière Hospitals: for radio-guided biopsy and subsequent follow-up and care, depending on the histological findings. 916 mammography examinations have been performed in 2019, with 978 breast ultrasound explorations and 197 breast MRIs. Breast imaging is performed in the radiology unit at the Sénopôle including mammograms, ultrasounds, core needle biopsies (micro and macrobiopsies), marking of non-palpable lesions and in case of difficult surgical localization by using wires and harpoons. Breast MRI and biopsies under MRI guidance are performed at the radiology department at Saint-Louis Hospital. The Senopôle and radiology department hold:
  • One mammograph with tomosynthesis (Hologic, Selenia Dimension). Another mammograph is available at Lariboisiere Hospital.
  • One dedicated breast macrobiopsy table (Hologic, MultiCare Platinum) with guidance by tomosynthesis
  • Two recent ultrasounds with elastography (Toshiba, Aplio 500) used for diagnosis and breast interventional radiology
  • Breast MRIs are performed on a 1.5 Tesla MRI sanner (Siemens, Aera), which will be replaced in January 2022 by a 3T GE scanner and a 1.5T GE scanner both with dedicated breast coils for screening, diagnosis, and biopsy. To improve diagnostic performance in breast MRI, the team has been working on diffusion for decades. This technology improves the specificity of MRI.


  • Thoracic oncology, radiology and thoracic surgery departments from Bichat Hospital via their commune multidisciplinary board: for follow-up, CT-scan guided biopsy or video-surgical biopsy and resection, based on the international guidelines, mainly the Nelson trial lung nodules follow-up guidelines.


A « lung nodule » outpatient pathway has been set up in the thoracic oncology department since 2017, with a dedicated coordinating nurse, in order to perform screening of an uncovered lung nodule in patients referred by a general practitioner. The examination is usually done in one day, including functional (cardiac and lung) assessment, positron emission tomography CT (PET-CT) in case of a nodule larger than 10 mm, lung thoracic oncologist consultation, tobacco quitting counseling consultation, and radio-guided biopsy whenever indicated with further follow-up to detect any complication. All patient cases are discussed during the multidisciplinary board meetings within a 7 to 10 days period (in case of biopsy to get the histological result), or shorter in case of smaller or pure GGO nodules, which do not deserve immediate biopsy. If radio-guided biopsy is indicated, further follow-up is carried out, based on 3D volume evolution, minimally invasive, video or robot-assisted surgery, or stereotactic radiotherapy is discussed in such MDTB gathering thoracic oncologists, pulmonologists, thoracic radiologists and surgeons.


  • Gynecology departments from Lariboisière, Bichat, Louis Mourier, Beaujon and Saint-Louis Hospitals: for gynecological examination and cervical biopsy


  • Dermatology departments from Saint-Louis and Bichat Hospitals: for melanocytic lesions, but also for pre-neoplastic lesions linked to chronic HPV infections (anal or vulval). An outpatient clinic is dedicated to these patients at Bichat and St-Louis Hospitals for diagnosis, local treatment or referral to specialist (proctologist or gynecologists).


Therefore, our Institute covers a large geographical area including the north areas of Paris (XVIIth, XVIIIth, XIXth districts), the south of Seine-Saint-Denis department (93), the east of Hauts-de-Seine department (92) and receives at-risk subjects from a more than 2.5 millions inhabitants region.


FHU MOSAIC (Pr. Vilgrain, Pr. Paradis)

  • Bichat Hospital participates to the CASCADE AP-HP sponsored study. This study is dedicated to low-dose CT screening of lung cancer in high risk women (20 packs per year or more smokers, aged between 50 and 64 years old), by participating to the interpretation of LDCT and implementing commercially available AI softwares performing malignancy prediction of uncovered nodules. Pr. Khalil’s team is particularly experimented in trans-thoracic CT-guided lung nodule biopsies with 150 procedures each year, especially in small nodules (<20 mm diameter), as recently reported in a seminal paper published in the ERJ Open Res journal.

The use of blood ctDNA value in such small nodules detected by LDCT screening is also currently ongoing in collaboration with other AP-HP centers from the CASCADE study.


  • Regarding breast cancer screening, Pr. C. de Bazelaire is the PI of a PHRC program entitled « ETOLE » aiming at evaluating tomosynthesis for characterization and management of breast lesions uncovered by mammography screening. He is the senior author of a retrospective study aiming at evaluating a second-opinion review on BI-RADS classification for non palpable breast lesions (De Margerie-Mellon C et al.  Eur. Radiol. 2021; 31: 5913-23), which pooled 1909 non palpable lesions in 1732 patients.


