A RECENT study examining the impact of airflow limitation (AL) on lung cancer (LC) screening outcomes suggests that the benefits of screening may be diminished for individuals with severe lung disease. The research, a secondary analysis of data from the National Lung Screening Trial, highlights how individuals with chronic obstructive pulmonary disease (COPD) may experience limited advantages from current screening methods, which are primarily based on age and smoking history.
The study followed 18,463 high-risk smokers, who underwent pre-bronchodilator spirometry tests and were tracked over a median period of 6.1 years. It found that the risk of developing LC and dying from it increased with worsening AL severity. However, individuals with severe AL (Global Initiative for Obstructive Lung Disease, GOLD grade 3–4) showed fewer adenocarcinomas and lower surgery rates, despite having higher LC risk and mortality. They also had significantly higher non-LC mortality.
In participants without AL, lung cancer deaths were significantly reduced with CT screening compared to chest X-rays. For those with AL, the reduction was less pronounced, particularly in severe cases, where no reduction in LC mortality was observed.
The findings suggest that while individuals with severe airflow limitation face higher risks of lung cancer, the potential benefit of screening through CT may be less effective due to the presence of advanced lung disease, leading to greater overall mortality from non-cancer-related causes. The study underscores the need for reevaluating screening criteria to account for co-morbidities like AL.
Reference
Young RP et al. Airflow limitation and mortality during cancer screening in the National Lung Screening Trial: why quantifying airflow limitation matters. Thorax. 2023;78(7):690-7.
