Emphysema Found on CT Scans Linked to Increased Mortality Risk

A recent study published in Radiology has established a significant connection between emphysema detected on baseline low-dose chest CT (LDCT) scans and mortality rates from various causes, including chronic obstructive pulmonary disease (COPD) and cardiovascular disease. The research involved over 9,000 asymptomatic adults who participated in a lung cancer screening program, with follow-up extending to 25 years.

Emphysema is a chronic lung condition characterized by the damage of air sacs in the lungs, which leads to difficulty in breathing. It is primarily caused by long-term exposure to harmful irritants, such as cigarette smoke and air pollution. According to Claudia I. Henschke, Ph.D., M.D., a leading radiologist at the Icahn School of Medicine at Mount Sinai in New York, this study marks a pivotal moment in understanding the prognostic value of emphysema scoring during lung cancer screening.

Long-Term Study Details

The research involved a cohort of 9,047 adults, aged between 40 and 85 at enrollment, who underwent baseline LDCT scans from 2000 to 2008. Participants were primarily evaluated for their smoking history, with a median of 43 pack-years of exposure. The study aimed to track the long-term health outcomes of these individuals, assessing the correlation between the severity of emphysema and overall mortality.

Each CT scan was examined by a qualified chest radiologist, who assigned an emphysema score ranging from 0 (no emphysema) to 3 (severe emphysema). The findings revealed that 70.9% of participants showed no signs of emphysema, while 21.1% had mild, 5.7% moderate, and 2.4% severe emphysema. Notably, nearly 80% of those identified with emphysema had not previously received a diagnosis.

Key Findings and Implications

By the end of 2024, the study reported that 3,738 participants (approximately 41.3%) had passed away, with the leading causes being cardiovascular disease (12.7%) and COPD (3.3%). The median age at death was 81 years, indicating a concerning trend linked to emphysema severity.

Statistical analysis confirmed that the presence of emphysema significantly increased the risk of mortality. For overall death risk, mild emphysema was associated with a 1.15-fold increase, while severe emphysema correlated with a 2.28-fold increase. The risk of death specifically due to COPD was even more pronounced, with mild emphysema presenting a 2.07-fold increase and severe emphysema a staggering 12.06-fold increase.

Dr. Henschke emphasized that these findings suggest emphysema is not just an incidental finding on CT scans, but a serious health risk associated with significant mortality rates across multiple conditions, not solely lung cancer. She advocates for a comprehensive approach to lung cancer screening that also addresses the risks of COPD and cardiovascular disease.

Furthermore, Dr. Henschke highlighted the need for collaboration among healthcare professionals, including pulmonologists, cardiologists, and radiologists, to adopt a holistic view of patient health. She expressed a desire to extend screening guidelines to include individuals who have never smoked, noting that 30,000 to 40,000 deaths from lung cancer annually occur in non-smokers.

The implications of this study are profound, potentially guiding healthcare providers in tailoring interventions based on emphysema severity. Dr. Henschke stated, “The amount of information you get and the ability to act on it in a meaningful way is something preventive health only dreamed of being just a few years ago.”

As the research continues to influence clinical practices, the integration of emphysema assessment into routine lung cancer screenings could shape the future of preventive healthcare, ultimately improving patient outcomes across diverse populations.