Outcomes of Lung Cancer Screening in Individuals With or Without Lung-Related Comorbidities

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In a prospective cohort study reported in JAMA Network Open, Metwally et al found no significant differences in positive examination, cancer detection, or false-positive rates among individuals with vs without self-reported lung-related comorbidities undergoing low-dose computed tomography lung cancer screening.

Data for the study were collected as part of the North Carolina Lung Screening Registry, a National Cancer Institute–funded research registry that prospectively collects data on individuals undergoing lung cancer screening as part of routine clinical practice at participating locations throughout North Carolina. The current analysis included individuals undergoing lung cancer screening at five participating academic and community screening sites between January 2014 and November 2020. Lung-related comorbidities included chronic obstructive pulmonary disease, chronic bronchitis, emphysema, asthma, bronchiectasis, pulmonary fibrosis, silicosis, asbestosis, sarcoidosis, and tuberculosis.

Key Findings

The study population consisted of 611 individuals who completed a one-page health history questionnaire. Of these, 335 (54.8%) had at least one lung-related comorbidity. In the total population, 308 patients (50.4%) were men, and the mean age was 64 years.

Individuals with vs without lung-related comorbidity were more likely to be female vs male (180 [53.7%] of 335 vs 123 [44.6%] of 276, P = .02), White vs non-White race (275 [84.4%] of 326 vs 193 [71.0%] of 272, P < .001), and to have an education level of high school or less vs greater than high school (108 [46.7%] of 231 vs 64 [30.8%] of 208, P = .001). For individuals with vs without lung-related comorbidity, lung cancer screening examinations were positive in 37 (16.0%) vs 22 (11.1%) at baseline examination (P = .14) and in 40 (12.3%) vs 23 (10.6%) at subsequent examination (P = .54). 

The cancer detection rate was 1.6 per 100 examinations in individuals with and 1.9 per 100 examinations in individuals without lung-related comorbidity (P = .73). The false-positive rate was 13.0 per 100 examinations vs 9.3 per 100 examinations in individuals with vs without lung-related comorbidity (P = .16). Among the 17 individuals diagnosed with lung cancer, 13 (76.5%) were diagnosed with stage I disease.

The investigators concluded, “The findings of this study suggest that individuals with self-reported lung-related comorbidities undergoing lung cancer screening were more likely to be female, of White race, and have less education than those without lung-related comorbidity. Although no statistically significant differences in the proportion of positive examinations, cancer detection rates, or false-positive rates by self-reported lung comorbidities were noted, additional studies with larger numbers of individuals undergoing screening are needed to understand lung cancer screening outcomes in those with lung-related comorbidities.”

Eman M. Metwally, MD, of the Cancer Control Education Program, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, is the corresponding author for the JAMA Network Open article.

Disclosure: The study was supported by grants from the National Cancer Institute. For full disclosures of the study authors, visit

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