ArticleAnnals of the American Thoracic Society2017
Reduced Expiratory Flow Rate among Heavy Smokers Increases Lung Cancer Risk. Results from the National Lung Screening Trial-American College of Radiology Imaging Network Cohort.
Article in Annals of the American Thoracic Society, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 3 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
36 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Lung Cancer Risk in US Adults with COPD: A Systematic Review and Meta-Analysis.International journal of chronic obstructive pulmonary disease · 2025Pooled it
- The prevalence of comorbidity in the lung cancer screening population: A systematic review and meta-analysis.Journal of medical screening · 2023Pooled it
- Pooled it
- Lung cancer incidence and risk factors in chronic obstructive pulmonary disease: a systematic review and meta-analysis of cohort studies.Journal of thoracic disease · 2026Article
- Personalised screening intensity based on existing lung cancer risk and spirometry.ERJ open research · 2026Article
- Interstitial lung abnormality with preserved pulmonary function in lung cancer screening-eligible individuals: long-term effects on function and prognosis.European radiology · 2026Article
- Comparison of Underlying Risk of Developing and Dying From Lung Cancer in Screened Populations.Chest · 2026Article
- Lung tissue T cells are activated in chronic obstructive pulmonary disease with non-small cell lung cancer patients.Scientific reports · 2025Article
- Article
- Impaired lung function and lung cancer risk in 461 183 healthy individuals: a cohort study.BMJ open respiratory research · 2024Article
- Lung cancer in patients who have never smoked - an emerging disease.Nature reviews. Clinical oncology · 2024Review
- Article
- Clinical Adjuncts to Lung Cancer Screening: A Narrative Review.Thoracic surgery clinics · 2023Review
- Review
- A Closer Look-Who Are We Screening for Lung Cancer?Mayo Clinic proceedings. Innovations, quality & outcomes · 2023Article
- Lung function impairment in lung cancer screening: discordance between risk and screening outcomes when looking through a PRISm.Translational lung cancer research · 2022Article
- Lung function impairment in the German Lung Cancer Screening Intervention Study (LUSI): prevalence, symptoms, and associations with lung cancer risk, tumor histology and all-cause mortality.Translational lung cancer research · 2022Article
- The effects of epithelial-mesenchymal transitions in COPD induced by cigarette smoke: an update.Respiratory research · 2022Review
- Airflow Limitation Increases Lung Cancer Risk in Smokers: The Lifelines Cohort Study.Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology · 2022Article
- Observational
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7 authors.
Funding
Abstract
rationaleAlthough epidemiological studies consistently show that chronic obstructive pulmonary disease is associated with an increased risk of lung cancer, debate exists as to whether there is a linear relationship between the severity of airflow limitation and lung cancer risk.
objectivesWe examined this in a large, prospective study of older heavy smokers from the American College of Radiology Imaging Network subcohort of the National Lung Screening Trial (ACRIN). Airflow limitation was defined by prebronchodilator spirometry subgrouped according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1-4.
methodsIn the National Lung Screening Trial-ACRIN cohort of 18,473 screening participants, 6,436 had airflow limitation (35%) and 12,037 (65%) had no airflow limitation. From these groups, 758 lung cancer cases were prospectively identified. Participants with airflow limitation were stratified according to GOLD groups 1 (n = 1,607), 2 (n = 3,528), 3 (n = 1,083), and 4 (n = 211). Lung cancer incidence at study end (mean follow-up, 6.4 yr) was compared between the GOLD groups and those with no airflow limitation (referent group). MEASUREMENTS AND MAIN
resultsCompared with those with no airflow limitation, where lung cancer incidence was 3.78/1,000 person years, incidence rates increased in a simple linear relationship: GOLD 1 (6.27/1,000 person yr); GOLD 2 (7.86/1,000 person yr); GOLD 3 (10.71/1,000 person yr); and GOLD 4 (13.25/1,000 person yr). All relationships were significant versus the reference group at a P value of 0.0001 or less.
conclusionsIn a large prospective study of high-risk cigarette smokers, we report a strong linear relationship between increasing severity of airflow limitation and risk of lung cancer.
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