Diagnosing COPD and targeted lung cancer screening

To the Editors: We agree with Sekine et al . [1] and endorse their view that screening smokers for evidence of chronic obstructive pulmonary disease (COPD) will help identify those for who computed tomography (CT) screening for lung cancer is most appropriate [2]. We outline below further evidence supporting this viewpoint, specifically how the inclusion of COPD in screening eligibility might improve both sensitivity and specificity of CT screening for lung cancer. With respect to sensitivity, current selection criteria for CT screening for lung cancer are limited to age and pack-yr exposure, despite this having poor predictive value [1]. If future CT screening is limited to those who meet the eligibility criteria used in the National Lung Screening Trial (NLST), we estimate only 47% of all lung cancers would be eligible for screening and over 50% of lung cancers will be missed [3]. Recent studies report that about 67% of lung cancer cases have underlying COPD based on spirometric criteria (Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1+) [4, …

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[11]  D. Brizel,et al.  National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology , 2012 .