Background: Pulsed field ablation (PFA) for atrial fibrillation (AF) has demonstrated comparable treatment efficacy with conventional thermal ablation. Despite its high safety profile and increasing adoption worldwide, little is known about the real-world data on the efficacy and safety of PFA in elderly AF patients. Methods: We conducted a retrospective observational study of patients with AF who underwent PFA with a pentaspline catheter (Farapulse, Boston Scientific). Patients were categorized into two groups: <80 years and ≥80 years, and baseline characteristics, procedural data, and recurrence of atrial arrhythmia were compared. Results: Among the 483 AF patients enrolled in the study (mean age 69±11, male 66%), 76 (16%) patients were ≥80 years of age. The octogenarian group was characterized by proportionally more females, lower body mass index, and a higher prevalence of vascular disease and chronic kidney disease, with significantly higher CHA 2 DS 2 -VASc scores compared to the younger group (P<0.001). Compared to the younger patients, more octogenarians underwent adjunctive posterior wall (71% vs. 50%, P<0.001) and anterior wall (26% vs. 12%, P =0.002) ablation. Procedure time, ablation catheter dwell time, and fluoroscopy times were comparable between the two age groups. There were zero complications in the octogenarian group and 9 (2.2%) complications in the younger group (P=0.19). Early follow-up data (128±100 days) showed comparable rates of atrial arrhythmia recurrence between the octogenarian and younger patient groups. Conclusions: PFA demonstrates acceptable efficacy and excellent safety in elderly patients aged ≥80 years despite a higher burden of comorbidities.

OBJECTIVE:We evaluated risk factors of thyroid abnormalities detected on low-dose computed tomography (LDCT) among nuclear weapons workers in a lung cancer screening program. METHODS:We conducted a matched case-control study of participants with (647 cases) and without (1941 controls) incidental thyroid abnormalities on LDCT, matching on LDCT year and age between August 2006 and June 2023. Multivariable conditional logistic regression analysis adjusted for demographic, smoking, and occupational attributes yielded matched adjusted odds ratio (MAOR) with 95% confidence intervals. RESULTS:Estimated occupational radiation exposure (medium exposure MAOR: 1.58 [1.07, 2.33] and high exposure MAOR: 1.52 [0.99, 2.33]), female (MAOR: 2.67 [2.03, 3.50]), African American (MAOR: 2.49 [1.79, 3.45]), and obesity (BMI: 30-39.9 kg/m 2 MAOR: 1.53 [1.14, 2.06], ≥40 kg/m 2 MAOR: 2.43 [1.55, 3.82]) were significantly associated with thyroid abnormalities. CONCLUSION:Further studies of occupationally exposed populations are warranted.

Background The low-dose CT (≤3 mGy) screening report of 1000 Early Lung Cancer Action Program (ELCAP) participants in 1999 led to the International ELCAP (I-ELCAP) collaboration, which enrolled 31 567 participants in annual low-dose CT screening between 1992 and 2005. In 2006, I-ELCAP investigators reported the 10-year lung cancer-specific survival of 80% for 484 participants diagnosed with a first primary lung cancer through annual screening, with a high frequency of clinical stage I lung cancer (85%). Purpose To update the cure rate by determining the 20-year lung cancer-specific survival of participants diagnosed with first primary lung cancer through annual low-dose CT screening in the expanded I-ELCAP cohort. Materials and Methods For participants enrolled in the HIPAA-compliant prospective I-ELCAP cohort between 1992 and 2022 and observed until December 30, 2022, Kaplan-Meier survival analysis was used to determine the 10- and 20-year lung cancer-specific survival of participants diagnosed with first primary lung cancer through annual low-dose CT screening. Eligible participants were aged at least 40 years and had current or former cigarette use or had never smoked but had been exposed to secondhand tobacco smoke. Results Among 89 404 I-ELCAP participants, 1257 (1.4%) were diagnosed with a first primary lung cancer (684 male, 573 female; median age, 66 years; IQR, 61-72), with a median smoking history of 43.0 pack-years (IQR, 29.0-60.0). Median follow-up duration was 105 months (IQR, 41-182). The frequency of clinical stage I at pretreatment CT was 81% (1017 of 1257). The 10-year lung cancer-specific survival of 1257 participants was 81% (95% CI: 79, 84) and the 20-year lung cancer-specific survival was 81% (95% CI: 78, 83), and it was 95% (95% CI: 91, 98) for 181 participants with pathologic T1aN0M0 lung cancer. Conclusion The 10-year lung cancer-specific survival of 80% reported in 2006 for I-ELCAP participants enrolled in annual low-dose CT screening and diagnosed with a first primary lung cancer has persisted, as shown by the updated 20-year lung cancer-specific survival for the expanded I-ELCAP cohort. © RSNA, 2023 See also the editorials by Grenier and by Sequist and Olazagasti in this issue.

