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Lung function predicts lung cancer risk in smokers: a tool for targeting screening programmes
E Calabrò1, G Randi, C La Vecchia
1Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
The European Respiratory Journal
|August 15, 2009
Summary
Even minimal lung function damage, indicated by reduced forced expiratory volume in 1 second (FEV(1)) percentage predicted, significantly predicts lung cancer risk in smokers. This suggests FEV(1) screening could identify high-risk individuals.
Area of Science:
- Pulmonology
- Oncology
- Epidemiology
Background:
- Smoking is a known cause of lung cancer and airflow obstruction.
- The role of minimal lung function impairment as an independent lung cancer risk factor is not well-established.
Purpose of the Study:
- To determine if reduced pulmonary function, specifically forced expiratory volume in 1 second (FEV(1)) percentage predicted, is an independent risk factor for lung cancer development in heavy smokers.
- To identify individuals at higher risk for lung cancer based on functional impairment.
Main Methods:
- Evaluated baseline pulmonary function tests (FEV(1) % predicted) in 3,806 heavy smokers undergoing annual chest CT screening.
- Compared FEV(1) % predicted between 57 lung cancer cases and 3,749 cancer-free subjects.
- Used unconditional logistic regression to calculate odds ratios (ORs) for lung cancer, adjusting for age, sex, study, and smoking variables.
Main Results:
- Subjects with FEV(1) <90% predicted had an OR of 2.45 (95% CI 1.39-4.33) for lung cancer compared to those with FEV(1) >=90% predicted.
- Subjects with FEV(1) <70% predicted had a higher OR of 2.90 (95% CI 1.34-6.27).
- Even a small reduction in FEV(1) % predicted was a significant predictor of increased lung cancer risk.
Conclusions:
- Reduced FEV(1) % predicted, even below 90%, is a significant independent predictor of lung cancer risk in heavy smokers.
- Pulmonary function testing (FEV(1)) could be a valuable tool for screening and identifying high-risk individuals for lung cancer.
- Screening for lung cancer using airflow obstruction criteria (FEV(1) <90%) warrants further consideration as a public health strategy.
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