We found significant higher levels of HIF-1α (125.8 pg/ml, SEM = 48.66 pg/ml) in EVs from COPD subjects who subsequently developed cancer (i.e. before CT scan detection) than COPD subjects who remained cancer free for at least three years (12.34 pg/ml, SEM = 2.835 pg/ml) (*p = 0.04) (Fig. 6H). The gene discussed is HIF1A; the disease is cancer.