Introduction: Atypical atrial flutter (aAFL) has been described in the absence of prior atrial interventions, but prognosis for these patients after catheter ablation is poorly defined. This study was designed to define characteristics and ablation outcomes in patients with de novo aAFL. Methods: Patients with non-CTI flutter, without prior ablation or cardiac surgery, were identified from an institutional database. Clinical, mapping, ablation, and follow up data were compared to an equally sized group of randomly selected patients with typical flutter (tAFL). Results: The 35 patients with aAFL had 45 mapped non-CTI flutters. aAFL patients had similar age, gender, cardiovascular comorbidities, and LA size compared to tAFL, except aAFL patients had higher LVEF (54 ± 12 vs 46 ± 19%, p=0.04). Cycle length of aAFL was longer (268 [IQR 231, 310] vs 230 [220, 250] msec, p=0.0006). aAFL localized to the RA in 16, LA in 28, and biatrial in 1. Mechanisms were macroreentry in 23 (8 RA, 15 LA) and localized reentry in 22 (8 RA, 14 LA). Areas of scar predominated in the lateral/posterior RA (N=9), anterior LA (N=14), and posterior LA (N=6). Most common LA circuits were perimitral reentry (N=8) and roof dependent (N=8), including dual loop reentry. Localized reentry occurred most commonly in the anterior LA (N=7) or involved the pulmonary veins (N=4). Ablation was acutely successful for 41/45 aAFLs (91%) and for all tAFL. After median follow-up of 33 [6.6, 55] mo, atrial arrhythmias recurred in 23/34 aAFL patients (68%) and 24/35 tAFL patients (69%); those with aAFL had earlier recurrences (1.9 [0.43, 11] vs 19 [2.3, 36] mo, p=0.01). First recurrences after aAFL ablation were more likely to be AFL rather than AF (83% vs 17%) whereas tAFL patients were more likely to recur with AF (24% AFL vs 76% AF, p<0.0001). Conclusions: Patients with de novo aAFL tend to have spontaneous scar, commonly in the lateral/posterior RA and anterior LA, consistent with an atrial myopathy. Ablation can be accomplished with high acute success, but recurrent atrial arrhythmias are common, most re-presenting with atrial tachycardias. Future studies should clarify if a substrate-based approach or adjunctive antiarrhythmic drugs would result in better long term outcomes.

