Chronic obstructive pulmonary disease prevalence and prediction in a high-risk lung cancer screening population
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RESEARCH ARTICLE
Open Access
Chronic obstructive pulmonary disease prevalence and prediction in a high-risk lung cancer screening population John R. Goffin1* , Gregory R. Pond1, Serge Puksa1, Alain Tremblay2, Michael Johnston3, Glen Goss4, Garth Nicholas4, Simon Martel5, Rick Bhatia6, Geoffrey Liu7, Heidi Schmidt7, Sukhinder Atkar-Khattra8, Annette McWilliams9, Ming-Sound Tsao7, Martin C. Tammemagi10 and Stephen Lam8
Abstract Background: Chronic obstructive pulmonary disease (COPD) is an underdiagnosed condition sharing risk factors with lung cancer. Lung cancer screening may provide an opportunity to improve COPD diagnosis. Using PanCanadian Early Detection of Lung Cancer (PanCan) study data, the present study sought to determine the following: 1) What is the prevalence of COPD in a lung cancer screening population? 2) Can a model based on clinical and screening low-dose CT scan data predict the likelihood of COPD? Methods: The single arm PanCan study recruited current or former smokers age 50–75 who had a calculated risk of lung cancer of at least 2% over 6 years. A baseline health questionnaire, spirometry, and low-dose CT scan were performed. CT scans were assessed by a radiologist for extent and distribution of emphysema. With spirometry as the gold standard, logistic regression was used to assess factors associated with COPD. Results: Among 2514 recruited subjects, 1136 (45.2%) met spirometry criteria for COPD, including 833 of 1987 (41.9%) of those with no prior diagnosis, 53.8% of whom had moderate or worse disease. In a multivariate model, age, current smoking status, number of pack-years, presence of dyspnea, wheeze, participation in a high-risk occupation, and emphysema extent on LDCT were all statistically associated with COPD, while the overall model had poor discrimination (c-statistic = 0.627 (95% CI of 0.607 to 0.650). The lowest and the highest risk decile in the model predicted COPD risk of 27.4 and 65.3%. Conclusions: COPD had a high prevalence in a lung cancer screening population. While a risk model had poor discrimination, all deciles of risk had a high prevalence of COPD, and spirometry could be considered as an additional test in lung cancer screening programs. Trial registration: (Clinical Trial Registration: ClinicalTrials.gov, number NCT00751660, registered September 12, 2008) Keywords: Lung cancer, Screening, Chronic obstructive pulmonary disease, Spirometry, CT scan
* Correspondence: [email protected] Notation of prior presentation: Presented in part at the 18th World Conference on Lung Cancer, October 18, 2017, Yokohama, Japan. 1 Department of Oncology, McMaster University, Juravinski Cancer Centre, 699 Concession St., Hamilton, ON L8V 5C2, Canada Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the orig
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