Detection of COPD in the SUMMIT Study lung cancer screening cohort using symptoms and spirometry.

Background: COPD is a major comorbidity in lung cancer screening (LCS) cohorts, with a high prevalence of undiagnosed COPD. Combining symptom assessment with spirometry in this setting may enable earlier diagnosis of clinically significant COPD and facilitate increased understanding of lung cancer risk in COPD. In this study, we wished to understand the prevalence, severity, clinical phenotype and lung cancer risk of individuals with symptomatic undiagnosed COPD in a LCS cohort.
Methods: 16 010 current or former smokers aged 55-77 years attended a lung health check as part of the SUMMIT Study. A respiratory consultation and spirometry were performed alongside LCS eligibility assessment. Those with symptoms, no previous COPD diagnosis and airflow obstruction were labelled as undiagnosed COPD. Baseline low-dose computed tomography (LDCT) was performed in those at high risk of lung cancer (PLCO _m2012 score ≥1.3% and/or meeting USPSTF 2013 criteria).
Results: Nearly one in five (19.7%) met criteria for undiagnosed COPD. Compared with those previously diagnosed, those undiagnosed were more likely to be male (59.1% versus 53.2%; p<0.001), currently smoking (54.9% versus 47.6%; p<0.001) and from an ethnic minority group (p<0.001). Undiagnosed COPD was associated with less forced expiratory volume in 1 s impairment (Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1 and 2: 85.3% versus 68.4%; p<0.001) and lower symptom/exacerbation burden (GOLD A and B groups: 95.6% versus 77.9%; p<0.001) than those with known COPD. Multivariate analysis demonstrated that airflow obstruction was an independent risk factor for lung cancer risk on baseline LDCT (adjusted OR 2.74, 95% CI 1.73-4.34; p<0.001), with a high risk seen in those with undiagnosed COPD (adjusted OR 2.79, 95% CI 1.67-4.64; p<0.001).
Conclusions: Targeted case-finding within LCS detects high rates of undiagnosed symptomatic COPD in those most at risk. Individuals with undiagnosed COPD are at high risk for lung cancer.
Competing Interests: Conflict of interest: S. Tisi, J.L. Dickson, C. Horst, H. Hall and P. Verghese are all funded or part-funded through GRAIL Inc., as part of the SUMMIT Study. S.M. Janes was a Wellcome Trust Senior Fellow in Clinical Science (WT107963AIA); is supported by Cancer Research UK (CRUK) programme grant EDDCPGM\100002, the Rosetrees Trust, the Roy Castle Lung Cancer foundation, the Garfield Weston Trust and UCLH Charitable Foundation; and reports fees for advisory board work from AstraZeneca, Bard1 Bioscience, Achilles Therapeutics and Jansen, assistance for travel to meetings from AstraZeneca and Takeda, grant income from GRAIL Inc. and Owlstone, and share options from Optellum and Bard1 Lifescience Ltd. S.L. Quaife is supported by a Cancer Research UK (CRUK) Population Research Fellowship (C50664/A24460) and Barts Charity (MRC&U0036). A. Nair is part-funded through the UCLH Biomedical Research Centre. A. Devaraj reports personal fees from Boehringer Ingelheim, Roche, Galacto Biotech, Galapagos and Vicore. A. Hackshaw reports consulting fees from Evidera Inc. and assistance for travel to meetings from GRAIL Inc. J.R. Hurst reports assistance for travel from AstraZeneca and Boehringer Ingelheim, and payment for lectures and presentations from AstraZeneca, Boehringer Ingelheim, Nutricia and Takeda. There are no disclosures from K. Gyertson, V. Bowyer, C. Levermore, A-M. Mullin, J. Teague and L. Farrelly.
(Copyright ©The authors 2022.)