New Study Suggests Lung-Related Comorbidities Have No Impact on Lung Cancer Detection

Emerging research suggests no statistically significant differences in lung cancer detection between patients with no lung-related comorbidities and those with at least one lung-related comorbidity.

For the prospective multicenter study, recently published in JAMA Network Open, the researchers compared lung cancer screening (LCS) results between 335 patients who had at least one lung-related comorbidity and 276 patients who had no lung-related comorbidities.¹ The mean age of the study population was 64 and slightly over half of the cohort were men (308 men), according to the study. The reported comorbidities included chronic obstructive pulmonary disease (COPD), asthma, pulmonary fibrosis, silicosis, chronic bronchitis, emphysema, tuberculosis, asbestosis, sarcoidosis, and bronchiectasis.

The study authors found that 16 percent of people with lung-related comorbidities had positive LCS findings at baseline in comparison to 11.1 percent of those without lung-related comorbidities. Upon a subsequent lung screening examination, 12.3 percent of those with comorbidities had positive lung cancer findings in comparison to 10.6 percent of those without morbidities, according to the study. The researchers also noted a 13.0 per 100 false-positive rate (FPR) among patients with lung-related comorbidities in comparison to a 9.3 per 100 FPR in patients without comorbidities.¹

“There were no significant differences in positive LCS examinations, (cancer detection rate), or FPR based on the presence of lung-related comorbidity,” wrote Louise M. Henderson, Ph.D, MSPH, a professor of radiology and director of the Epidemiology Research Team at the University of North Carolina, and colleagues.

Henderson and colleagues suggested that one of the contributing factors to a lack of differences in LCS findings may have been a lack of health insurance in 7.2 percent of the study population.

“This group may be more likely to postpone follow-up care after a positive LCS finding, leading to a lower observed rate of cancer detection and a higher rate of false-positive reports within 365 days,” noted Henderson and colleagues.

The researchers found that people with lung-related comorbidities were more likely to be female (53.7 percent), White (84.4 percent) and have high school or less education (46.7 percent).¹ In comparison to the National Lung Screening Trial (NLST), Henderson and colleagues noted a higher prevalence of self-reported comorbidities including CPOD (45.7 percent vs. 17.5 percent) and asthma (14.6 percent vs. 6.2 percent).^1,2

“The higher prevalence of comorbidities during LCS at the population level compared with NLST warrant incorporation of comorbidities into screening decisions because they affect general health status and, based on severity, may affect the balance of risks and benefits observed in the NLST,” pointed out Henderson and colleagues.

In regard to study limitations, the authors noted a lack of detail on the severity of the comorbidities noted in the study as well as the self-reporting of the comorbidities. They also acknowledged possible under- or overdiagnosis of COPD in the study population as well as the possibility of patients being lost to follow-up if they sought treatment at another facility.

References

1. Metwally EM, Riviera MP, Durham DD, et al. Lung cancer screening in individuals with and without lung-related comorbidities. JAMA Netw Open. 2022;5(9):e2230146. Doi:10:1001/jamanetworkopen.2022.30146.

2. National Lung Screening Trial Research Team; Aberle DR, Adams AM, Berg CD, et al. Baseline characteristics of participants in the randomized national lung screening trial. J Natl Cancer Inst. 2020;102(23):1771-9.