Assessing the relationship between lung cancer risk and emphysema detected on low-dose CT of the chest.

RATIONALE Identification of risk factors for lung cancer can help in selecting patients who may benefit the most from smoking cessation interventions, early detection, or chemoprevention. OBJECTIVE To evaluate whether the presence of emphysema on low-radiation-dose CT (LDCT) of the chest is an independent risk factor for lung cancer. METHODS The study used data from a prospective cohort of 1,166 former and current smokers participating in a lung cancer screening study. All individuals underwent a baseline LDCT and spirometry followed by yearly repeat LDCT studies. The incidence density of lung cancer among patients with and without emphysema on LDCT was estimated. Stratified and multiple regression analyses were used to assess whether emphysema is an independent risk factor for lung cancer after adjusting for age, gender, smoking history, and the presence of airway obstruction on spirometry. RESULTS On univariate analysis, the incidence density of lung cancer among individuals with and without emphysema on LDCT was 25.0 per 1,000 person-years and 7.5 per 1,000 person-years, respectively (risk ratio [RR], 3.33; 95% confidence interval [CI], 1.41 to 7.85). Emphysema was also associated with increased risk of lung cancer when the analysis was limited to individuals without airway obstruction on spirometry (RR, 4.33; 95% CI, 1.04 to 18.16). Multivariate analysis showed that the presence of emphysema (RR, 2.51; 95% CI, 1.01 to 6.23) on LDCT but not airway obstruction (RR, 2.10; 95% CI, 0.79 to 5.58) was associated with increased risk of lung cancer after adjusting for potential cofounders. CONCLUSIONS Results suggest that the presence of emphysema on LDCT is an independent risk factor for lung cancer.

[1]  Merete Osler,et al.  Effect of smoking reduction on lung cancer risk. , 2005, JAMA.

[2]  G. Swanson,et al.  Lung cancer risk in families of nonsmoking probands: Heterogeneity by age at diagnosis , 1999, Genetic epidemiology.

[3]  N. Anthonisen,et al.  Airways obstruction and the risk for lung cancer. , 1987, Annals of internal medicine.

[4]  Jennifer L. Kelsey,et al.  Methods in Observational Epidemiology , 1986 .

[5]  Tobacco carcinogens, their biomarkers and tobacco-induced cancer , 2004, Nature Reviews Cancer.

[6]  P. Burney,et al.  References values for forced spirometry. Group of the European Community Respiratory Health Survey. , 1998, The European respiratory journal.

[7]  W. Willett,et al.  Misinterpretation and misuse of the kappa statistic. , 1987, American journal of epidemiology.

[8]  R. Nakashima,et al.  Emphysema detected by lung cancer screening with low‐dose spiral CT: Prevalence, and correlation with smoking habits and pulmonary function in Japanese male subjects , 2006, Respirology.

[9]  Steven Piantadosi,et al.  Patients at high risk of death after lung-volume-reduction surgery. , 2001, The New England journal of medicine.

[10]  R. Stockley,et al.  Longitudinal changes in physiological, radiological, and health status measurements in alpha(1)-antitrypsin deficiency and factors associated with decline. , 2001, American journal of respiratory and critical care medicine.

[11]  O. Miettinen,et al.  Survival of Patients with Stage I Lung Cancer Detected on CT Screening , 2008 .

[12]  Josep Roca,et al.  References values for forced spirometry , 1998 .

[13]  S. Mayne,et al.  Previous lung disease and risk of lung cancer among men and women nonsmokers. , 1999, American journal of epidemiology.

[14]  S. Duffy,et al.  Defining high-risk individuals in a population-based molecular-epidemiological study of lung cancer. , 2006, International journal of oncology.

[15]  P. Greenland,et al.  Selection and interpretation of diagnostic tests and procedures. Principles and applications. , 1981, Annals of internal medicine.

[16]  Avrum Spira,et al.  State of the art. Chronic obstructive pulmonary disease, inflammation, and lung cancer. , 2006, Proceedings of the American Thoracic Society.

[17]  N. Anthonisen,et al.  The Effects of a Smoking Cessation Intervention on 14.5-Year Mortality , 2005 .

[18]  M. Thun,et al.  Chronic obstructive pulmonary disease is associated with lung cancer mortality in a prospective study of never smokers. , 2007, American journal of respiratory and critical care medicine.

[19]  J. Ferlay,et al.  Global Cancer Statistics, 2002 , 2005, CA: a cancer journal for clinicians.

[20]  Diane C. Tsai.  Methods in Observational Epidemiology , 1988, The Yale Journal of Biology and Medicine.

[21]  S. Hasan.  ATS statement--cigarette smoking and health. , 1996, American journal of respiratory and critical care medicine.

[22]  M S Frank,et al.  CT of the lung in patients with pulmonary emphysema: diagnosis, quantification, and correlation with pathologic and physiologic findings. , 1994, AJR. American journal of roentgenology.

[23]  M. Pirożyński.  100 years of lung cancer. , 2006, Respiratory medicine.

[24]  J. Gurney,et al.  The correlation of emphysema or airway obstruction with the risk of lung cancer: a matched case-controlled study , 2002, European Respiratory Journal.

[25]  Phillips Yy,et al.  Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, November 1986. , 1987, The American review of respiratory disease.

[26]  L. Tanoue.  CT Screening for Lung Cancer: Five-year Prospective Experience , 2007 .

[27]  B. Stoel,et al.  Densitometry for assessment of effect of lung volume reduction surgery for emphysema , 2007, European Respiratory Journal.

[28]  C. Henschke.  Early lung cancer action project , 2000, Cancer.

[29]  J. Brody,et al.  Chronic obstructive pulmonary disease, inflammation, and lung cancer , 2006 .

[30]  Tao-Sheng Li,et al.  Computed Tomography–Diagnosed Emphysema, Not Airway Obstruction, Is Associated with the Prognostic Outcome of Early-Stage Lung Cancer , 2006, Clinical Cancer Research.

[31]  R. Pauwels,et al.  Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WHO Global Initiative for Chronic Obstructive Lung Disease (GOLD) Workshop summary. , 2001, American journal of respiratory and critical care medicine.

[32]  Z. Qing.  Early Lung Cancer Detection Using Spiral Computed Tomography and Positron Emission Tomography , 2007 .