Lung nodule occurrence in nonsmokers higher than previously thought

Representative chest low-dose CT images show lung nodules (arrows) and were included in the study. (A) A solid lung nodule, 82 mm3, in a 77-year-old male participant. (B) A clinically relevant nodule, 174 mm3, in a 55-year-old female participant. (C) An actionable nodule, 422 mm3, in a 79-year-old female participant. (D) A typical perifissural nodule, 183 mm3, in a 46-year-old male participant.
Representative chest low-dose CT images show lung nodules (arrows) and were included in the study. (A) A solid lung nodule, 82 mm3, in a 77-year-old male participant. (B) A clinically relevant nodule, 174 mm3, in a 55-year-old female participant. (C) An actionable nodule, 422 mm3, in a 79-year-old female participant. (D) A typical perifissural nodule, 183 mm3, in a 46-year-old male participant.
Radiology

Most research that examines size and prevalence of lung nodules and lung cancer occurs in people who smoke, but a new study published in Radiology examined these factors in a large population of nonsmokers in the Netherlands. 

Using low-dose chest computed tomography (CT), researchers discovered that more than 40% of nonsmokers had at least one lung nodule, and 11% had clinically relevant or actionable nodules (measuring 6 to 8 mm) that could increase the risk of lung cancer. Investigators of the study also noted that lung nodule prevalence increased significantly with age and was more common in men than women (47.5% versus 37.7%). 

“Contrary to our anticipation of a lower lung nodule prevalence in our population compared with the previous lung cancer screening studies [11.1% versus 10.7%], our findings showed that clinically relevant nodules are not uncommon in the nonsmoking population and are at least slightly more common than we routinely recognize,” said lead author Jiali Cai, MD, of the department of epidemiology at the University of Groningen in the Netherlands.

The study comprised 10,431 nonsmoking adults from the Imaging in Lifelines (ImaLife) study. Of the group, 4,812 never smoked and 5,619 formerly smoked an average of 7.9 pack/years with an average of 27.4 years since quitting. Women made up 56.6% of the study participants and the median age was 60.4 years. 

“This study is groundbreaking as it provides the first comprehensive analysis of the prevalence and size distribution of solid lung nodules in a population-based Northern European non-smoking cohort. Unlike prior studies that predominantly targeted high-risk lung cancer screening cohorts or Asian cohorts, this research yields fundamental data for the general nonsmoking population,” said senior author Rozemarjin Vliegenthart, MD, PhD, radiologist and professor of cardiothoracic imaging at University Medical Center Groningen.

More than 57% of participants with at least one nodule present were former smokers and did not meet the primary screening eligibility guidelines. 

“Of former smokers, 93.9% (n=5277) were outside of U.S. Preventive Services Task Force eligibility criteria and were considered non-high-risk individuals,” the authors said.

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