Introduction Patient anatomical features, such as shorter membranous septum (MS) length, on computed tomography have been shown to predict conduction abnormalities after transcatheter aortic valve replacement (TAVR). This relationship has not yet been evaluated using transesophageal echocardiography (TEE). Our hypothesis is that the distance from the aortic annulus to the septal bulge, a surrogate of MS distance and length, will be associated with a new interventricular conduction delay and heart block post-TAVR. Likewise, we hypothesize an implantation depth of the valve closer to the septal bulge will also predict post-TAVR interventricular conduction delay. Methods Comprehensive intraprocedural echocardiographic data were analyzed retrospectively on 88 patients who underwent TAVR under general anesthesia with TEE. Pre-procedural MS distance and post-procedural implantation depth (quantified as the inferior border of valve to septal bulge) were measured in the mid-esophageal long axis view of the aortic valve in mid-systole. EKGs were evaluated pre-TAVR and immediately post-valve deployment. Univariate logistic regression was used to identify predictors of a need for post-operative pacemaker (PM) implantation and new bundle branch block (BBB). Results The population consisted of 88 patients undergoing TAVR with TEE from 2017-2018 at our institution. The median age was 84, 45/88 (51.1%) were female. After TAVR, 7/88 (7.9%) had PPM placed and 21/88 (23.8%) had a new bundle branch block, transient or permanent. MS length was inversely associated with the risk of developing an interventricular conduction delay after TAVR (OR=0.19, CI 0.05-0.75, p=0.018). As shown in Table 1, the implantation distance was inversely associated with the need for a pacemaker or developing a new interventricular conduction delay after TAVR (OR=0.19, Cl 0.06-0.6, p=0.006). Discussion MS length and valve implantation depth on intraprocedural TEE are inversely associated with the risk of developing conduction abnormalities post-TAVR. TEE assessment may be comparable to CT in predicting post-TAVI high-grade atrioventricular block, and has the additional benefit of being performed intraprocedurally in selected patients.

Creating AV block with direct-current energy3 or with cryo energy4 revealed, however, total AV block with preserved preexcitation due to conduction over an accessory pathway (AP) connecting the right atrium with the RV. These decremental anterograde-conducting connections, not localized in the AV node or the distal part of the conduction system, were mentioned as being Mahaim-like APs. However, more in detail, the definition of these fibers is as follows: decrementally conducting accessory AV pathways connecting the right atrium with a part of the right bundle branch (RBB), or atriofascicular (AF) pathways.

A large number of World Trade Center (WTC) rescue and recovery workers are affected by asthma. While physical and mental health comorbidities have been associated with poor asthma control in this population, the potential role of allergen sensitization is unknown. This study examined the association of indoor sensitization and exposure as a risk factor for increased asthma morbidity in WTC workers. We used data from a prospective cohort of 331 WTC workers with asthma. Sensitization to indoor allergens was assessed by measurement of antigen-specific serum immunoglobulin E (IgE) levels. We used validated tools to evaluate the exposure to indoor allergens. Asthma morbidity outcomes included level of control (Asthma Control Questionnaire, ACQ), quality of life (Asthma Quality of Life Questionnaire, AQLQ) and acute resource utilization. The prevalence of sensitization to cat, dog, mouse, dust mite, cockroach, and mold allergens were 33%, 21%, 17%, 40%, 17%, and 17%, respectively. Unadjusted and regression analyses showed no significant relationship between sensitization and increased asthma morbidity (p > 0.05 for all comparisons), except for sensitization to Aspergillus Fumigatus, cat and mouse epithelium, which were associated with decreased morbidity.

American Journal of Industrial MedicineVolume 62, Issue 7 p. 625-626 LETTER TO THE EDITOR The editors respond to Dr Paustenbach Rodney Ehrlich MBChB, FCPHM(SA), PhD, Corresponding Author Rodney Ehrlich MBChB, FCPHM(SA), PhD rodney.ehrlich@uct.ac.za orcid.org/0000-0001-5736-9237 School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa Correspondence Rodney Ehrlich, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town 7925, South Africa. Email: rodney.ehrlich@uct.ac.zaSearch for more papers by this authorSteven Markowitz MD, DrPH, Steven Markowitz MD, DrPH orcid.org/0000-0002-0052-6745 Queens College, City University of New York, New York, New YorkSearch for more papers by this author Rodney Ehrlich MBChB, FCPHM(SA), PhD, Corresponding Author Rodney Ehrlich MBChB, FCPHM(SA), PhD rodney.ehrlich@uct.ac.za orcid.org/0000-0001-5736-9237 School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa Correspondence Rodney Ehrlich, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town 7925, South Africa. Email: rodney.ehrlich@uct.ac.zaSearch for more papers by this authorSteven Markowitz MD, DrPH, Steven Markowitz MD, DrPH orcid.org/0000-0002-0052-6745 Queens College, City University of New York, New York, New YorkSearch for more papers by this author First published: 12 June 2019 https://doi.org/10.1002/ajim.22988Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume62, Issue7July 2019Pages 625-626 RelatedInformation

