Emphysema underdiagnosed, but low-dose CT provides opportunity to identify, intervene
Emphysema may be underdiagnosed among patients screened for lung cancer. But low-dose CT provides an opportunity to identify the disease, help patients quit smoking and initiate treatment, experts advised in a new large-scale study.
Reviewing data from nearly 53,000 patients who underwent computed tomography to check for cancer, scientists found eye-opening results. Nearly 24% of patients had evidence of emphysema and more than 76% of those patients reported no prior diagnosis of chronic obstructive pulmonary disease.
That’s despite 23.6% of those 2,258 individuals having moderate to severe emphysema, experts recently detailed in Clinical Imaging.
“Our findings further support the observation that COPD may be underdiagnosed, even when there is advanced emphysema,” corresponding author Claudia Henschke, PhD, MD, with Mount Sinai Hospital’s Department of Radiology, and dozens of co-authors wrote March 20. “LDCT may facilitate the diagnosis of emphysema, which is associated with an increase in morbidity and deaths due to lung cancer and other causes. The diagnosis provides opportunities to initiate smoking cessation and pharmacotherapy for COPD, and can direct the clinician to look for important, treatable conditions that coexist in patients with COPD."
Chronic obstructive pulmonary disease is the third leading cause of death in the United States and responsible for more than $36 billion in costs. Emphysema, one form of COPD, can increase the risk of worsening disease, death and lung cancer. However, for various reasons, clinicians can sometimes overlook this concern, experts noted.
Wanting to determine the prevalence of emphysema among those who self-reported COPD—or those who did not—Henschke looked to data from the International Early Lung Cancer Action Program. Her team analyzed a cohort of 52,726 individuals who underwent a LDCT for lung cancer between 2003 to 2016. Among the 12,542 participants with CT evidence of emphysema, there were a few significant predictors of having the disease but no prior diagnosis of COPD. Those included patients who were younger men, had lower pack-years of smoking, obtained their college degree, had no family history of lung cancer, or had no self-reported cardiac disease or hypertension, the authors noted.
Experts urged radiologists and other clinicians to keep an eye out for these patients and seize the opportunity to initiate treatment.
“The finding of emphysema by CT in smokers with or without a diagnosis of COPD should compel the supervising physician to initiate therapeutic intervention,” the authors advised. “LDCT can inform the clinician as to the presence of important comorbid systemic manifestations of COPD including coronary artery disease, osteoporosis and muscle wasting, and help dictate further global management of the patient,” they added later.
You can read more of the analysis in the New York Roentgen Society's official journal here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.