Chronic obstructive lung diseases and risk of non-small cell lung cancer in women

Our plain-English summary of Chronic obstructive lung diseases and risk of non-small cell lung cancer in women, by A.G. Schwartz, M.L. Cote, A.S. Wenzlaff, et al (Journal of Thoracic Oncology, 2009).

The study

• Authors: A.G. Schwartz, M.L. Cote, A.S. Wenzlaff, A. Van Dyke, W. Chen, J.C. Ruckdeschel, S. Gadgeel, A.O. Soubani
• Journal: Journal of Thoracic Oncology
• Published: 2009;4(3):291-9
• Cited by: 53 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: The link between lung cancer and chronic obstructive lung diseases (COPD) has not been well studied in women even though lung cancer and COPD account for significant and growing morbidity and mortality among women.

Methods: We evaluated the relationship between COPD and non-small cell lung cancer in a population-based case-control study of women and constructed a time course of chronic lung diseases in relation to onset of lung cancer. Five hundred sixty-two women aged 18 to 74, diagnosed with non-small cell lung cancer and 564 population-based controls matched on race and age participated. Multivariable unconditional logistic regression models were used to estimate risk associated with a history of COPD, chronic bronchitis, or emphysema.

Results: Lung cancer risk increased significantly for white women with a history of COPD (odds ratios [OR] = 1.85; 95% confidence intervals [CI]: 1.21-2.81), but this was not seen in African American women. Risk associated with a history of chronic bronchitis was strongest when diagnosed at age 25 or earlier (OR = 2.35, 95% CI: 1.17-4.72); emphysema diagnosed within 9 years of lung cancer was also associated with substantial risk (OR = 6.36, 95% CI: 2.36-17.13). Race, pack-years of smoking, exposure to environmental tobacco smoke as an adult, childhood asthma, and exposure to asbestos were associated with a history of COPD among lung cancer cases.

Conclusions: In women, COPD is associated with risk of lung cancer differentially by race. Untangling whether COPD is in the causal pathway or simply shares risk factors will require future studies to focus on specific COPD features, while exploring underlying genetic susceptibility to these diseases.

In plain English

This case-control study compared 562 Detroit-area women aged 18 to 74 with non-small cell lung cancer, diagnosed 2001 to 2005, and 564 randomly selected local women. Women reported any doctor-diagnosed COPD, emphysema or chronic bronchitis. After adjusting for smoking and other factors, any of these diseases was linked to higher odds of lung cancer overall (odds ratio 1.67, 95% confidence interval 1.15 to 2.41) and in white women (1.85, 1.21 to 2.81). In African American women the link was not statistically significant (1.11, 0.49 to 2.49). Emphysema (3.21, 1.60 to 6.45) and chronic bronchitis (1.71, 1.13 to 2.59) were each linked to higher odds. Among women with lung cancer, those with such a history more often reported asbestos exposure (24.0% versus 16.3%). In a combined model, asbestos exposure was associated with that history in these women (odds ratio 1.69, 1.05 to 2.72). The authors concluded that COPD is associated with lung cancer risk differently by race. Citing shared risk factors, including asbestos, the authors said whether COPD lies on the causal path remains unanswered. They noted self-reported diagnoses may be misclassified.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Population-based case-control study (interviews), with a case-only survival analysis
• Who was studied: 562 women aged 18 to 74 living in metropolitan Detroit, diagnosed with primary non-small cell lung cancer from November 2001 to October 2005, and 564 population-based controls. Controls were found by random digit dialing and frequency-matched on race and five-year age group. All participants were white or African American.
• Exposure: The main exposure was a self-reported physician diagnosis of COPD, emphysema and/or chronic bronchitis made more than 1 year before lung cancer diagnosis or interview. Asbestos exposure was recorded as a yes/no factor. The article does not describe how asbestos exposure was assessed and does not name any fiber type.
• Main results:
  • For all subjects, a history of any chronic obstructive lung disease was reported by 31.1% of cases and 14.4% of controls. The adjusted odds ratio was 1.67 (95% CI 1.15–2.41).
  • In white women, the adjusted odds ratio for any chronic obstructive lung disease was 1.85 (95% CI 1.21–2.81). In African American women it was 1.11 (95% CI 0.49–2.49), which was not statistically significant.
  • For all subjects, a history of emphysema was associated with an adjusted odds ratio of 3.21 (95% CI 1.60–6.45). Emphysema was reported by 15.1% of cases and 2.1% of controls.
  • For all subjects, a history of chronic bronchitis was associated with a 1.7-fold increased risk of lung cancer (95% CI 1.13–2.59).
  • Chronic bronchitis diagnosed on or before age 25 was associated with an odds ratio of 2.35 (95% CI 1.17–4.72). Emphysema diagnosed within 9 years of lung cancer was associated with an odds ratio of 6.36 (95% CI 2.36–17.13).
  • Among lung cancer cases, 24.0% of those with a chronic obstructive lung disease diagnosis (42 of 175) reported asbestos exposure. This compared with 16.3% of those without one (63 of 387), with a p-value of 0.04.
  • Among lung cancer cases, asbestos exposure was associated with having a history of chronic obstructive lung disease. The univariable odds ratio was 1.59 (95% CI 1.02–2.47) and the multivariable odds ratio was 1.69 (95% CI 1.05–2.72).
  • Among cases, a history of chronic obstructive lung disease, emphysema or chronic bronchitis showed no significant differences in survival.
• The authors' conclusion: The authors concluded that, in women, COPD is associated with lung cancer risk differently by race. They noted that the factors linked to COPD among cases, including asbestos exposure, are risk factors for both diseases. It therefore remains unanswered whether COPD is in the causal pathway or simply shares risk factors with lung cancer.
• Limitations the authors state:
  • Lung disease history was self-reported, so it may have been misclassified.
  • The very high emphysema odds ratios in light smokers and in women with earlier-onset lung cancer were most likely due to emphysema being very rare among controls in those groups.
  • No information was collected on use of inhaled corticosteroids.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Obstructive Lung Disease, Non-Small Cell Lung Cancer, Lung Cancer, COPD, Case-Control Study, Emphysema, Odds Ratio, confidence interval.

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