Objective: To determine long-term survival of visceral pleural invasion (VPI) and parenchymal invasion (PAI) (angiolymphatic and/or vascular) on survival of NSCLCs less than 30 mm in maximum diameter. Methods: Kaplan-Meier survivals for NSCLCs, with and without VPI and/or PAI, were determined for a prospective cohort of screening participants stratified by pathologic tumor size (<= 10 mm, 11-20 mm, and 21-30 mm) and nodule consistency. Log-rank test statistics were calculated. Results: The frequency of PAI versus VPI was significantly lower in patients with subsolid nodules than in those with solid nodules (4.9% versus 27.7% [p < 0.0001]), and correspondingly, Kaplan-Meier lung cancer survival was significantly higher among patients with subsolid nodules (99.1% versus 91.3% [p = 0.0009]). Multivariable Cox regression found that only tumor diameter (adjusted hazard ratio [HR] = 1.07, 95% confidence interval [CI]: 1.01-1.14, p = 0.02) and PAI (adjusted HR = 3.15, 95% CI: 1.25-7.90, p = 0.01) remained significant, whereas VPI was not significant (p = 0.15). When clinical and computed tomography findings were included with the pathologic findings, Cox regression showed that the risk of dying of lung cancer increased 10-fold (HR = 10.06, 95% CI: 1.35-75.30) for NSCLCs in patients with solid nodules and more than twofold (by a factor of 2.27) in patients with moderate to severe emphysema (HR = 2.27, 95% CI: 1.01-5.11), as well as with increasing tumor diameter (HR = 1.06, 95% CI: 1.01-1.13), whereas PAI was no longer significant (p = 0.19). Conclusions: Nodule consistency on computed tomography was a more significant prognostic indicator than either PAI or VPI. We propose that patients with NSCLC with VPI and a maximum tumor diameter of 30 mm or less not be upstaged to T2 without further large, multicenter studies of NSCLCs, stratified by the new T status and that classification be considered separately for patients with subsolid or solid nodules. (C) 2019 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

BACKGROUND:Asthma is a major source of morbidity among World Trade Center (WTC) rescue and recovery workers. While physical and mental health comorbidities have been associated with poor asthma control, the potential role and determinants of adherence to self-management behaviors (SMB) among WTC rescue and recovery workers is unknown. OBJECTIVES:To identify modifiable determinants of adherence to asthma self-management behaviors in WTC rescue and recovery worker that could be potential targets for future interventions. METHODS:We enrolled a cohort of 381 WTC rescue and recovery workers with asthma. Sociodemographic data and asthma history were collected during in-person interviews. Based on the framework of the Model of Self-regulation, we measured beliefs about asthma and controller medications. Outcomes included medication adherence, inhaler technique, use of action plans, and trigger avoidance. RESULTS:Medication adherence, adequate inhaler technique, use of action plans, and trigger avoidance were reported by 44%, 78%, 83%, and 47% of participants, respectively. Adjusted analyses showed that WTC rescue and recovery workers who believe that they had asthma all the time (odds ratio [OR]: 2.37; 95% confidence interval [CI]: 1.38-4.08), that WTC-related asthma is more severe (OR: 1.73; 95% CI: 1.02-2.93), that medications are important (OR: 12.76; 95% CI: 5.51-29.53), and that present health depends on medications (OR: 2.39; 95% CI: 1.39-4.13) were more likely to be adherent to their asthma medications. Illness beliefs were also associated with higher adherence to other SMB. CONCLUSIONS:Low adherence to SMB likely contributes to uncontrolled asthma in WTC rescue and recovery workers. Specific modifiable beliefs about asthma chronicity, the importance of controller medications, and the severity of WTC-related asthma are independent predictors of SMB in this population. Cognitive behavioral interventions targeting these beliefs may improve asthma self-management and outcomes in WTC rescue and recovery workers. Key message: This study identified modifiable beliefs associated with low adherence to self-management behaviors among World Trade Center rescue and recovery rescue and recovery workers with asthma which could be the target for future interventions. CAPSULE SUMMARY:Improving World Trade Center-related asthma outcomes will require multifactorial approaches such as supporting adherence to controller medications and other self-management behaviors. This study identified several modifiable beliefs that may be the target of future efforts to support self-management in this patient population.

