Non–Cystic Fibrosis Bronchiectasis Increases the Risk of Lung Cancer Independent of Smoking Status
Hayoung Choi, Hye Yun Park, Kyungdo Han, Juhwan Yoo, Sun Hye Shin, Bumhee Yang, Youlim Kim, Tai Sun Park, Dong Won Park, Ji‐Yong Moon, Seung Won, Sang‐Heon Kim, Tae‐Hyung Kim, Yeon‐Mok Oh, Ho Joo Yoon, Jang Won Sohn, Hyun Lee
Abstract
Abstract Rationale It remains unclear whether non-cystic fibrosis bronchiectasis increases the risk of lung cancer, because smoking history was not considered in previous studies. Objectives To evaluate whether participants with bronchiectasis have a higher risk of incident lung cancer than those without bronchiectasis with information on smoking status. Methods This was a population-based cohort study of 3,858,422 individuals who participated in the 2009 National Health Screening Program. We evaluated the incidence of lung cancer in participants with bronchiectasis (n = 65,305) and those without bronchiectasis (n = 3,793,117). We followed the cohort up until the date of lung cancer diagnosis, date of death, or December 2018. Cox proportional hazard regression models were used to evaluate the relative risk of lung cancer between participants with bronchiectasis and those without bronchiectasis. Results The incidence of lung cancer in participants with bronchiectasis was significantly higher than in those without bronchiectasis (2.1 vs. 0.7 per 1,000 person-years; P < 0.001), with an adjusted hazard ratio (aHR) of 1.22 (95% confidence interval [CI], 1.14–1.30) in the model adjusting for potential confounders and accounting for the competing risk of mortality. Regardless of smoking status, the risk of lung cancer was significantly higher in participants with bronchiectasis than in those without bronchiectasis (aHR, 1.28 [95% CI, 1.17–1.41] for never-smokers; aHR, 1.26 [95% CI, 1.10–1.44] for ever-smokers). Although bronchiectasis did not increase the risk of lung cancer among participants with chronic obstructive pulmonary disease (COPD), it significantly increased the risk of lung cancer in participants without COPD (aHR, 1.19 [95% CI, 1.09–1.31]). Conclusions The presence of bronchiectasis was associated with a higher risk of lung cancer after considering the smoking status.