Smoking behaviors among patients receiving computed tomography for lung cancer screening. Systematic review in support of the U.S. preventive services task force

Abstract

Rationale: Lung cancer screening using low-dose computed tomography (LDCT) is now widely recommended for adults who are current or former heavy smokers. It is important to evaluate the impact of screening on smoking abstinence rates.

Objective: Among current and former smokers eligible for lung cancer screening, we sought to determine the consequence of screening with LDCT, as well as subsequent results, on smoking cessation and relapse rates.

Evidence review: We searched the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth quarter, 2012), MEDLINE (2000 to May 31, 2013), reference lists of papers, and Scopus for relevant English-language studies and systematic reviews. To evaluate the effect of LDCT screening on smoking abstinence, we included only randomized controlled trials (RCTs) involving asymptomatic adults. To evaluate the association of particular results and/or recommendations from a screening CT with smoking behaviors, we included results from RCTs as well as cohort studies.

Measurements and main results: A total of 8,215 abstracts were reviewed. Three publications from two European RCTs and five publications from three cohort studies conducted in the United States met inclusion criteria. The process of LDCT lung cancer screening did not influence smoking behaviors. LDCT recipients with results concerning for lung cancer had higher abstinence rates than those with scans without such findings. This association may have a dose-response relationship in terms of the number of abnormal CT scans as well as the seriousness of the finding.

Conclusions: Limited evidence suggests LDCT lung cancer screening itself does not influence smoking behaviors, but positive results are associated with increased abstinence. As lung cancer screening is implemented in the general population, it is very important to evaluate its association with smoking behaviors to maximize its potential as a teachable moment to encourage long-term abstinence. Clinicians should consider tailoring LDCT result communication to emphasize the importance of smoking abstinence.