INTERSTITIAL lung disease (ILD) is independently associated with a significantly higher risk of developing lung cancer, according to new findings from a large population-based cohort study that controlled for genetic factors. Researchers found that this association was present across all major histological subtypes, underscoring the need to incorporate ILD into lung cancer risk assessment models.
Using data from over 5.4 million individuals in Sweden, investigators applied both population-based and sibling-controlled study designs to evaluate the relationship between ILD and lung cancer. Participants were followed for up to 30 years, with adjustments made for sex, age, calendar period, educational attainment, and smoking-related diseases.
During follow-up, the incidence rate of lung cancer was markedly higher in individuals with ILD compared to those without the condition, 355.4 versus 26.2 per 100,000 person-years, respectively. After adjustment, ILD was linked to more than double the risk of lung cancer in the general population (hazard ratio [HR], 2.16; 95% CI, 1.89–2.46). In sibling-controlled analyses, which further account for shared genetic and early-life environmental factors, the risk was even higher (HR, 2.91; 95% CI, 1.98–4.27).
Elevated risk was consistent across histological subtypes, with the strongest associations observed for small cell carcinoma (HR, 3.29; 95% CI, 2.32–4.68) and squamous cell carcinoma (HR, 2.56; 95% CI, 1.99–3.29). Increased risk was also present for adenocarcinoma (HR, 1.60; 95% CI, 1.28–2.01) and other histological types (HR, 2.32; 95% CI, 1.78–3.01).
The findings suggest that ILD is an independent risk factor for lung cancer and should be formally recognized in clinical risk models. Incorporating ILD status into screening and surveillance protocols may improve early detection strategies for high-risk patients.
Reference:
Xu H et al. Interstitial lung disease and risk of lung cancer. JAMA Netw Open. 2025;8(7):e2519630.
