Emphysema linked to increased risk of lung cancer.

Abstract

CancerVolume 128, Issue 18 p. 3277-3277 CancerScopeFree Access Emphysema linked to increased risk of lung cancer First published: 26 August 2022 https://doi.org/10.1002/cncr.34432AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Computed tomography (CT)-detected emphysema is associated with a greater risk of developing lung cancer, a risk that increases with emphysema severity, according to new research published in the journal Radiology.1 Emphysema is a chronic respiratory disease characterized by damage to the alveoli and shares many risk factors with lung cancer, the leading cause of cancer-related deaths worldwide. Cigarette smoking is one of the important shared risk factors of emphysema and lung cancer, as it increases inflammation, DNA damage, and accelerated aging; people with emphysema who have never smoked, however, also have an increased risk of lung cancer. “Other underlying mechanisms like genetic susceptibility, chronic inflammation, or DNA damage and abnormal repair mechanisms, or a combination thereof, have been proposed to link emphysema and lung cancer,” said study co-author Marleen Vonder, MSc, PhD, a postdoctoral researcher in the department of epidemiology at University Medical Center Groningen in Groningen, Netherlands, in a statement. In the study, investigators searched three large databases—PubMed, Embase, and Cochrane—to identify studies focused on the association between emphysema assessed visually or quantitatively with CT and lung cancer. An analysis of 21 studies involving more than 107,000 patients found a connection between visual and quantitative, or measurable, CT assessments of emphysema and lung cancer. The associations were determined by emphysema severity (trace, mild, or moderate to severe, assessed visually and quantitively) and subtype (centrilobular or paraseptal, assessed visually). The overall pooled odds ratios (ORs) for lung cancer given the presence of emphysema were 2.3 (95% confidence interval [CI], 2.0–2.6; I2 = 35%; 19 subsets) and 1.02 (95% CI, 1.01–1.02; six subsets) per 1% increase in low attenuation area. Studies with visual (pooled OR, 2.3; 95% CI, 1.9–2.6; I2 = 48%; 12 subsets) and quantitative (pooled OR, 2.2; 95% CI, 1.8–2.8; I2 = 3.7%; eight subsets) assessments yielded comparable results for the dichotomous assessment. Based on six studies (1,716 patients), the pooled ORs for lung cancer increased with emphysema severity and were higher for visual assessment (2.5, 3.7, and 4.5 for trace, mild, and moderate to severe, respectively) than for quantitative assessment (1.9, 2.2, and 2.5) based on point estimates. Compared with no emphysema, only centrilobular emphysema (noted in three studies) was associated with lung cancer (pooled OR, 2.2; 95% CI, 1.5–3.2; p = .001). In an accompanying editorial, Andetta Hunsaker, MD, chief of thoracic imaging at Brigham and Women’s Hospital and associate professor of radiology at Harvard Medical School, both in Boston, said the findings were valuable for cancer care.2 “It may be that lung cancer screening as we know it will need to undergo some modification to include emphysema as one of the category descriptors, which will contribute to the Lung CT Screening Reporting and Data System score and follow-up screening intervals,” Dr. Hunsaker wrote. “Adding emphysema as a separate risk category will improve the identification of those at higher risk for lung cancer and put them in the category of early detection.” References 1 Yang X, Wisselink HJ, Vliegenthart R, et al. Association between chest CT-defined emphysema and lung cancer: a systematic review and meta-analysis. Radiology. Published online May 3, 2022. doi:10.1148/radiol.212904 2 Hunsaker AR. Emphysema as a predictor of lung cancer: implications for lung cancer screening. Radiology. Published online May 3, 2022. doi:10.1148/radiol.22069 Volume128, Issue18September 15, 2022Pages 3277-3277 This article also appears in:CancerScope Articles ReferencesRelatedInformation