Pablo Sánchez-Salcedo, Respiratory Medicine Service, Clinica Universidad de Navarra, Pamplona, Spain
Juan Berto, Respiratory Medicine Service, Clinica Universidad de Navarra, Pamplona, Spain
Javier J. Zulueta, Respiratory Medicine Service, Clinica Universidad de Navarra, Pamplona, Spain
Lung cancer and chronic obstructive pulmonary disease are two major public health problems that are projected to remain among the top leading causes of death worldwide over the next decade. Recently, lung cancer screening with low-dose computed tomography of the chest in a high-risk population of smokers has been shown to be effective in reducing mortality from lung cancer in the National Lung Screening Trial. There is increasing evidence that individuals with chronic obstructive pulmonary disease and/or emphysema are at increased risk of having lung cancer. When compared to smokers without chronic obstructive pulmonary disease, several studies have shown that patients with the disease (forced expiratory volume in one second to forced vital capacity ratio < 70%) have a 2-6-fold greater risk of having lung cancer. Radiographic emphysema is particularly interesting as its presence, even without airway obstruction, is an independent risk factor for lung cancer. The risk of lung cancer is greatest in individuals with concomitant airway obstruction and emphysema. There is evidence that screening patients with chronic obstructive pulmonary disease is effective and can potentially reduce mortality. A specific lung cancer screening score for patients with chronic obstructive pulmonary disease has been developed and can be useful to select those with the highest risk. Multidisciplinary evaluations of patients with chronic obstructive pulmonary disease should be useful in attenuating potential harms from diagnostic and therapeutic procedures, especially in those with severe disease. This article reviews the evidence of the lung cancer-chronic obstructive pulmonary disease association, describes potential mechanisms that relate both diseases, evaluates lung cancer risk assessments in population-based studies and lung cancer screening cohorts, and discusses different clinical aspects to consider when performing screening in a chronic obstructive pulmonary disease population.
Keywords: COPD. Emphysema. LDCT. Lung cancer screening. Selection criteria.
