Determination of a high risk lung cancer group who would benefit from screening: The roles of smoking, age and COPD

Background: Identifying a lung cancer high risk group by using age, smoking status and COPD may lead to a cost-effective, early detection strategy that results in lower mortality associated with lung cancer. Method: We conducted a prospective cohort study of 925 persons diagnosed with lung cancer in Budapest, Hungary in 2009. We collected data on the following: age, smoking habits, COPD, lung cancer cell types, stage of disease, and treatment using anonymous questionnaires. We estimated the risk of the lung cancer diagnosis in the high risk population (COPD, smoking history [>40 PYI=pack year index], age [>50])compared to the general population at risk (age, smoking and COPD) in Budapest. Results: Patients were, on average 63,7 years (95%>50). 79% of the patients had smoking histories (69% current and 31% former). The average pack year index was 33. 44% of patients had COPD comorbidity (non smokers:16%; smokers:69%). The risk of developing lung cancer was 13,5 times higher among the risk population (older age, smokers and COPD comorbidity) versus the general population in Budapest by statistical analyses (Bayes statistical estimation). Conclusion: While low-dose computer tomography (LDCT) has been not been seen as a good strategy for population-wide screening, it may be useful in a high risk population, including those who are age>50, with a long smoking history >40 PYI, and diagnosis of COPD.