Characterizing COPD - Lung Cancer Patients, with Joseph Friedberg, MD

Lung cancer remains the deadliest cancer in the US, despite the widespread availability of low dose computed tomography (CT) scanning and recently updated guidelines to expand the threshold for high lung cancer risk among current or former smokers.1 In fact, only just more than 1 in 8 high-risk patients were screened for lung cancer in 2024.2

Interestingly, a highly common comorbidity in patients with lung cancer which increases the likelihood of mortality may also provide more opportunities for timely screening and escalation to life-altering care or surgery — just by presenting more apparently.

In an interview with HCPLive at the 2025 Global Initiative for Chronic Obstructive Lung Disease (GOLD) International COPD Conference in Philadelphia, PA, this week, Joseph Friedberg, MD, Thoracic Surgeon-in-Chief at Temple University and professor of thoracic medicine and surgery at Lewis Katz School of Medicine, discussed the burden and prevalence of COPD in patients with lung cancer.

By Friedberg’s estimation, approximately two-thirds of patients he performs lung cancer surgery on have a comorbid COPD diagnosis — an unsurprising rate, given the prevalence of either disease due to high risk factors including cigarette smoking. All the same, the presentation of comorbid COPD and lung cancer on low dose CT scans is very diverse.

“We’re seeing patients with suspicious lesions that would be radiographically occult on a chest X-ray — you wouldn’t even see them,” Friedberg explained. “We’re seeing a lot more ground glass opacities, which are hard-to-see smoking-related cancers. We’re seeing smaller lung cancers.”

These presentations are hardly relevant when addressing lung cancer, a predominately asymptomatic cancer until it has metastasized. Friedberg noted that the most common clinical presentation of lung cancer for years was seizures — an indication that it had already spread to a patient’s brain. The comorbid presentation of COPD may provide an incidental opportunity to identify potentially deadly lung cancer sooner than anticipated.

“Typically, we end up with patients who are discovered on an incidental finding — some trauma that warrants getting a CAT scan or an X-ray, that sort of thing,” Friedberg said. “These days, I would say that patient is [coming from] the emergency room or a family care physician who is just getting an annual screening and is referred to a pulmonologist.”

References

1. Jani CT, Singh H, Abdallah N, et al. Trends in Lung Cancer Incidence and Mortality (1990-2019) in the United States: A Comprehensive Analysis of Gender and State-Level Disparities. JCO Glob Oncol. 2023;9:e2300255. doi:10.1200/GO.23.00255
2. Kunzmann K. What Ails Lung Cancer Screening, with Douglas Wood, MD. HCPLive. Published October 20, 2025.
   https://www.hcplive.com/view/what-ails-lung-cancer-screening-douglas-wood-md