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Denholm, R.* ; Schüz, J.* ; Straif, K.* ; Stücker, I.* ; Jöckel, K.-H.* ; Brenner, D.R.* ; De Matteis, S.* ; Boffetta, P.* ; Guida, F.* ; Brüske, I. ; Wichmann, H.-E. ; Landi, M.T.* ; Caporaso, N.* ; Siemiatycki, J.* ; Ahrens, W.* ; Pohlabeln, H.* ; Zaridze, D.* ; Field, J.K.* ; McLaughlin, J.* ; Demers, P.* ; Szeszenia-Dabrowska, N.* ; Lissowska, J.* ; Rudnai, P.* ; Fabianova, E.* ; Dumitru, R.S.* ; Bencko, V.* ; Foretova, L.* ; Janout, V.* ; Kendzia, B.* ; Peters, S.* ; Behrens, T.* ; Vermeulen, R.* ; Brüning, T* ; Kromhout, H.* ; Olsson, A.C.*

Is previous respiratory disease a risk factor for lung cancer?

Am. J. Respir. Crit. Care Med. 190, 549-559 (2014)

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RATIONALE: Previous respiratory diseases have been associated with increased risk of lung cancer. Respiratory conditions often co-occur and few studies have investigated multiple conditions simultaneously. OBJECTIVES: Investigate lung cancer risk associated with chronic bronchitis, emphysema, tuberculosis, pneumonia, and asthma. METHODS: The SYNERGY project pooled information on previous respiratory diseases from 12,739 case subjects and 14,945 control subjects from 7 case-control studies conducted in Europe and Canada. Multivariate logistic regression models were used to investigate the relationship between individual diseases adjusting for co-occurring conditions, and patterns of respiratory disease diagnoses and lung cancer. Analyses were stratified by sex, and adjusted for age, center, ever-employed in a high-risk occupation, education, smoking status, cigarette pack-years, and time since quitting smoking. MEASUREMENTS AND MAIN RESULTS: Chronic bronchitis and emphysema were positively associated with lung cancer, after accounting for other respiratory diseases and smoking (e.g., in men: odds ratio [OR], 1.33; 95% confidence interval [CI], 1.20-1.48 and OR, 1.50; 95% CI, 1.21-1.87, respectively). A positive relationship was observed between lung cancer and pneumonia diagnosed 2 years or less before lung cancer (OR, 3.31; 95% CI, 2.33-4.70 for men), but not longer. Co-occurrence of chronic bronchitis and emphysema and/or pneumonia had a stronger positive association with lung cancer than chronic bronchitis "only." Asthma had an inverse association with lung cancer, the association being stronger with an asthma diagnosis 5 years or more before lung cancer compared with shorter. CONCLUSIONS: Findings from this large international case-control consortium indicate that after accounting for co-occurring respiratory diseases, chronic bronchitis and emphysema continue to have a positive association with lung cancer.

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