Chest
Volume 129, Issue 5, May 2006, Pages 1305-1312
Journal home page for Chest

Original Research: Lung Cancer
Prevalence of COPD in Women Compared to Men Around the Time of Diagnosis of Primary Lung Cancer

https://doi.org/10.1378/chest.129.5.1305Get rights and content

Purpose

COPD is a well-known independent risk factor that is associated with primary lung cancer. There is, however, a striking paucity of women in studies demonstrating this association. The purpose of this study was to compare the prevalence of COPD as determined by pulmonary function tests (PFTs) between women and men at around the time of lung cancer diagnosis.

Methods

We retrospectively reviewed patients with newly diagnosed primary lung cancer who had undergone PFTs prior to their treatment. The diagnosis of airflow obstruction was made according to American Thoracic Society guidelines. Comparisons of the prevalence of COPD between men and women were performed using univariate and multivariate logistic regression analysis.

Results

Of the 294 patients in the study, 151 patients (51.4%) were men and 143 patient (48.6%) were women. Of the men, 110 patients (72.8%) had COPD compared with 75 patients (52.5%) among the women. This represented a significantly lower prevalence of COPD in women than in men (odds ratio [OR], 0.41; 95% confidence interval [CI], 0.25 to 0.67; p = 0.0003). When adjusted for age and smoking status, a sustained lower prevalence of COPD was noted in women compared to men (OR, 0.44; 95% CI, 0.26 to 0.74; p = 0.002). In a subset of 256 smokers, there remained a lower prevalence of COPD in women compared to men (OR, 0.45; 95% CI, 0.27 to 0.77; p = 0.003). Adjusted analysis to control for age and number of pack-years of smoking in this subset again showed a sustained reduction in the OR for women presenting with COPD (OR, 0.48; 95% CI, 0.28 to 0.83; p = 0.009).

Conclusions

When COPD was examined as an end point among patients who had newly diagnosed lung cancer, a significantly higher proportion of women had normal PFT results. Gender-based differences on PFT results should be considered during the screening of lung cancer, because the stratification of high-risk patients based on the presence of COPD may miss a significant proportion of women with lung cancer.

Section snippets

Materials and Methods

All patients in whom primary lung cancer was diagnosed at Memorial Sloan-Kettering Cancer Center (MSKCC) between March 1995 and January 1997 and who had undergone PFTs prior to their treatment were included in the study. The interpretation of the PFT results was based on the guidelines of the American Thoracic Society (ATS).11 Patients were considered to have COPD when the FEV1/FVC ratio was < 70%.

When PFTs were performed at MSKCC, measurements were made from spirometry (GS Pulmonary Module

Results

During the study period, primary lung cancer was diagnosed in 436 patients. Of these, 294 patients (67%) had undergone PFTs prior to receiving treatment and were included in the study. The median time from the date of the PFTs to the diagnosis of lung cancer in the study was 0.1 month (range, −3.8 to 10.7 months). In 78%, 18%, 3%, and 1% of patients, respectively, PFTs were performed 1 month, 1 to 3 months, 3 to 6 months, and > 6 months from the date of lung cancer diagnosis. There was no

Discussion

The results of this study show that at or around the time of lung cancer diagnosis, fewer women were noted to have spirometric evidence of airflow obstruction compared to men. When adjusted for age and smoking history, there remained a significantly lower proportion of women with COPD. These data suggest (although they do not prove) that the prevalence of COPD in lung cancer patients may be different in women compared to men. The findings from this study supplement results from the literature,2

Conclusion

Around the time of the lung cancer diagnosis, a significantly lower proportion of women showed evidence of airways obstruction on spirometry compared to men. Based on this information, gender-based differences in spirometry should be considered when constructing strategies for the screening for lung cancer. Future studies should prospectively examine the prevalence of airflow obstruction in a gender-matched population with and without lung cancer. The understanding of gender-based risk factors

References (38)

  • RischHA et al.

    Lung cancer risk for female smokers

    Science

    (1994)
  • StabileLP et al.

    Sex and gender differences in lung cancer

    J Gend Specif Med

    (2003)
  • SkillrudDM et al.

    Higher risk of lung cancer in COPD: a prospective randomized matched controlled study

    Ann Intern Med

    (1986)
  • TockmanMS et al.

    Airways obstruction and the risk for lung cancer

    Ann Intern Med

    (1987)
  • KullerLH et al.

    Relation of forced expiratory volume (FEV-1) to lung cancer mortality in the Multiple Risk Factor Intervention Trial (MRFIT)

    Am J Epidemiol

    (1990)
  • NomuraA et al.

    Prospective study of pulmonary function and lung cancer

    Am Rev Respir Dis

    (1991)
  • American Thoracic Society. Standardization of spirometry: 1994 update

    Am J Respir Crit Care Med

    (1995)
  • CrapoRO et al.

    Reference spirometric values using techniques and equipment that meet ATS recommendations

    Am Rev Respir Dis

    (1981)
  • Cited by (0)

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).

    View full text