Lung function impairment in lung cancer screening: discordance between risk and screening outcomes when looking through a PRISm

Young, Robert P.; Scott, R.J.; Gamble, Greg

doi:10.21037/tlcr-22-634

“…Our findings are consistent with the report published by Young et al in 2022, which found that individuals with PRISm have more advanced lung cancers and the greatest lung cancer lethality. [21] The prevalence of PRISm and AO in previous population-based and hospital-based studies gave a wide range of results. In our study, the proportions of PRISm and AO were 14.3% and 7.9%, compared to 10.2% and 13.1% in a population-based cohort in Korea.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings are consistent with the report published by Young et al in 2022, which found that individuals with PRISm have more advanced lung cancers and the greatest lung cancer lethality. [21]…”

Section: Discussionmentioning

confidence: 99%

“…Lung cancer screening did not have a mortality reduction benefit in people with severe airflow limitation. [21, 42] By incorporating FEV1 into screening criteria, we may preferentially select people who are not healthy enough to undergo follow-up curative treatments for lung cancer, or whose life expectancy is limited that they do not benefit from early detection of their cancer.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impaired lung function and lung cancer risk in 461,183 healthy individuals: a cohort study

Kyaw,

Tsai,

Wen

et al. 2023

Preprint

0

View full text Add to dashboard Cite

BackgroundIt has been known that smoking and various lung diseases including lung cancer can cause lung function impairment. However, the impact of different types of lung function impairments, such as preserved ratio impaired spirometry (PRISm) and airflow obstruction (AO), on the incidence and mortality of lung cancer in both general and never-smoker populations remains unclear. We wished to examine the effect of lung function impairments on lung cancer risks.MethodsThis was a retrospective cohort study of individuals from a health surveillance program in Taiwan who underwent baseline spirometry tests at the entry point. PRISm was defined as an FEV1/FVC (Forced Expiratory Volume in 1 second/ Forced Vital Capacity) ratio >0.7 and FEV1 <0.8, while AO was defined as an FEV1/FVC ratio <0.7. Cox proportional hazards models and cubic spline curves were used to examine the associations between lung function impairments and lung cancer risks.ResultsThe study included 461,183 individuals, of whom 14.3% had PRISm and 7.9% had AO. A total of 4,038 cases of lung cancer and 3,314 lung cancer-related deaths were identified during the 23 years of follow-up. Individuals with PRISm and AO exhibited a higher risk of lung cancer incidence and mortality compared to those with normal lung function. The adjusted hazard ratios (aHRs) and 95% confidence intervals (95%CI) were 1.14 (1.03-1.26) and 1.23 (1.10-1.37) in the overall cohort, and 1.08 (0.93-1.24), and 1.23 (1.05-1.45) in the never-smoker cohort. The risks of both developing and dying of lung cancer increased with the severity levels of lung function impairments and lower FEV1 values.ConclusionImpaired lung function is associated with increased risks of developing lung cancer and subsequent mortality. The study highlights the importance of considering lung function in lung cancer screening for better candidate selection.WHAT IS ALREADY KNOWN ON THIS TOPICImpaired lung function is a common condition that can be observed in people with smoking habits and other respiratory illnesses including lung cancer. However, the effect of lung function impairment alone on the risks of lung cancer incidence and mortality is not clear. Early detection of lung cancer is essential for effective disease management, and lung cancer screening is a key preventive measure that can help achieve this. However, current lung cancer screening guidelines only consider age and smoking history, not lung function status.WHY THIS STUDY ADDSImpaired lung function is associated with an increased risk of lung cancer in a large Asian cohort. Nonetheless, among never-smoking individuals exhibiting spirometrically defined PRISM/AO, the observed risks were found to lack statistical significance, with the exception of lung cancer mortality within the non-smoking PRISm subgroup.HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICYLung function status should be taken into consideration in lung cancer screening criteria. The importance of monitoring and addressing lung function impairment in lung cancer risk management should also be widely shared with the medical community and the public.

show abstract

“…Our findings are consistent with the report published by Young et al in 2022, which found that individuals with PRISm have more advanced lung cancers and the greatest lung cancer lethality. 21 Prevalence of PRISm and AO The prevalence of PRISm and AO in previous populationbased and hospital-based studies gave a wide range of results. In our study, the proportions of PRISm and AO were 14.3% and 7.9%, compared with 10.2% and 13.1% in a population-based cohort in Korea.…”

Section: Discussionmentioning

confidence: 99%

Impaired lung function and lung cancer risk in 461 183 healthy individuals: a cohort study