American Journal of Industrial MedicineVolume 61, Issue 3 p. 272-273 LETTER TO THE EDITOR The editors respond to Drs Mowat and Sheehan Rodney Ehrlich, Corresponding Author Rodney Ehrlich rodney.ehrlich@uct.ac.za orcid.org/0000-0001-5736-9237 School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa Correspondence Rodney Ehrlich, MBChB, FCPHM(SA), PhD, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa Email: rodney.ehrlich@uct.ac.zaSearch for more papers by this authorSteven Markowitz, Steven Markowitz orcid.org/0000-0002-0052-6745 Barry Commoner Center for Health and the Environment, Queens College, New York, New YorkSearch for more papers by this author Rodney Ehrlich, Corresponding Author Rodney Ehrlich rodney.ehrlich@uct.ac.za orcid.org/0000-0001-5736-9237 School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa Correspondence Rodney Ehrlich, MBChB, FCPHM(SA), PhD, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa Email: rodney.ehrlich@uct.ac.zaSearch for more papers by this authorSteven Markowitz, Steven Markowitz orcid.org/0000-0002-0052-6745 Barry Commoner Center for Health and the Environment, Queens College, New York, New YorkSearch for more papers by this author First published: 18 January 2018 https://doi.org/10.1002/ajim.22808Citations: 1 Institutions at which the work was performed: School of Public Health and Family Medicine, University of Cape Town, and Barry Commoner Center for Health and the Environment, Queens College, New York. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume61, Issue3March 2018Pages 272-273 RelatedInformation

article discusses various aspects of the career of the late biologist, teacher, and author Barry Commoner, and it mentions Commoner's laws of ecology, his views about environmental crises, and his book entitled The Closing Circle. Articles about energy-based environmental risks and a public health response to climate change, which appear in previous issues of the journal, are examined. Environmental protection-based decision making and environmental justice are assessed.

A fully automated computer algorithm has been developed to evaluate coronary artery calcification (CAC) from lowdose CT scans. CAC is identified and evaluated in three main coronary artery groups: Left Main and Left Anterior Descending Artery (LM + LAD) CAC, Left Circumflex Artery (LCX) CAC, and Right Coronary Artery (RCA) CAC. The artery labeling is achieved by segmenting all CAC candidates in the heart region and applying geometric constraints on the candidates using locally pre-identified anatomy regions. This algorithm was evaluated on 1,359 low-dose ungated CT scans, in which each artery CAC content was categorically visually scored by a radiologist into none, mild, moderate and extensive. The Spearman correlation coefficient R was used to assess the agreement between three automated CAC scores (Agatston-weighted, volume, and mass) and categorical visual scores. For Agatston-weighted automated scores, R was 0.87 for total CAC, 0.82 for LM + LAD CAC, 0.66 for LCX CAC and 0.72 for RCA CAC; results using volume and mass scores were similar. CAC detection sensitivities were: 0.87 for total, 0.82 for LM + LAD, 0.65 for LCX and 0.74 for RCA. To assess the impact of image noise, the dataset was further partitioned into three subsets based on heart region noise level (low<= 80HU, medium=(80HU, 110HU], high>110HU). The low and medium noise subsets had higher sensitivities and correlations than the high noise subset. These results indicate that location specific heart risk assessment is possible from low-dose chest CT images.

It has been brought to the Editor's attention that Reference #23 in the above publication contains an error. The article was published in Volume 36, Number 3 of the journal. DOI of the original article: 10.1055/s-0035-1549449.

