Is previous respiratory disease a risk factor for lung cancer?

Denholm R, Schüz J, Straif K, Stücker I, Jöckel KH, Brenner DR, De Matteis S, Boffetta P, Guida F, Brüske I, Wichmann HE, Landi MT, Caporaso N, Siemiatycki J, Ahrens W, Pohlabeln H, Zaridze D, Field JK, McLaughlin J, Demers PA, Szeszenia-Dabrowska N, Lissowska J, Rudnai P, Fabianova E, Dumitru RS, Bencko V, Foretova L, Janout V, Kendzia B, Peters S, Behrens T, Vermeulen R, Brüning T, Kromhout H, Olsson A. Is Previous Respiratory Disease a Risk Factor for Lung Cancer? Am J Respir Crit Care Med. 2014;190(5):549-559. doi:10.1164/rccm.201402-0338OC

Rationale: Previous respiratory diseases have been associated with increased risk of lung cancer. Respiratory conditions often co-occur and few studies have investigated multiple conditions simultaneously.

Objectives: Investigate lung cancer risk associated with chronic bronchitis, emphysema, tuberculosis, pneumonia, and asthma.

Methods: The SYNERGY project pooled information on previous respiratory diseases from 12,739 case subjects and 14,945 control subjects from 7 case-control studies conducted in Europe and Canada. Multivariate logistic regression models were used to investigate the relationship between individual diseases adjusting for co-occurring conditions, and patterns of respiratory disease diagnoses and lung cancer. Analyses were stratified by sex, and adjusted for age, center, ever-employed in a high-risk occupation, education, smoking status, cigarette pack-years, and time since quitting smoking.

Measurements and Main Results: Chronic bronchitis and emphysema were positively associated with lung cancer, after accounting for other respiratory diseases and smoking (e.g., in men: odds ratio [OR], 1.33; 95% confidence interval [CI], 1.20-1.48 and OR, 1.50; 95% CI, 1.21-1.87, respectively). A positive relationship was observed between lung cancer and pneumonia diagnosed 2 years or less before lung cancer (OR, 3.31; 95% CI, 2.33-4.70 for men), but not longer. Co-occurrence of chronic bronchitis and emphysema and/or pneumonia had a stronger positive association with lung cancer than chronic bronchitis “only.” Asthma had an inverse association with lung cancer, the association being stronger with an asthma diagnosis 5 years or more before lung cancer compared with shorter.

Conclusions: Findings from this large international case-control consortium indicate that after accounting for co-occurring respiratory diseases, chronic bronchitis and emphysema continue to have a positive association with lung cancer.