Increased Risk of Lung Cancer With COPD,
Even in Never Smokers

Pam Harrison

April 07, 2020

The risk of lung cancer in never smokers who develop chronic obstructive pulmonary disease (COPD) is actually higher than it is in ever smokers who do not have COPD, an observational cohort study has shown.

Patients with COPD who had never smoked had more than double the risk of developing lung cancer (with an adjusted hazard ratio [HR] of 2.67) compared to individuals without COPD who had never smoked.

This was slightly higher than the increased risk seen in individuals who had smoked but who did not have COPD. This group had an almost double the risk of developing lung cancer (adjusted HR, 1.97), again compared to never smokers, the investigators added.

The highest risk of lung cancer was in patients who had COPD and who had smoked; this group had a sixfold risk of developing lung cancer (adjusted HR, 6.19) compared with never smokers without COPD, they note.

"COPD was a strong independent risk factor for lung cancer incidence in never smokers," conclude the authors, led by Hye Yun Park, MD, Samsung Medical Center, Seoul, South Korea.

"Future studies should evaluate whether COPD patients are candidates for lung cancer screening, irrespective of smoking status," they suggest.

The study was published March 10 in the journal Thorax.  

It was based on an analysis of data from the National Health Insurance (NHS) Service National Sample Cohort between January 2002 and December 2013.

"We included all men and women, 40 to 84 years of age, who underwent at least one health screening examination provided by the NHS during the study period," Park and colleagues explain.

Overall, the cohort included 338,548 men and women. Participants were followed-up for a median of 7 years.

Over the study interval, 1834 participants developed lung cancer.

Table. Association Between COPD and Lung Cancer

COPD and smoking status Incidence rate/
1000 person yrs
Hazard Ratio

Never smokers without COPD

0.5 Reference
Never smokers with COPD 3.0 2.67
Ever smokers without COPD 1.2 1.97
Ever smokers with COPD 9.5 6.19


"The risk of disease [lung cancer] in never smokers with COPD was higher than that in ever smokers without COPD," the investigators observe.

"Given that poor lung function in COPD is often a barrier to optimal lung cancer treatment due to increased risk of treatment-related morbidities, our study suggests that early detection of lung cancer in COPD patients may reduce the risk of treatment complications," the authors write.

The study was supported by the National Research Foundation of Korea. The authors have disclosed no relevant financial relationships.

Thorax. Published online March 10, 2020. Full text

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