ArticleAmerican journal of respiratory and critical care medicine2015
Airflow Limitation and Histology Shift in the National Lung Screening Trial. The NLST-ACRIN Cohort Substudy.
Article in American journal of respiratory and critical care medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 70 papers, 6 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
70 citing papers in PubMed, 6 syntheses or guidelines pooled it, 143 citations in OpenAlex.
- Screening for lung cancer: A systematic review of overdiagnosis and its implications.Molecular oncology · 2026Pooled it
- Lung Cancer Risk in US Adults with COPD: A Systematic Review and Meta-Analysis.International journal of chronic obstructive pulmonary disease · 2025Pooled it
- Prevalence of lung cancer in chronic obstructive pulmonary disease: A systematic review and meta-analysis.Frontiers in oncology · 2022Pooled it
- Guideline
- Recommendations from the European Society of Thoracic Surgeons (ESTS) regarding computed tomography screening for lung cancer in Europe.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2017Guideline
- Can CT Screening Give Rise to a Beneficial Stage Shift in Lung Cancer Patients? Systematic Review and Meta-Analysis.PloS one · 2016Pooled it
- Chronic obstructive pulmonary disease prevalence and prediction in a high-risk lung cancer screening population.BMC pulmonary medicine · 2020Trial
- Prevalence, Symptom Burden, and Underdiagnosis of Chronic Obstructive Pulmonary Disease in a Lung Cancer Screening Cohort.Annals of the American Thoracic Society · 2020Trial
- Sequential screening for lung cancer in a high-risk group: randomised controlled trial: LungSEARCH: a randomised controlled trial of Surveillance using sputum and imaging for the EARly detection of lung Cancer in a High-risk group.The European respiratory journal · 2019Trial
- Nicotine dependence as an independent risk factor for atherosclerosis in the National Lung Screening Trial.BMC public health · 2019Trial
- Impact of COPD on Lung Cancer Screening Positivity in a Specialist-Managed Cohort From Brazil.CHEST pulmonary · 2026Article
- Personalised screening intensity based on existing lung cancer risk and spirometry.ERJ open research · 2026Article
- Lung tissue T cells are activated in chronic obstructive pulmonary disease with non-small cell lung cancer patients.Scientific reports · 2025Article
- Structured narrative review on lung cancer screening: current evidence, clinical practice implications and implementation insights from a multidisciplinary task force and patient representatives.European respiratory review : an official journal of the European Respiratory Society · 2025Review
- Therapeutic Vaccines for Non-Communicable Diseases: Global Progress and China's Deployment Pathways.Vaccines · 2025Review
- The Application of Ultrasonography in the Detection of Airway Obstruction: A Promising Area of Research or Unnecessary Gadgetry?Life (Basel, Switzerland) · 2025Review
- From chronic obstructive pulmonary disease (COPD) to lung cancer: a Mendelian randomization study revealing mediation pathways through plasma metabolomics, proteomics, and immunophenotyping.Discover oncology · 2025Article
- A Low Expression of NRF2 Enhances Oxidative Stress and Autophagy in Myofibroblasts, Promoting Progression of Chronic Obstructive Pulmonary Disease.Current medicinal chemistry · 2025Article
- COPD Severity as an Independent Predictor of Long-Term Survival in Operable Lung Cancer: A Retrospective Analysis from a High-Volume Thoracic Surgery Center.International journal of chronic obstructive pulmonary disease · 2025Article
- Novel Strategies for Lung Cancer Interventional Diagnostics.Journal of clinical medicine · 2024Review
10 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
8 authors at 4 institutions in 3 countries.
Funding
Abstract
rationaleAnnual computed tomography (CT) is now widely recommended for lung cancer screening in the United States, although concerns remain regarding the potential harms, including those from overdiagnosis.
objectivesTo examine the effect of airflow limitation on overdiagnosis by comparing lung cancer incidence, histology, and stage shift in a subgroup of the National Lung Screening Trial (NLST).
methodsIn an NLST subgroup (n = 18,714), screening participants were randomized to annual computed tomography (CT, n = 9,357) or chest radiograph (n = 9,357) screening and monitored for a mean of 6.1 years. After baseline prebronchodilator spirometry, to identify the presence of airflow limitation, 18,475 subjects (99%) were assigned as having chronic obstructive pulmonary disease (COPD) or no COPD. Lung cancer prevalence, incidence, histology, and stage shift were compared after stratification by COPD. MEASUREMENTS AND MAIN
resultsFor screening participants with spirometric COPD (n = 6,436), there was a twofold increase in lung cancer incidence (incident rate ratio, 2.15; P < 0.001) and, when compared according to screening arm, no excess lung cancers and comparable histology. Compared with chest radiography, there was also a trend favoring reduced late-stage and increased early-stage cancers in the CT arm (P = 0.054). For those with normal baseline spirometry (n = 12,039), we found an excess of lung cancers during screening in the CT arm, almost exclusively early-stage adenocarcinoma-related cancers (histology shift and overdiagnosis). After correction for these excess cancers, stage shift was marginal (P = 0.077).
conclusionsIn the CT arm of the NLST-ACRIN (American College of Radiology Imaging Network) cohort, COPD status was associated with a doubling of lung cancer incidence, no apparent overdiagnosis, and a more favorable stage shift.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.