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Response to “Exploring the impact of screening with low-dose CT on lung cancer mortality in mild to moderate COPD patients”

2014; Elsevier BV; Volume: 108; Issue: 5 Linguagem: Inglês

10.1016/j.rmed.2014.01.011

1532-3064

Juan P. de‐Torres, Javier J. Zulueta,

Interstitial Lung Diseases and Idiopathic Pulmonary Fibrosis

We greatly appreciate Dr Young's interest in our publication and his comments. He points out three important issues about targeting patients with mild to moderate COPD for lung cancer screening [[1]de Torres J.P. Casanova C. Marin J.M. et al.Exploring the impact of screening with low-dose CT on lung cancer mortality in mild to moderate COPD patients: a pilot study.Respir Med. 2013; 107: 702-707Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar]: the number of patients needed to screen, the “absence” of overdiagnosis, and the importance of incorporating spirometry into lung cancer screening programs. As he mentions, the lung cancer detection rate in our cohort was 3.8 fold greater than in the National Lung Screening Trial (NLST) [[2]The National Lung Screening Trial Research Team Reduced lung-cancer mortality with low-dose computed tomographic screening.N Eng J Med. 2011; 365: 395-409Crossref PubMed Scopus (6875) Google Scholar] and similar to that seen in the Pittsburg Lung Screening Study (PluSS) [[3]Wilson D.O. Ryan A. Fuhrman C. et al.Doubling times and CT screen-detected lung cancers in the Pittsburgh Lung Screening Study.Am J Respir Crit Care Med. 2012; 185: 85-89Crossref PubMed Scopus (78) Google Scholar]. If these numbers are confirmed by other groups we could significantly decrease the number of patients needed to screen (NNS) by more than 70%. Incorporating COPD into the selection criteria for high-risk patients could improve the risk-benefit ratio of lung cancer screening programs. The apparent “absence” of overdiagnosis is another important issue raised by Dr Young. Based on existing data [[4]Caramori G. Casolari P. Cavallesco G.N. et al.Mechanisms involved in lung cancer development in COPD.Int J Biochem Cell Biol. 2011; 43: 1030-1044https://doi.org/10.1016/j.biocel.2010.08.022Crossref PubMed Scopus (77) Google Scholar], we believe that the proposed “remodeling/repair microclimate” [[5]Houghton A.M. Mouded M. Shapiro S.D. Common origins of lung cancer and COPD.Nat Med. 2008; 14: 1023-1024Crossref PubMed Scopus (135) Google Scholar] favors the development and progression of lung cancer in COPD patients. It may also favor the development of more aggressive tumors in this population, thus reducing the proportion of overdiagnosis in comparison to a population of healthy smokers [[6]Veronesi G. Maisonneuve P. Bellomi M. et al.Estimating over-diagnosis in low-dose computed tomography screening for lung cancer.Ann Int Med. 2012; 157: 776-784Crossref PubMed Scopus (131) Google Scholar]. Lastly, but perhaps more importantly, we agree with Dr Young's assertion that lung cancer screening programs should incorporate spirometry even considering we are screening asymptomatic current and former smokers. Such a program may be the ideal setting to tackle two of the most prevalent and deadly tobacco associated diseases: COPD and lung cancer. Underdiagnosis of COPD of around 70–80% is a consistent finding in all population-based studies performed around the world [7Menezes A.M. Perez-Padilla R. Jardim J.R. Muiño A. Lopez M.V. Valdivia G. Montes de Oca M. Talamo C. Hallal P.C. Victora C.G. PLATINO Team Chronic obstructive pulmonary disease in five Latin American cities (the PLATINO study): a prevalence study.Lancet. 2005; 366: 1875-1881Abstract Full Text Full Text PDF PubMed Scopus (718) Google Scholar, 8Buist A.S. McBurnie M.A. Vollmer W.M. Gillespie S. Burney P. Mannino D.M. Menezes A.M. Sullivan S.D. Lee T.A. Weiss K.B. Jensen R.L. Marks G.B. Gulsvik A. Nizankowska-Mogilnicka E. BOLD Collaborative Research GroupInternational variation in the prevalence of COPD (the BOLD Study): a population-based prevalence study.Lancet. 2007; 370: 741-750Abstract Full Text Full Text PDF PubMed Scopus (1655) Google Scholar]. Adding spirometry will not only help identificaty individuals with higher risk for lung cancer, but will also help detect COPD in its early stages when interventions like smoking cessation may have a greater impact on outcomes. CT screening in COPD: Impact on lung cancer mortality: de Torres JP, Casanova C, Marin JM et al. Exploring the impact of screening with low-dose CT on lung cancer mortality in mild to moderate COPD patients: A pilot study. 2013; 107: 702–707Respiratory MedicineVol. 108Issue 5PreviewWe congratulate de Torres and colleagues on their recently published pilot study reporting a significant survival advantage in patients with mild to moderate COPD diagnosed with lung cancer using computed tomographic (CT) screening [1]. We agree that while further studies are needed, their results raise three important issues about targeted CT screening. Full-Text PDF Open Archive