Detection of Emphysema During Lung Cancer Screening
In an article published in Annals of the American Thoracic Society, James L. Mulshine, MD, and colleagues maintained that the high frequency of emphysema newly identified during low-dose computed tomography (CT) lung cancer screening presents an important opportunity to engage individuals with such findings in conversations and practices aimed at optimizing their overall health.
James L. Mulshine, MD
Frequency of Emphysema in Lung Cancer Screening
As related by the authors, two large studies—together including more than 79,000 participants—have identified a high frequency of emphysema during lung cancer screening.
In the International Early Lung Cancer Program (I-ELCAP), baseline lung cancer screening scans detected emphysema in 23.8% of participants. Among the 12,542 participants found to have emphysema, 9,595 (76.5%) had no prior diagnosis of emphysema or chronic obstructive pulmonary disease (COPD).
In the National Lung Screening Trial (NLST), baseline scans identified emphysema in 31% of participants. Among these, 82% had no prior history of COPD/emphysema.
As stated by the authors, “Therefore, lung cancer screening participation resulted in frequent detection of emphysema in these two screening cohorts and typically, screening participants had no prior awareness of this pulmonary disease.”
Potential Benefits of Early Detection of Emphysema During Lung Cancer Screening
As related by the authors, the early detection of emphysema during lung cancer screening presents opportunities to benefit the health of affected individuals. These opportunities include the following:
- Provides additional personalized motivation for tobacco cessation in current smokers to mitigate lung cancer risk, limit emphysema progression, and preserve lung tissue from further destruction, as well as limit progression of other tobacco-related chronic diseases such as coronary artery disease
- Provides earlier recognition for primary care providers to identify individuals who would benefit from detailed symptom screening to prompt spirometric assessment for COPD detection, as well as to encourage screening compliance to detect early lung cancer
- May also provide additional motivation by reinforcing other existing preventive recommendations such as increasing physical activity or complying with vaccination to reduce the burden of respiratory infections.
- Empowers screening participants to use their personalized health information obtained from the analysis of CT scans to improve their own health, which in turn, may improve annual lung cancer screening adherence
- May allow for personalizing additional nonpharmacologic interventions for subsequent rounds of lung cancer screening to evolve the annual screening encounter to a more screening participant–engaging annual health check.
The authors represent a broad spectrum of advocates, clinicians, imaging scientists, behavioral scientists, and other relevant experts, who concluded, “Recent publications demonstrate that emphysema can be frequently detected by thoracic CT scans performed for lung cancer screening. The joint detection of these two frequent lethal tobacco-related diseases provides a new opportunity to manage these diseases in a more cohesive fashion that may enhance the public investment related to the delivery of national lung cancer screening.”
They continued: “For individuals considering participation in annual lung cancer screening, information about the frequent detection of other significant imaging findings such as emphysema must be routinely discussed as it is a major health determinant. Detecting emphysema, like detecting early-stage lung cancer, may allow important opportunities for tobacco-exposed individuals to manage their lung health using safe and economical preventive interventions.”
Dr. Mulshine, of the Center for Healthy Aging, Department of Medicine, Rush University, is the corresponding author for the Annals of the American Thoracic Society article.
Disclosure: For full disclosures of the study authors, visit atsjournals.org.
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