Does participation in a lung cancer screening program affect the likelihood that a person will try to quit smoking?

A patient's participation in a lung cancer screening program appears to create a "teachable moment" that increases the likelihood that he or she will quit smoking, at least in the short term. This finding is particularly strong if the initial scan shows an abnormality. These findings are consistent with those seen in US and Danish lung cancer screening trials. (LOE = 1b-)

Brain K, Carter B, Lifford KJ, et al. Impact of low-dose CT screening on smoking cessation among high-risk participants in the UK Lung Cancer Screening Trial. Thorax 2017;72(10):912-918.  [PMID:28710339]

Randomized controlled trial (nonblinded)

Government

Outpatient (any)

The UK Lung Cancer Screening Trial recruited 4055 participants aged 50 years to 75 years at high risk of lung cancer according to a validated risk score. The participants were randomized to receive screening with low-dose computed tomography or no screening. They were asked about tobacco use at baseline, and were classified as current smokers, ex-smokers, or never smokers. The participants were contacted 2 weeks later to complete a psychosocial questionnaire (short-term follow-up), which was sent again at an unspecified time in the future (long-term follow-up). Data were imputed if missing. All participants were offered smoking cessation advice at the time of enrollment. Approximately 40% were current smokers (n = 1544), and at the short-term follow-up significantly more in the screening group had reported that they had quit smoking (adjusted odds ratio [aOR] 2.4; 95% CI 1.6 - 3.6). In absolute terms, 9.9% quit in the screened group and 4.6% in the control group at this initial follow-up (number needed to scan [NNS] to result in 1 person quitting = 20). This was also true at the long-term follow-up (aOR 1.6; 1.2 - 2.2), and the absolute effect was similar (15% vs 10%; NNS = 20). A sensitivity analysis using only complete cases found similar results at the short-term follow-up, but no significant difference at long-term follow-up. The effect was stronger among participants who had an initial positive screening result (aOR 2.9 [1.8 - 4.5] for short-term follow-up; aOR 2.3 [1.6 - 3.2] for long-term follow-up).