Prior lung disease and risk of lung cancer in a large prospective study

Cancer Causes Control. 2004 Oct;15(8):819-27. doi: 10.1023/B:CACO.0000043432.71626.45.


Objectives: While 75-90% of people who develop lung cancer are smokers, only a small proportion of smokers develop lung cancer. Identifying factors that increase a smoker's risk of developing lung cancer may help scientists to better understand the etiology of lung cancer and more effectively target high-risk groups for screening.

Methods: Information on physician-diagnosed non-malignant lung diseases [asbestosis, asthma, chronic bronchitis or emphysema (CB/E), pneumonia, and tuberculosis] was obtained at baseline from 17,698 men and women involved in CARET, a randomized lung cancer prevention trial of beta-carotene and vitamin A among heavy smokers and asbestos-exposed workers. Hazard ratios for lung cancer were estimated through Cox regression models, after controlling for potential confounding factors, included smoking. Analyses were restricted to former and current smokers.

Results: During a median follow up of 9.1 years, 1028 cases of lung cancer occurred. Those who developed lung cancer were more likely to report a history of CB/E than controls (adjusted HR = 1.29, 95% CI: 1.09-1.53). In subgroup analyses, the association between a history of CB/E and lung cancer was stronger for those who were younger at diagnosis/reference, men in the heavy smoker cohort, former smokers, and those with squamous cell carcinomas. There was little association between a history of other lung diseases and lung cancer.

Conclusions: Smokers with a history of CB/E may be at higher risk of developing lung cancer, independent of their smoking history.

MeSH terms

  • Adult
  • Aged
  • Bronchitis / complications*
  • Case-Control Studies
  • Emphysema / complications*
  • Female
  • Humans
  • Lung Neoplasms / epidemiology*
  • Lung Neoplasms / etiology*
  • Male
  • Medical History Taking
  • Middle Aged
  • Prospective Studies
  • Regression Analysis
  • Risk Factors