Emphysema on baseline lung cancer CT a sign of future mortality risk
It isn’t just lung nodules that could be problematic if detected on lung cancer CT screenings. New research suggests other baseline findings could lead to adverse health outcomes in the future.
New data published in RSNA’s flagship journal Radiology indicate that the presence of emphysema on baseline low-dose CT screening (LDCT) has significant associations with death from all causes, chronic obstructive pulmonary disease (COPD), and cardiovascular disease within 25 years. Experts involved in the study suggest their findings highlight the utility of these exams beyond lung cancer.
“Lung cancer screening shouldn’t just be looking for nodules,” noted Claudia I. Henschke, PhD, MD, a radiologist and professor of radiology in the Department of Diagnostic, Molecular, and Interventional Radiology at Icahn School of Medicine at Mount Sinai, in New York. “That’s a small part of what we see on the CT scan. As radiologists, we’re responsible for the entire image.”
The analysis included data from more than 9,000 individuals with a history of smoking. Each underwent an LDCT exam between 2000 and 2008 and had intermittent follow-up data available until their death or Dec. 31, 2024. A chest radiologist analyzed each exam for the presence of emphysema, scoring the severity on a scale from 0 to 3, with the latter indicating more serious disease.
Around 29% of those screened showed emphysema on their baseline lung cancer CT screening. Mild cases accounted for 21.1% of the exams, while 5.7% were considered moderate and 2.4% were categorized as severe. The majority (nearly 80%) had not been diagnosed with emphysema prior to the exam, including 5% who had moderate or severe disease.
Just over 40% of the cohort had passed away by the end of the analysis. Of those, 12.7% died from cardiovascular disease (CVD) and 3.3% from COPD. Older age and higher cumulative exposure to smoking were both associated with higher odds of developing COPD and CVD.
“Clinically, these findings suggest emphysema is not merely an incidental CT finding, but a distinct disease entity associated with worst outcomes and increased mortality, not only from lung cancer but also from respiratory and cardiovascular diseases,” Henschke said. “The findings show an increased risk of all causes of death by the presence of emphysema and its severity, ranging from a 1.15-fold increase for mild disease and a 2.28-fold increase for severe emphysema. For deaths due to COPD, the increased risk ranged from a 2.07-fold for mild disease to 12.06-fold increase for severe emphysema.”
The team added that their findings could help better inform risk-based assessments capable of addressing the disease before it progresses.
Read more about the study here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.