Kyaw,

Tsai,

Wen

et al. 2024

BMJ Open Resp Res

0

View full text Add to dashboard Cite

BackgroundIt has been known that smoking and various lung diseases including lung cancer can cause lung function impairment. However, the impact of different types of lung function impairments, such as preserved ratio impaired spirometry (PRISm) and airflow obstruction (AO), on the incidence and mortality of lung cancer in both general and never-smoker populations remains unclear. We wished to examine the effect of lung function impairments on lung cancer risks.MethodsThis was a retrospective cohort study (1 January 1994 to 31 December 2017) of individuals from a health surveillance programme in Taiwan who underwent baseline spirometry tests at the entry point. PRISm was defined as an FEV1/FVC (forced expiratory volume in 1 s/forced vital capacity) ratio >0.7 and FEV1<0.8, while AO was defined as an FEV1/FVC ratio <0.7. Cox proportional hazards models and cubic spline curves were used to examine the associations between lung function impairments and lung cancer risks.ResultsThe study included 461,183 individuals, of whom 14.3% had PRISm and 7.9% had AO. A total of 4038 cases of lung cancer and 3314 lung cancer-related deaths were identified during the 23 years of follow-up. Individuals with PRISm and AO exhibited a higher risk of lung cancer incidence and mortality compared with those with normal lung function. The adjusted HRs and 95% CIs were 1.14 (1.03 to 1.26) and 1.23 (1.10 to 1.37) in the overall cohort, and 1.08 (0.93 to 1.24), and 1.23 (1.05 to 1.45) in the never-smoker cohort. The risks of both developing and dying of lung cancer increased with the severity levels of lung function impairments and lower FEV1values.ConclusionImpaired lung function is associated with increased risks of developing lung cancer and subsequent mortality. The study highlights the importance of considering lung function in lung cancer screening for better candidate selection.

show abstract

“…However, unexpectedly, the people with a greater smoking burden are not those with the larger benefit of LC screening. This is due, on the one hand, to the higher incidence in these subjects of more aggressive and less curable LC histotypes as small-cell carcinoma and squamous-cell carcinoma [ 73 , 100 , 101 ] and, on the other hand, to the effect of comorbidities as competing causes of death, especially CVD, which substantially decrease the years of life that can be potentially gained in subjects with screening-detected LC [ 50 , 52 , 73 , 102 , 103 ].…”

Section: Open Questionsmentioning

confidence: 99%

Lung Cancer Screening with Low-Dose CT: What We Have Learned in Two Decades of ITALUNG and What Is Yet to Be Addressed

Mascalchi

¹

,

Picozzi

²

,

Puliti

³

et al. 2023

Diagnostics

7

0

View full text Add to dashboard Cite

The ITALUNG trial started in 2004 and compared lung cancer (LC) and other-causes mortality in 55–69 years-aged smokers and ex-smokers who were randomized to four annual chest low-dose CT (LDCT) or usual care. ITALUNG showed a lower LC and cardiovascular mortality in the screened subjects after 13 years of follow-up, especially in women, and produced many ancillary studies. They included recruitment results of a population-based mimicking approach, development of software for computer-aided diagnosis (CAD) and lung nodules volumetry, LDCT assessment of pulmonary emphysema and coronary artery calcifications (CAC) and their relevance to long-term mortality, results of a smoking-cessation intervention, assessment of the radiations dose associated with screening LDCT, and the results of biomarkers assays. Moreover, ITALUNG data indicated that screen-detected LCs are mostly already present at baseline LDCT, can present as lung cancer associated with cystic airspaces, and can be multiple. However, several issues of LC screening are still unaddressed. They include the annual vs. biennial pace of LDCT, choice between opportunistic or population-based recruitment. and between uni or multi-centre screening, implementation of CAD-assisted reading, containment of false positive and negative LDCT results, incorporation of emphysema. and CAC quantification in models of personalized LC and mortality risk, validation of ultra-LDCT acquisitions, optimization of the smoking-cessation intervention. and prospective validation of the biomarkers.

show abstract

Lung function impairment in lung cancer screening: discordance between risk and screening outcomes when looking through a PRISm

Cited by 5 publications

References 25 publications

Impaired lung function and lung cancer risk in 461,183 healthy individuals: a cohort study

Impaired lung function and lung cancer risk in 461,183 healthy individuals: a cohort study

Impaired lung function and lung cancer risk in 461 183 healthy individuals: a cohort study

Lung Cancer Screening with Low-Dose CT: What We Have Learned in Two Decades of ITALUNG and What Is Yet to Be Addressed

Contact Info

Product

Resources

About