Lung Cancer Detection in Patients With Airflow Obstruction Identified in a Primary Care Outpatient Practice

Bechtel, Joel J.; Kelley, William A.; Coons, Teresa; Klein, Michael; Slagel, Daniel D.; Petty, Thomas L.

doi:10.1016/s0012-3692(15)34459-7

Cited by 32 publications

(39 citation statements)

References 11 publications

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“…We believe that, just as it is important to measure and document blood pressure (for risk of future stroke), bone mineral density (for risk of future fractures) or BMI (for risk of future diabetes), lung function should be measured and recorded for assessing the risk of future lung cancer [10,[13][14][15]34]. The assessment of lung cancer risk and the utility of measuring lung function have potential clinical benefits in smoking cessation [30][31][32] and targeted CT screening [35]. There may also be utility in the early diagnosis of lung cancer where delays in the diagnosis [16], tumour size and mortality are closely related [36].…”

Section: Thoracic Oncology Rp Young Et Almentioning

confidence: 99%

See 1 more Smart Citation

COPD prevalence is increased in lung cancer, independent of age, sex and smoking history

Young¹,

Hopkins²,

Christmas³

et al. 2009

European Respiratory Journal

575

493

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Chronic obstructive pulmonary disease (COPD) is a common comorbid disease in lung cancer, estimated to affect 40-70% of lung cancer patients, depending on diagnostic criteria. As smoking exposure is found in 85-90% of those diagnosed with either COPD or lung cancer, coexisting disease could merely reflect a shared smoking exposure. Potential confounding by age, sex and pack-yr smoking history, and/or by the possible effects of lung cancer on spirometry, may result in over-diagnosis of COPD prevalence.In the present study, the prevalence of COPD (pre-bronchodilator Global Initiative for Chronic Obstructive Lung Disease 2+ criteria) in patients diagnosed with lung cancer was 50% compared with 8% in a randomly recruited community control group, matched for age, sex and pack-yr smoking exposure (n5602, odds ratio 11.6; p,0.0001).In a subgroup analysis of those with lung cancer and lung function measured prior to the diagnosis of lung cancer (n5127), we found a nonsignificant increase in COPD prevalence following diagnosis (56-61%; p50.45). After controlling for important variables, the prevalence of COPD in newly diagnosed lung cancer cases was six-fold greater than in matched smokers; this is much greater than previously reported.We conclude that COPD is both a common and important independent risk factor for lung cancer.KEYWORDS: Chronic obstructive pulmonary disease, epidemiology, lung cancer, risk, spirometry A s only 10-15% of chronic smokers get lung cancer [1], host susceptibility factors have been implicated. Age, smoking history, family history and impaired lung function have been identified as key risk factors [2]. The question that then arises is: does the association between chronic obstructive pulmonary disease (COPD) and lung cancer come down to more than a shared smoking history?Cross-sectional studies show that the prevalence of COPD is 40-70% of those diagnosed with lung cancer [3,4], although prevalence is highly dependent on diagnostic criteria, age, sex and smoking exposure [5]. As none of these studies compared the prevalence of COPD in their lung cancer cohorts with a smoking cohort matched for these variables, the significance of this finding is uncertain. Moreover, none of these studies considered that lung cancer may itself cause an obstructive effect on spirometry. It is possible that potential confounding by age, sex and packyr smoking history on COPD prevalence, and/or the possible effects of lung cancer per se on spirometry, could result in over-diagnosis of COPD and a falsely increased association between COPD and lung cancer.

