The associations of interstitial lung abnormalities with cancer diagnoses and mortality

Gisli T. Axelsson, Rachel K. Putman, Thor Aspelund, Elias F. Gudmundsson, Tomayuki Hida, Tetsuro Araki, Mizuki Nishino, Hiroto Hatabu, Vilmundur Gudnason, Gary M. Hunninghake, Gunnar Gudmundsson

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Abstract

An increased incidence of lung cancer is well known among patients with idiopathic pulmonary fibrosis. It is not known whether interstitial lung abnormalities, i.e. early fibrotic changes of the lung, are a risk factor for lung cancer in the general population.The study's objective was to assess whether interstitial lung abnormalities were associated with diagnoses of, and mortality from, lung cancer and other cancers. Data from the AGES-Reykjavik study, a cohort of 5764 older Icelandic adults, were used. Outcome data were ascertained from electronic medical records. Gray's tests, Cox proportional hazards models and proportional subdistribution hazards models were used to analyse associations of interstitial lung abnormalities with lung cancer diagnoses and lung cancer mortality as well as diagnoses and mortality from all cancers.There was a greater cumulative incidence of lung cancer diagnoses (p<0.001) and lung cancer mortality (p<0.001) in participants with interstitial lung abnormalities than in others. Interstitial lung abnormalities were associated with an increased hazard of lung cancer diagnosis (hazard ratio 2.77) and lung cancer mortality (hazard ratio 2.89) in adjusted Cox models. Associations of interstitial lung abnormalities with all cancers were found in models including lung cancers but not in models excluding lung cancers.People with interstitial lung abnormalities are at increased risk of lung cancer and lung cancer mortality, but not of other cancers. This implies that an association between fibrotic and neoplastic diseases of the lung exists from the early stages of lung fibrosis and suggests that interstitial lung abnormalities could be considered as a risk factor in lung cancer screening efforts.

Original languageEnglish
JournalThe European respiratory journal
Volume56
Issue number6
DOIs
Publication statusPublished - 1 Dec 2020

Bibliographical note

Support statement:
Supported by National Institutes of Health (NIH) grants K08 HL140087 (R.K. Putman); R01 CA203636 (M. Nishino); and R01 HL111024, R01 HL130974 and R01 135142 (G.M. Hunninghake); National Institute on Aging (NIA) grant 27120120022C (V. Gudnason); the Icelandic Research Fund, project grant 141513-051 (G. Gudmundsson, V. Gudnason and G.M. Hunninghake); Oddur Olafsson Fund; and Landspitali Scientific Fund A-2015-030 and A-2016-023 (G. Gudmundsson). The Age, Gene/Environment Susceptibility-Reykjavik Study was supported by NIH contracts N01-AG-1-2100 and HHSN27120120022C, the NIA Intramural Research Program, Hjartavernd (the Icelandic Heart Association) and the Althingi (the Icelandic Parliament). Funding information for this article has been deposited with the Crossref Funder Registry.

Publisher Copyright:
Copyright ©ERS 2020.

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