Asthma is one the most common chronic conditions affecting World Trade Center (WTC) rescue and recovery workers in the aftermath of the terrorist attacks on September 11, 2001. Although exposure-response gradients between asthma risk and duration of work at the WTC site, exposure to the dust cloud, and work in the Ground Zero pit, compounded by inadequate protection, have been described, 1 Antao V.C. Pallos L.L. Shim Y.K. et al. Respiratory protective equipment, mask use, and respiratory outcomes among World Trade Center rescue and recovery workers. Am J Ind Med. 2011; 54: 897-905 Crossref PubMed Scopus (34) Google Scholar , 2 Lippmann M. Cohen M.D. Chen L.C. Health effects of World Trade Center (WTC) dust: an unprecedented disaster's inadequate risk management. Crit Rev Toxicol. 2015; 45: 492-530 Crossref PubMed Scopus (73) Google Scholar , 3 Wheeler K. McKelvey W. Thorpe L. et al. Asthma diagnosed after 11 september 2001 among rescue and recovery workers: findings from the World Trade Center health registry. Environ Health Perspect. 2007; 115: 1584-1590 Crossref PubMed Scopus (105) Google Scholar there is limited knowledge about how exposure and other factors affect long-term asthma outcomes among WTC rescue and recovery workers. In this study, we used data from a cohort of WTC workers with a physician diagnosis of asthma to study factors associated with worse asthma control, acute asthma-related outpatient and inpatient resource use, and poor quality of life.

Asbestos-related diseases persist, because millions of workers have had prior exposure and many industrializing countries continue to use asbestos. Globally, an estimated 107,000 people die annually from lung cancer, malignant mesothelioma, and asbestosis due to occupational asbestos exposure. Malignant mesothelioma and lung cancer are caused by all major types of asbestos. Asbestos causes more lung cancer deaths than malignant mesothelioma of the pleura; most cases of the latter are due to asbestos exposure. The cancer risk increases with cumulative asbestos exposure, with increased risk even at low levels of exposure to asbestos. Based on empirical studies, an estimated cumulative occupational exposure to asbestos of 1 fiber/mL-year substantially raises malignant mesothelioma risk. No safe threshold for asbestos exposure has been established for lung cancer and mesothelioma. The validity of fiber-type risk assessments depends critically on the quality of exposure assessments, which vary considerably, leading to a high degree of uncertainty. Asbestos exposure without asbestosis and smoking increases the risk of lung cancer. The joint effect of asbestos and smoking is supra-additive, which may depend in part on the presence of asbestosis. Asbestos workers who cease smoking experience a dramatic drop in lung cancer risk, which approaches that of nonsmokers after 30 years. Studies to date show that longer, thinner fibers have a stronger association with lung cancer than shorter, less thin fibers, but the latter nonetheless also show an association with lung cancer and mesothelioma. Low-dose chest computed tomographic scanning offers an unprecedented opportunity to detect early-stage lung cancers in asbestos-exposed workers.

Purpose: To address the prevalence of lung cancer in high and low-risk people according to their smoking history, age, and CT findings of emphysema.Methods: We reviewed the baseline low-dose CF scans of 62,124 current, former and never smokers, aged 40-90 to determine the prevalence of lung cancer. We performed logistic regression analysis of the prevalence of lung cancer to determine the odds ratio (OR) for emphysema, conditionally on age, female gender, and ethnicity.Results: The prevalence of lung cancer was 1.4% (95% CI: 1.3-1.6) for current smokers, 1.1% (95% CI: 1.0-1.2) for former smokers, and 0.4% (95% CI: 0.3-0.6) for never smokers. Emphysema was identified in 28.5% (6,684), 20.6% (5,422), and 1.6% (194) of current, former, and never smokers, respectively. The prevalence of lung cancer among current smokers was 1.1% for those without emphysema vs. 2.3% for those with emphysema (odds ratio [OR] 1.8; 95% confidence interval [CI]: 1.4-2.2) and the corresponding difference for former smokers was 0.9% vs. 1.8% (OR: 1.7; 95% CI: 13-2.2), and for never smokers, it was 0.4% vs. 2.6% (OR: 6.3; 95% CI: 2.4-16.9).Conclusions: Identification of emphysema in low-dose CT scans increases the risk of lung cancer and is important in determining follow-up of current, former, and never smokers. (c) 2015 Elsevier Ireland Ltd. All rights reserved.