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Emphysema and Airway Obstruction as Risk Factors for Lung Cancer

We read with great interest the article by Dr. Wilson and colleagues entitled "Association of Radiographic Emphysema and Airflow Obstruction with Lung Cancer" (1). Regarding the relationship between emphysema and risk of lung cancer, we are delighted that this work reproduces the results previously published by our group, thus validating their significance (2). There are a few comments we would like to make about this important study.

First, although we acknowledge the differences in the study populations (age, smoking history and status, and clinical characterization), the higher prevalence of emphysema (47%) and chronic obstructive pulmonary disease (COPD) (47%) in comparison to our cohort is somewhat surprising. The higher prevalence of emphysema may be explained by the age (older) and smoking history (greater) of Wilson and coworkers' population. Perhaps the higher prevalence of COPD is due to the fact that in their study, Wilson and coworkers performed spirometry without bronchodilator to diagnose and grade COPD. Lack of use of bronchodilators has elsewhere been associated with overdiagnosis of COPD in as many as 33% of individuals (3). In Wilson and coworkers' group, many individuals may not have COPD according to current defining criteria, and many others may have less severe COPD, both of which results could seriously influence the statistical analysis. We wonder whether a correct diagnosis of COPD by post-bronchodilator spirometry would also result in a negative association between airway obstruction and risk of lung cancer, as we found in our cohort.

Second, we encourage the authors to analyze the association between the pathologic characterization of the 99 lung cancers diagnosed in their cohort and the presence of emphysema. In our study, emphysema was associated more commonly with adenocarcinoma, and the tumors were located in the emphysematous areas in the majority of patients. Finally, we feel that a more detailed description of the protocol for the diagnosis of lung cancer in this screening trial is warranted. We find that the drop in compliance to 25% by the third year is quite striking.

In spite of these discrepancies, we believe that studies such as Wilson and coworkers' and the one published by our group underline the importance of the relationship between two of the most common and deadly diseases among smokers.

Juan P. de Torres and Javier J. Zulueta

University of Navarra
Pamploma, Spain

Juan P. Wisnivesky

Mount Sinai School of Medicine
New York, New York

FOOTNOTES

Conflict of Interest Statement: None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

1. Wilson DO, Weissfeld JL, Balkan A, Schragin JG, Fuhrman CR, Fisher SN, Wilson J, Leader JK, Siegfried JM, Shapiro SD, et al. Association of radiographic emphysema and airflow obstruction with lung cancer. Am J Respir Crit Care Med 2008;178:738–744.[Abstract/Free Full Text]
2. de Torres JP, Bastarrika G, Wisnivesky JP, Alcaide AB, Campo A, Seijo LM, Pueyo JC, Villanueva A, Lozano MD, Montes U, et al. Assessing the relationship between lung cancer risk and emphysema detected on low-dose CT of the chest. Chest 2007;132:1932–1938.[CrossRef][Medline]
3. Pérez-Padilla R, Hallal PC, Vázquez-García JC, Muiño A, Máquez M, López MV, de Oca MM, Tálamo C, Valdivia G, Pertuzé J, et al.; PLATINO group. Impact of bronchodilator use on the prevalence of COPD in population-based samples. COPD 2007;4:113–120.[Medline]

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