Lung Cancer Screening in Patients with Chronic Obstructive Pulmonary Disease

Results from the National Lung Screening Trial (NLST) showed that annual lung cancer screening with low-dose computed tomography reduces lung cancer-related mortality. On the basis of NLST selection criteria, major health organizations have made recommendations regarding the population who should be offered lung cancer screening. Although chronic obstructive pulmonary disease (COPD) is an independent risk factor for lung cancer, most organizations do not include this specifically as part of their eligibility criteria for screening. This review aims to summarize the epidemiologic evidence connecting airflow obstruction and emphysema seen in COPD to the development of lung cancer, the biological mechanisms linking these 2 diseases, and the impact of COPD severity on lung cancer risk. Inclusion of COPD patients in lung cancer screening guidelines, regardless of whether they meet the smoking criteria of the NLST, may be a potential avenue for improving the target population who benefits the most from lung cancer screening by low-dose computed tomography, although careful consideration of risks and benefits is necessary.