  • Regarding colorectal cancer, Pr. F. Prat led a translational research dedicated to the evaluation of new imaging modality for resected polyps during colonoscopy, namely full-field optical coherence tomography (FFOCT) to on-site assessment of tissue architecture in order to determine whether to discard polyps and immediately advise patients on subsequent surveillance or to warrant further histologic analysis. Full-field Optical Coherence Tomography: A New Imaging Modality for Rapid On-Site Evaluation of Resected Polyps During Colonoscopy. Camus M, Beuvon F, Barret M, Dalimier E, El Bacha H, Leblanc S, Coriat R, Chaussade S, Terris B, Prat F.Gastroenterology. 2018


  • Based on the substantial expertise in infectious diseases, and the strong activity of the virology department in Bichat Hospital, several studies focusing on HPV epidemiology have been performed. Dr. Abramowitz assessed prevalence and incidence of patients with in-hospital diagnosis for potentially HPV-related cancers and estimated costs related to their management in France (PLoS One. 2018 Sep 20;13(9):e0202564.doi: 10.1371/journal.pone.0202564. eCollection 2018). Considering the high rate of social deprivation in our area, Pr. Mandelbrot and collaborators have performed a retrospective study to determine the factors associated with a diagnosis of cervical cancer at advanced stages in one of our district (BMC Womens Health. 2022 Mar 30;22(1):97. doi: 10.1186/s12905-022-01668-3).

Basic science:

  • U1149 Inserm « Centre de Recherch sur l’Inflammation (CRI) », équipe des Biomarqueurs en Imagerie (LBI)
  • Institut Cochin (Inserm U1016) : plateforme d’imagerie (G. Renault)
  • Inserm U1160 Equipe 3 : Immunité intestinale dans l’inflammation et le cancer (Pr M. Allez)


  • Antoine Khalil, Pr. G. Zalcman and Dr. V. Gounant have been involved in the writing of the French recommendations on lung cancer screening as leaders of the French Thoracic Cooperative Intergroup (IFCT).
  • M. Koskas and Dr. C. Gonthier (Bichat Hospital) organize the national teaching of colposcopy for Paris University every three years. Every year, between 5 and 10 students perform their practical internship in Bichat Hospital.

[Recommendations of French specialists on screening for lung cancer]. Couraud S, Ferretti G, Milleron B, Cortot A, Girard N, Gounant V, Laurent F, Leleu O, Quoix E, Revel MP, Wislez M, Westeel V, Zalcman G, Scherpereel A, Khalil A.Rev Mal Respir. 2021 Mar;38(3):310-325.

Intergroupe francophone de cancérologie thoracique, Société de pneumologie de langue française, and Société d’imagerie thoracique statement paper on lung cancer screening. Couraud S, Ferretti G, Milleron B, Cortot A, Girard N, Gounant V, Laurent F, Leleu O, Quoix E, Revel MP, Wislez M, Westeel V, Zalcman G, Scherpereel A, Khalil A.Diagn Interv Imaging. 2021 Apr;102(4):199-211.

[Individual lung cancer screening in practice. Perspectives on the propositions from the multidisciplinary group of the Intergroupe francophone de cancérologie thoracique, the Société d’imagerie thoracique and the Groupe d’oncologie de langue française]. Girard N, Gounant V, Mennecier B, Greillier L, Cortot AB, Couraud S, Besse B, Brouchet L, Castelnau O, Ferretti GR, Frappé P, Khalil A, Lefebure P, Laurent F, Liebart S, Margery J, Molinier O, Quoix E, Revel MP, Stach B, Souquet PJ, Thomas P, Trédaniel J, Lemarié E, Zalcman G, Barlési F, Milleron B; groupe de travail multidisciplinaire de l’Intergroupe francophone de cancérologie thoracique, de la Société d’imagerie thoracique et du Groupe d’oncologie de langue française. Rev Mal Respir. 2014 Jan;31(1):91-103.

From randomized trials to the clinic: is it time to implement individual lungcancer screening in clinical practice? A multidisciplinary statement from French experts on behalf of the French intergroup (IFCT) and the groupe d’Oncologie de langue francaise (GOLF). Couraud S, Cortot AB, Greillier L, Gounant V, Mennecier B, Girard N, Besse B, Brouchet L, Castelnau O, Frappé P, Ferretti GR, Guittet L, Khalil A, Lefebure P, Laurent F, Liebart S, Molinier O, Quoix E, Revel MP, Stach B, Souquet PJ, Thomas P, Trédaniel J, Lemarié E, Zalcman G, Barlési F, Milleron B; French lung cancer screening statement taskforce; groupe d’Oncologie de langue française.Ann Oncol. 2013 Mar;24(3):586-97.

  • De Bazelaire chaired the workshop dedicated to breast imaging at the 6th 2016 International Congress on breast disease, hosted in Paris and co-organized by Pr. L. Texeira and Dr. M. Espié from the Senopole of Saint-Louis Hospital.