The epidemiology of interstitial lung disease and its association with lung cancer

Abstract

The criteria and terminology for diagnosing interstitial lung disease (ILD), a diverse range of pulmonary fibrotic disorders that affect the alveoli of the lungs, have been variable and confusing; however, there have been recent major improvements to an internationally agreed classification. Evidence from recent analyses of populations suggests that the incidence and prevalence rates of ILD are on the increase, particularly when the broad definition of ILD is used. In most patients with ILD a cause is not identified; nevertheless, among the established causes are a number of drug therapies and infections. Occupational causes are lessening in importance, while cigarette smoking is now an established risk factor. Radiation therapy for cancer is a well-established cause of ILD that usually, but not always, localises within the radiation portal and may occur later after completion of therapy. Similarly, exposure to drugs long after radiation therapy may be an aetiological factor for the development of ILD later in life, although the magnitude of this risk requires further epidemiological investigation. The possibility that ILD and lung cancer are associated has been recognised for >50 years, but it remains unclear whether ILD precedes lung cancer or vice versa. In this review, we examine the epidemiology of ILD and the basis for its association with lung cancer.

Figure 1

Changes in respiratory evaluation after unilateral thoracic radiotherapy, with and without sporadic radiation pneumonitis (reprinted from Morgan and Breit, 1995). Copyright © 1995 Elsevier. Relative values relate to numbers of cells per million per litre and absolute gallium lung scan values. ^*Changes reaching statistical significance P<0.05. TWBC, total white blood cell count; MAC, macrophages; LYM, lymphocytes; NEU, neutrophilis; VC, vital capacity; DLCO, carbon monoxide transfer factor; GAL, gallium lung scan.