Open Access Highly Accessed Open Badges Research article

Lung cancer stage at diagnosis: Individual associations in the prospective VITamins and lifestyle (VITAL) cohort

Christopher G Slatore12*, Michael K Gould3, David H Au45, Mark E Deffebach26 and Emily White78

Author Affiliations

1 Portland VA Medical Center, Health Services Research & Development; Portland, OR, USA

2 Oregon Health & Sciences University, Division of Pulmonary and Critical Care Medicine; Portland, OR, USA

3 Keck School of Medicine of the University of Southern California, Division of Pulmonary and Critical Care Medicine; Los Angeles, CA, USA

4 VA Puget Sound Health Care System, Health Services Research and Development; Seattle, WA, USA

5 University of Washington, Division of Pulmonary and Critical Care; Seattle, WA, USA

6 Portland VA Medical Center; Portland, OR, USA

7 University of Washington, Department of Epidemiology; Seattle, WA, USA

8 Fred Hutchinson Cancer Research Center, Cancer Prevention Program; Seattle, WA, USA

For all author emails, please log on.

BMC Cancer 2011, 11:228  doi:10.1186/1471-2407-11-228

Published: 7 June 2011



Lung cancer is the leading cause of cancer death in the United States. Identifying factors associated with stage of diagnosis can improve our understanding of biologic and behavioral pathways of lung cancer development and detection. We used data from a prospective cohort study to evaluate associations of demographic, health history, and health behaviors with early versus late stage at diagnosis of non-small cell lung cancer (NSCLC).


We calculated odds ratios (ORs) for the association of patient-level characteristics with advanced stage of diagnosis for NSCLC. The OR's were then adjusted for age, gender, race/ethnicity, smoking status, income, education, chronic obstructive pulmonary disease, and a comorbidity index.


We identified 612 cases of NSCLC among 77,719 adults, aged 50 to 76 years from Washington State recruited in 2000-2002, with followup through December 2007. In univariate analyses, subjects who quit smoking <10 years (OR 2.56, 95% CI 1.17 - 5.60) and were college graduates (OR 1.67, 95% CI, 1.00 - 2.76) had increased risks of being diagnosed with advanced stage NSCLC, compared to never smokers and non-college graduates, respectively. Receipt of sigmoidoscopy/colonoscopy, compared to no receipt, was associated with a decreased risk of advanced stage (OR 0.65, 95% CI, 0.43 - 0.99). The adjusted OR for receipt of sigmoidoscopy/colonoscopy was 0.55 (95% CI, 0.36 - 0.86). There was evidence that increasing the number of screening activities was associated with a decreased risk of advanced stage NSCLC (P for trend = 0.049).


Smoking status, education, and a screening activity were associated with stage at diagnosis of NSCLC. These results may guide future studies of the underlying mechanisms that influence how NSCLC is detected and diagnosed.