Low-Dose CT Scans and Cardiovascular, Respiratory, and Oncological Disease

Low-dose computed tomography (LDCT) scans undertaken for lung cancer screening may also provide clinically relevant information concerning cardiovascular disease, respiratory disease, and oncological disease, according to findings published recently in BMC Pulmonary Medicine. Associations were observed between certain LDCT findings and subsequent cardiovascular, respiratory, and oncological disease.

Although annual lung cancer screening in high risk populations through LDCT is recommended by the US Preventive Services Task Force, studies have shown conflicting evidence of the value of this screening. In the current study, investigators sought to determine whether findings of low-dose CT lung cancer screening scans had prognostic as well as diagnostic value for diseases other than lung cancer.

Toward that end, the researchers conducted a secondary analysis of an ongoing single-center observational prospective proof-of- concept study at Campus Bio-Medico University and Teaching Hospital in Rome, Italy. Of the 1000 individuals admitted for acute care who received LDCT scan from April 2014 to May 2015, data were available on 974 patients. The investigators’ analysis focused on 746 patients with a smoking history (mean age 62±5years; 62% male; 72% current smokers; mean pack year 49.5±19.9) for comparable analysis with previous lung cancer screening trials and excluded the 228 patients eligible due to exposure to carcinogens and history of chronic obstructive pulmonary disease.

The investigators evaluated the association between LDCT scan abnormal findings with cardiovascular, respiratory, and oncological diseases through univariable and multivariable logistic regression models. The analysis found that selected LDCT scan results in variable proportion succeeded as signals of cardiovascular, respiratory, and oncological disease, identified according to acute care admissions (8.6% for cardiovascular disease, 4.3% for respiratory disease and 5.2% for oncological disease) in the 3 years following the LDCT scan screening.

Specifically, with respect to cardiovascular diseases, the analysis found that mucus plugs and valve (but not coronary) calcifications were positively associated with cardiovascular disease admissions, while subpleural fibrosis showed a negative association. With respect to respiratory diseases, emphysema (mainly when centrilobular) was associated with respiratory disease admissions in the univariable but not in the adjusted model. Oncological disease admissions were positively associated with lung nodules larger than 8 mm, tracheal deviation, and mucus plugs.

The researchers concluded that this data “show that selected LDCT findings have multiple prognostic properties in a population with smoking exposure over the threshold for screening eligibility, and, thus, are worthy of being carefully searched for and recorded.” However, the investigators also noted that their study did not shed light on whether targeting people at risk of CD, RD, or OD for LDCT procedure was a cost-effective approach, and that confirmation of their study in a larger population was needed.

Reference

Finamore P, Tanese L, Longo F, et al. The additional value of lung cancer screening program in identifying unrecognized diseases. BMC Pulm Med. 2022;22(1):48. doi:10.1186/s12890-022-01826-1