Checking for emphysema during a lung cancer screening could reduce a person’s risk of death from future illness.
Researchers found that emphysema detected on baseline low-dose chest CT (LDCT) in the lung cancer screening cohort of more than 9,000 asymptomatic adults was associated with all-cause mortality, COPD and cardiovascular disease within a 25-year follow-up period.
The study, “Emphysema at Baseline Low-Dose CT Lung Cancer Screening Predicts Death from Chronic Obstructive Pulmonary Disease and Cardiovascular Disease Up to 25 Years Later,” was published in Radiology, a journal of the Radiological Society of North America.
“Until now, we didn’t know if baseline visual emphysema scoring on LDCT in the lung cancer screening setting had any prognostic value,” said Claudia Henschke, PhD, MD, radiologist and professor of radiology in the department of diagnostic, molecular and interventional radiology at Icahn School of Medicine at Mt. Sinai in New York, in a news release. “Our study stands out for its long follow-up and comprehensive analysis of the causes of death in a large lung cancer screening cohort.”
In the study, a lung cancer screening cohort of 9,047 asymptomatic adults (ages 40-85 at enrollment; 4,614 female) with a smoking history underwent a baseline LDCT in New York beginning in 2000 and were followed for up to 25 years as part of the International Early Lung Cancer Action Program (I-ELCAP). An experienced chest radiologist assessed each LDCT and assigned a score reflecting the level of emphysema present from 0 (none) to 3 (severe).
A little more than 70% of the study’s participants had no evidence of emphysema, while 21.1% had mild emphysema. Beyond that, 5.7% were diagnosed with moderate emphysema, while 2.4% had severe cases.
By the end of 2024, 41.3% of the patients had died, most commonly from cardiovascular disease. The median age at the time of death from all causes was 81. For COPD, cardiovascular disease and other causes, the median ages were 81, 82 and 81, respectively. A statistical analysis between emphysema and mortality showed that the lung disease was associated with COPD mortality, but not cardiovascular disease mortality.
“Clinically, these findings suggest emphysema is not merely an incidental CT finding, but a distinct disease entity associated with [the] worst outcomes and increased mortality, not only from lung cancer but also from respiratory and cardiovascular diseases,” Dr. Henschke said. “The findings show an increased risk of all causes of death by the presence of emphysema and its severity, ranging from a 1.15-fold increase for mild disease and a 2.28-fold increase for severe emphysema. For deaths due to COPD, the increased risk ranged from a 2.07-fold for mild disease to 12.06-fold increase for severe emphysema.”
Dr. Henschke said the results will enable health care providers to tailor risk-based treatment to prevent the progression of emphysema.
