from both the pulmonary and the cancer research communities
because several lines of evidence indicate a connection between
COPD and lung cancer. The role of environmental smoke exposure
in the development of chronic lung disease and lung cancer
was underscored by the 2004 Surgeon General’s Report on the
Health Consequences of Smoking ( 8 ). Similar to COPD, lung
cancer is more likely to occur in the poor and in the less educated
( 9 ). Low lung function is an established risk factor for lung cancer,
and among smokers, those with airfl ow obstruction have the greatest
risk of developing lung cancer. Several studies ( 3 , 10 – 12 ) have
shown that having moderate-to-severe COPD increases the risk of
developing lung cancer up to 4.5-fold. Interestingly, recent data
( 13 ) also demonstrate that the presence of emphysema is associated
with poor prognosis in those with lung cancer. Complementary to
this is the observation that the incidence of lung cancer is associated
with specifi c stages of COPD severity. Lung cancer is assigned