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Section: Thoracic Oncology Rp Young Et Almentioning

confidence: 99%

“…This association has clinical implications for the wider use of spirometry for the early identification of those at the greatest risk of lung cancer [10,[13][14][15]34] and those who will have the most to gain from targeted smoking cessation and early diagnostic work-up for lung cancer [35].…”

Section: Thoracic Oncology Rp Young Et Almentioning

confidence: 99%

COPD prevalence is increased in lung cancer, independent of age, sex and smoking history

Young¹,

Hopkins²,

Christmas³

et al. 2009

European Respiratory Journal

575

493

View full text Add to dashboard Cite

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“…However, there is growing data to suggest that a ''COPD-based'' (but not exclusive) approach to help define screening eligibility might substantially improve these rates ( fig. 1) [4,7,8]. The Pittsburgh (PA, USA) study is the only CT screening study to date that has published the results of spirometry-defined COPD and CT-based emphysema in both the screened cohort and lung cancer cases [4].…”

Section: To the Editorsmentioning

confidence: 99%

“…These findings are supported by a large prospective study by MANNINO et al [7] showing over a 20 yr follow-up that lung cancer occurred 5-fold more frequently in those with spirometry-based COPD compared with normal lung function. Lastly, BECHTEL et al [8] screened exclusively current/ former smokers with COPD in a 1 yr community-based CT screening study and reported a lung cancer detection rate of 4-6%. Based on these observations, we suggest that lung cancer detection rates (specificity) can be improved by using a multivariate approach to CT screening eligibility that includes variables indicative of COPD [2][3][4].…”

Section: To the Editorsmentioning

confidence: 99%

Diagnosing COPD and targeted lung cancer screening: Figure 1–

Young

2012

Eur Respir J

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“…Smokers with reduced FEV1 carry as much as a five to six-fold risk of lung cancer compared with smokers with normal lung function [2,[20][21][22]. Other factors identifying a smoker at high risk of lung cancer include: the magnitude of smoking exposure (.30 pack-yrs or .30 yrs duration); age .50 yrs; family history of lung cancer; and previous asbestos exposure [23]. In a primary care screening study, these factors, in combination with impaired lung function, were shown to cost-effectively identify smokers or ex-smokers at high risk of lung cancer for computed tomography (CT) screening purposes [23].…”

Section: Reduced Fev1 and Future Morbidity/mortalitymentioning

confidence: 99%

Forced expiratory volume in one second: not just a lung function test but a marker of premature death from all causes

Young¹,

Hopkins²,

Eaton³

2007

European Respiratory Journal

259

218

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The clinical utility of spirometric screening of asymptomatic smokers for early signs of air flow limitation has recently come under review. The current authors propose that reduced forced expiratory volume in one second (FEV1) is more than a measure of airflow limitation, but a marker of premature death with broad utility in assessing baseline risk of chronic obstructive pulmonary disease (COPD), lung cancer, coronary artery disease and stroke, collectively accounting for 70-80% of premature death in smokers.Reduced FEV1 identifies undiagnosed COPD, has comparable utility to that of serum cholesterol in assessing cardiovascular risk and defines those smokers at greatest risk of lung cancer. As such, reduced FEV1 should be considered a marker that identifies smokers at greatest need of medical intervention.Smoking cessation has been shown to attenuate FEV1 decline and, if achieved before the age of 45-50 yrs, may not only preserve FEV1 within normal values but substantially reduce cardiorespiratory complications of smoking.Recent findings suggest inhaled drugs (bronchodilators and corticosteroids), and possibly statins, may be effective in reducing morbidity and mortality in patients with chronic obstructive pulmonary disease. The current authors propose that spirometry has broad utility in identifying smokers who are at greatest risk of cardiorespiratory complications and greatest benefit from targeted preventive strategies, such as smoking cessation, prioritised screening and effective pharmacotherapy.

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Lung Cancer Detection in Patients With Airflow Obstruction Identified in a Primary Care Outpatient Practice

Cited by 32 publications

References 11 publications

COPD prevalence is increased in lung cancer, independent of age, sex and smoking history

COPD prevalence is increased in lung cancer, independent of age, sex and smoking history

Diagnosing COPD and targeted lung cancer screening: Figure 1–

Forced expiratory volume in one second: not just a lung function test but a marker of premature death from all causes

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