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VA Researchers Find High Risk Of Lung Cancer In Older Smokers Previously Considered Low Risk

Pictured are Washington DC VA Medical Center Research Physicians from left to right: Ali Ahmed, MD, MPH, Associate Chief of Staff for Health and Aging; J. Anthony Nations, MD, Deputy Chief of Staff; Helen M. Sheriff, MD; and Charles Faselis, MD, Chief of Staff.

Washington DC VA Medical Center Physician Researchers have found that current and former older smokers, who were previously not recommended for annual lung-cancer screening, may have a high risk of lung cancer.

Their research was published in the Journal of the American Medical Association (JAMA) Oncology, on July 28, 2022.

“The findings of our study provide new information about the risk of lung cancer in subsets of smokers who are considered low risk, or free of risk of lung cancer, and are not currently recommended for lung cancer screening,” said lead author of the study and Chief of Staff at the Washington DC VA Medical Center, Charles Faselis, MD.

Smoking is the largest preventable cause of lung cancer and the leading cause of cancer death in the United States. Dr. Faselis said the results of the study are important for Veterans because they are twice as likely to smoke as their civilian counterparts, placing them at a higher risk for lung cancer.

According to Washington DC VA Medical Center’s Deputy Chief of Staff, J. Anthony Nations, MD, the 2021 U.S. Preventative Task Force recommends adults 50-80 years old, who have a history of smoking 20 packs a year and currently smoke or have quit within the past 15 years, get screened annually for lung-cancer. However, findings from this study have identified additional groups of smokers who have a 10-fold higher-risk of developing the disease.

Dr. Nations, who is the second author of this study, said, “Low-dose CT scan is effective at detecting early lung cancer and lowering the risk of death, but it is often associated with false positive results, which can lead to complications from invasive diagnostic procedures. Considering that only a small proportion of smokers develop lung cancer, it is important that we develop advanced risk prediction models that can correctly identify these smokers so they can be selected for screening and earlier detection.”

Senior Author of the study and Associate Chief of Staff for Health and Aging at the Washington DC VA Medical Center, Ali Ahmed, MD, MPH, said, “We had expected that these other smokers, for whom lung cancer screening is not recommended, would have a high risk of having lung cancer, but we were surprised to see a 10 times higher risk. To put the magnitude of a 10 times higher risk into perspective, it equates to 1000% higher risk.”

Dr. Ahmed compared high blood pressure’s correlation to heart failure with smoking’s correlation to lung cancer, to show the importance of this new study. He explained that patients with high blood pressure are 50% more at risk for heart failure, making high blood pressure an important public health risk. In comparison, this study shows that older, current, or former smokers, who are not recommended for annual lung cancer screening, are 1000% more likely to develop lung cancer, which also makes this a vital public health risk to address.

“This remarkably high risk of lung cancer, taken together with many other harmful health effects of smoking, reiterates the importance of abstinence and early cessation,” said Ahmed.

The researchers studied 4,279 older adults in the Cardiovascular Health Study (CHS) who were initially free of cancer and had detailed data on their smoking history, to include cessation history for former smokers. The study participants were categorized into heavy and non-heavy smokers based on a smoking history of a 20-pack-per-year cutoff. Former smokers were then categorized into two groups based on a 15-year smoking cessation cutoff. Occurrence of lung cancer was identified from hospital records during a median of 13 (maximum 23) years of follow-up.

The CHS was a large prospective population-based study funded by the National Heart, Lung and Blood Institute of the National Institutes of Health.

To learn about VA smoking cessation resources available to Veterans, click here.

Other co-authors in the study include: Charity J. Morgan, PhD; Jared Antevil, MD; Sijian Zhang, MB, MS, MPH; Helen M. Sheriff, MD; Gregory D. Trachiotis, MD; Prakash Deedwania, MD; Qing Zeng-Trietler, PhD; and Daniel D. Taub, PhD, from the Washington DC VA Medical Center; Richard M. Allman, MD; Jeffrey M. Roseman, MD, PhD, MPH; and George Howard, DrPH from the University of Alabama at Birmingham, Birmingham, AL; Amiya A. Ahmed, MD, Yale University, New Haven, CT; and Gregg Fonarow, MD, University of California, Los Angeles, CA; Dr. Morgan is also affiliated with the University of Alabama at Birmingham, Birmingham, AL; Dr. Deedwania with University of California, San Francisco, CA; and Dr. Antevil with Uniformed Services University, Washington, DC.