Smokers screened with lung CT more likely to quit
Smokers who underwent CT scan for lung cancer screening were more likely to quit smoking than those on usual care without screening, according to the UKLS* pilot trial.
“[There were] concerns that taking part in lung screening may offer a ‘license to smoke’, especially for smokers who receive favourable screening results,” said the researchers. “[Our study shows that] CT lung cancer screening does not appear to falsely reassure smokers or reduce their motivation to stop smoking.”
At 2 weeks, smoking cessation rates were higher among smokers who had CT intervention compared with the controls receiving usual care (10 percent vs 5 percent), with the intervention group being more than twice as likely to quit smoking as the controls (adjusted odd ratio [aOR], 2.38; p<0.001). [Thorax 2017;doi:10.1136/thoraxjnl-2016-209690]
Longer-term follow-up of up to 2 years also showed similar results, with participants in CT screening showing higher cessation rates (15 percent vs 10 percent) and greater odds of quitting (aOR, 1.60; p=0.003) than the controls.
In addition, those who required additional clinical investigation after the baseline scan ─ due to major abnormalities, incidental findings, or repeat scan ─ were also more likely to quit smoking in the longer term than the controls (aOR, 2.29; p=0.007) and those with a negative CT results/not requiring further investigation (aOR, 2.43; p<0.001).
“[Our findings suggest] that a positive lung screening result may provide an additional stimulus for quitting over and above that of screening participation,” said the researchers.
Receiving a negative result on the CT scan did not significantly impact smoking cessation (aOR, 0.90; p=0.64), although the researchers advised caution in interpreting the findings.
The study included 4,055 current smokers (mean age 66 years, 70 percent males) identified to have a high risk for lung cancer based on the Liverpool Lung Project risk prediction model. The participants were randomized to undergo low-dose CT screening (n=759) or usual care (control; n=787), and were followed up on smoking cessation for up to 2 years.
“Our trial shows that CT lung cancer screening offers a teachable moment for smoking cessation among high-risk groups [especially among those who receive a positive scan result],” said lead author Dr Kate Brain from Cardiff University School of Medicine in Cardiff, UK. “The current evidence suggests that an integrated package of CT lung screening and smoking cessation support has the potential to expedite quitting in smokers who are motivated and receptive.”
“Engaging with lung screening can give smokers an opportunity to access smoking cessation support ─ at a time when they are likely to be more receptive to offers of help,” said study principal investigator Professor John Field of University of Liverpool, UK.
As most smokers participating in the study were already motivated to quit at study entry, the authors said “it will be critical to evaluate actual quit rates prompted by screening, and whether they are maintained over time in the context of a lung screening health service.”
“We found that longer term study retention was less likely in smokers who were from socioeconomically deprived areas and who had experience of lung cancer [due to fear, stigma, or scepticism about screening benefits],” noted Brain and co-authors.
“Smoking cessation counselling combined with pharmacotherapy [has been shown to be] effective, and could be successfully implemented in the lung screening setting,” they suggested.