Coronary Artery Calcium Score and Incident Lung Cancer in a Population-based Cohort: The Screening Perspective

Purpose To estimate the extent in which coronary artery calcium (CAC) score and incident lung cancer diagnosis are associated and determine if use of CAC score to predict lung cancer could improve lung cancer screening (LCS). Materials and Methods This retrospective analysis analyzed data from an ongoing, prospective, population-based cohort study (Heinz Nixdorf Recall study) in which participants aged 45-75 years underwent electron-beam CT of the heart. The association between CAC score and incident lung cancer was assessed using Cox proportional hazard regression models adjusted for potential confounders. The area under the receiver operating characteristic curve (AUC) was used to assess predictive performance of CAC score for lung cancer in all participants, eligible participants, and ineligible participants for LCS. Results The study included 4605 participants (mean age, 59.7 [SD, 7.8] years; 2328 female). During a median follow-up time of 15.2 years, incident lung cancer was diagnosed in 111 participants. CAC score as a continuous variable (log CAC+1) was associated with incident lung cancer (hazard ratio [HR] in the fully adjusted model: 1.21 [95% CI: 1.10, 1.32]). A CAC score of 400 or higher versus 0 was associated with a more than fourfold higher risk of lung cancer (adjusted HR: 4.31 [95% CI: 2.19, 8.51]). CAC score alone showed poor performance for predicting lung cancer in the total study sample (AUC, 0.63) and subgroups of participants eligible (AUC, 0.56) and ineligible (AUC, 0.61) for LCS. Conclusion CAC score was associated with incident lung cancer but did not demonstrate potential to improve the efficiency of LCS. Keywords: Epidemiology, Screening, Arteriosclerosis, Cardiac, Thorax, CT, Lung Cancer Supplemental material is available for this article. © RSNA, 2025.