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Introduction: Lung cancer (LC) is the most common cause of cancer-related deaths worldwide, and its prognosis upon metastasis remains poor. Patients with COPD face a significantly elevated LC risk, up to six times greater than those with normal lung function. We aimed to investigate LC prevalence and stage distribution among COPD outpatients. Furthermore, we aimed to outline the COPD-related variables associated with referral for LC examination., Methods: We conducted a retrospective analysis encompassing the period from 1 January 2012 to 31 December 2018 on all outpatients with COPD and LC and individuals referred for LC examinations., Results: Among all COPD outpatients, 2231 patients (18%) were referred for LC examinations and 565 (4.6%) were diagnosed with LC. LC patients with COPD were more likely to be stage I-II, in contrast to the non-COPD LC population (46% versus 26%, p<0.001 for all). Patients referred for LC examinations exhibited higher use of COPD-related medications, reported more severe dyspnoea (69% versus 66% with Medical Research Council dyspnoea score >2) and experienced a greater frequency of exacerbations (30% versus 24% with two or more exacerbations)., Conclusion: Our study revealed a notably high LC incidence among COPD outpatients. LC patients with COPD were diagnosed at earlier stages, and outpatients with more pronounced COPD symptoms were more inclined to undergo LC diagnostics. The overrepresentation of LC cases among COPD outpatients emphasises the importance of tailoring specific screening initiatives for this demographic., Competing Interests: Conflict of interest: The authors have nothing to disclose., (Copyright ©The authors 2024.)

Background: Lung cancer, once rare, has evolved into the global leading cause of cancer-related mortality, primarily driven by widespread cigarette smoking in the 20th century. This study explores the historical trends of lung cancer incidence in Denmark over four decades, emphasizing the impact of smoking prevalence, age, and gender on the observed patterns., Materials and Methods: Drawing upon data from the Danish National Patient Register and information on smoking habits provided by the Danish Health Authority, this study investigates lung cancer incidence rates, demographic shifts, and smoking prevalence from 1980 to 2022., Results: Smoking prevalence exhibited a consistent decline in males from 1950 to 2022, whereas female smoking prevalence maintained a stable level from 1950 to 1987, followed by a subsequent decline from 1987 to 2022. A peak in lung cancer crude incidence rates was identified during 2014-2017, with no significant difference observed before and after this period. Over the period, the gender distribution transitioned from a male majority to an equal male-female ratio, and age-specific disparities indicated declines in patients aged 50-59 and increases in those above 80 years., Interpretation: The certainty of a decline in lung cancer incidence in the coming years remains unclear. Based on smoking prevalence, it might still be a decade away. To ensure a sustained decline in lung cancer incidence, targeted interventions are imperative, including customized smoking cessation programs that could be designed favorably for females. Given the modest decline in smoking prevalence over the last decade, legislation aimed at discouraging young individuals from smoking is pivotal. As of now, these efforts have not been implemented in Denmark.

Lung cancer is the leading cause of cancer-related death in Denmark and the world. The increase in CT examinations has led to an increase in detection of pulmonary nodules divided into solid and subsolid (including ground glass and part solid). Risk factors for malignancy include age, smoking, female gender, and specific ethnicities. Nodule traits like size, spiculation, upper-lobe location, and emphysema correlate with higher malignancy risk. Managing these potentially malignant nodules relies on evidence-based guidelines and risk stratification. These risk stratification models can standardize the approach for the management of incidental pulmonary findings, as argued in this review., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

INTRODUCTION In recent decades, lung cancer is being diagnosed at ever earlier stages, leading to higher resection rates and improved survival. Therefore, more patients live with the sequelae of thoracic surgery. The standardised Danish follow-up programme after lung cancer resection includes CT and clinical evaluation at set times. METHODS An e-mail survey was conducted to evaluate local practices at lung cancer investigation sites with respect to the setup of follow-up programmes after lung cancer resection. In addition, 50 consecutive patients were seen three months after their lung cancer resection. Spirometry was performed and patients reported on their use of inhalation medicine, smoking status and quality of life. RESULTS The study revealed heterogeneous setups regarding routine spirometry (5/12 sites) and assessment by a respiratory physician (6/12). In a single-centre study including 50 patients three months after lung cancer resection, 22% of patients were using a bronchodilator even though 50% of patients were obstructive on spirometry and 48% reported shortness of breath (SOB). 17% of patients were active smokers, whereas the majority reported symptoms of a physical nature such as fatigue, SOB and cough. CONCLUSIONS It is important to establish the optimal follow-up setup with an emphasis on detection of recurrence, symptom improvement and smoking cessation. This study highlighted the importance of symptom assessment by a respiratory physician/nurse. A spirometry should be performed if patients experience SOB and the potential benefit of inhalation medicine should be assessed. FUNDING none. TRIAL REGISTRATION not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)