Impaired lung function and lung cancer risk in 461 183 healthy individuals: a cohort study

Thu Win Kyaw; Min-Kuang Tsai; Chi Pang Wen; Chin-Chung Shu; Ta-Chen Su; Xifeng Wu; Wayne Gao

doi:10.1136/bmjresp-2023-001936

Impaired lung function and lung cancer risk in 461 183 healthy individuals: a cohort study

BMJ Open Respir Res. 2024 May 7;11(1):e001936. doi: 10.1136/bmjresp-2023-001936.

Authors

Thu Win Kyaw¹, Min-Kuang Tsai¹, Chi Pang Wen², Chin-Chung Shu^{3

4}, Ta-Chen Su⁵, Xifeng Wu⁶, Wayne Gao⁷

Affiliations

¹ Global Health and Health Security Program, School of Public Health, Taipei Medical University College of Public Health and Nutrition, Taipei, Taiwan.
² National Health Research Institutes, Zhunan, Taiwan.
³ Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁴ National Taiwan University, Taipei, Taiwan.
⁵ Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁶ School of Public Health, Zhejiang Medical University, Hangzhou, China.
⁷ Global Health and Health Security Program, School of Public Health, Taipei Medical University College of Public Health and Nutrition, Taipei, Taiwan waynegao@tmu.edu.tw.

Abstract

Background: It has been known that smoking and various lung diseases including lung cancer can cause lung function impairment. However, the impact of different types of lung function impairments, such as preserved ratio impaired spirometry (PRISm) and airflow obstruction (AO), on the incidence and mortality of lung cancer in both general and never-smoker populations remains unclear. We wished to examine the effect of lung function impairments on lung cancer risks.

Methods: This was a retrospective cohort study (1 January 1994 to 31 December 2017) of individuals from a health surveillance programme in Taiwan who underwent baseline spirometry tests at the entry point. PRISm was defined as an FEV₁/FVC (forced expiratory volume in 1 s/forced vital capacity) ratio >0.7 and FEV₁ <0.8, while AO was defined as an FEV₁/FVC ratio <0.7. Cox proportional hazards models and cubic spline curves were used to examine the associations between lung function impairments and lung cancer risks.

Results: The study included 461,183 individuals, of whom 14.3% had PRISm and 7.9% had AO. A total of 4038 cases of lung cancer and 3314 lung cancer-related deaths were identified during the 23 years of follow-up. Individuals with PRISm and AO exhibited a higher risk of lung cancer incidence and mortality compared with those with normal lung function. The adjusted HRs and 95% CIs were 1.14 (1.03 to 1.26) and 1.23 (1.10 to 1.37) in the overall cohort, and 1.08 (0.93 to 1.24), and 1.23 (1.05 to 1.45) in the never-smoker cohort. The risks of both developing and dying of lung cancer increased with the severity levels of lung function impairments and lower FEV₁ values.

Conclusion: Impaired lung function is associated with increased risks of developing lung cancer and subsequent mortality. The study highlights the importance of considering lung function in lung cancer screening for better candidate selection.

Keywords: lung cancer; respiratory function test.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Cohort Studies
Female
Forced Expiratory Volume
Humans
Incidence
Lung / physiopathology
Lung Neoplasms* / epidemiology
Lung Neoplasms* / mortality
Male
Middle Aged
Retrospective Studies
Risk Factors
Spirometry*
Taiwan / epidemiology
Vital Capacity