Beyond lung cancer screening, an opportunity for early detection of chronic obstructive pulmonary disease and cardiovascular diseases

Abstract

Background: Lung cancer screening programs concern smokers at risk for cardiovascular diseases (CVDs) and chronic obstructive pulmonary disease (COPD). The LUMASCAN (LUng Cancer Screening, MArkers and low-dose computed tomography SCANner) study aimed to evaluate the acceptability and feasibility of screening for these 3 diseases in a community population with centralized organization and to determine low-dose computed tomography (CT) markers associated with each disease.

Methods: This cohort enrolled participants meeting National Comprehensive Cancer Network criteria (v1.2014) in an organized lung cancer-screening program including low-dose CT scans; spirometry; evaluations of coronary artery calcifications (CACs); and a smoking cessation plan at inclusion, 1, and 2 years; then telephone follow-up. Outcomes were the participation rate and the proportion of participants affected by lung cancer, obstructive lung disease, or CVD events. Logistic-regression models were used to identify radiological factors associated with each disease.

Results: Between 2016 and 2019, a total of 302 participants were enrolled: 61% men; median age 58.8 years; 77% active smoker; 11% diabetes; 38% hypertension; and 27% taking lipid-lowering agents. Inclusion, 1-year, and 2-year participation rates were 99%, 81%, 79%, respectively. After a median follow-up of 5.81 years, screenings detected 12 (4%) lung cancer, 9 of 12 via low-dose CT (78% localized) and 3 of 12 during follow-up (all stage IV), 83 (27%) unknown obstructive lung disease, and 131 (43.4%) moderate to severe CACs warranting a cardiology consultation. Preexisting COPD and moderate to severe CACs were associated with major CVD events with odds ratios of 1.98 (95% confident interval [CI] = 1.00 to 3.88) and 3.27 (95% CI = 1.72 to 6.43), respectively.

Conclusion: The LUMASCAN study demonstrated the feasibility of combined screening for lung cancer, COPD, and CVD in a community population. Its centralized organization enabled high participation and coordination of healthcare practitioners.

Figure 1.

LUng Cancer Screening, MArkers and low-dose computed tomography SCANner (LUMASCAN) study flowchart. ^aStudy exclusion criteria between inclusion (T0) and 1 year (T1): another cancer (n = 5), long-term oxygen therapy (n = 1), other diseases (n = 2), aged older than 75 years (n = 1). ^bStudy exclusion criteria between 1-year (T1) and 2-year visits (T2): another cancer diagnosed (n = 3), other diseases (n = 2). ^cStudy exclusion criteria between T2 and telephone follow-up: another cancer diagnosed (n = 7). ^dPersonal or medical reason(s).

Figure 2.

Cross-referencing of the big-3 diseases for LUng Cancer Screening, MArkers and low-dose computed tomography SCANner (LUMASCAN) program participants (Venn diagram); 6 participants were removed from this figure because of the absence of spirometry. These participants had neither lung cancer nor major CVD. Lung cancer (blue circle) represents incident lung cancer detected during the screening program. The detection of obstructive lung disease (yellow circle) is based on spirometry results at baseline. Participants with major CVD (green circle) were those with major CVD prior to inclusion or/and during follow-up. Finally, 123 were not included in any group. CVD = cardiovascular disease LC = lung cancer; OLD = obstructive lung disease.