Impact of lung cancer screening results on smoking cessation

Abstract

Background: Lung cancer screening programs may provide opportunities to reduce smoking rates among participants. This study evaluates the impact of lung cancer screening results on smoking cessation.

Methods: Data from Lung Screening Study participants in the National Lung Screening Trial (NLST; 2002-2009) were used to prepare multivariable longitudinal regression models predicting annual smoking cessation in those who were current smokers at study entry (n = 15489, excluding those developing lung cancer in follow-up). The associations of lung cancer screening results on smoking cessation over the trial period were analyzed. All hypothesis testing used two sided P values.

Results: In adjusted analyses, smoking cessation was strongly associated with the amount of abnormality observed in the previous year's screening (P < .0001). Compared with those with a normal screen, individuals were less likely to be smokers if their previous year's screen had a major abnormality that was not suspicious for lung cancer (odds ratio [OR] = 0.811; 95% confidence interval [CI] = 0.722 to 0.912; P < .001), was suspicious for lung cancer but stable from previous screens (OR = 0.785; 95% CI = 0.706 to 0.872; P < .001), or was suspicious for lung cancer and was new or changed from the previous screen (OR = 0.663; 95% CI = 0.607 to 0.724; P < .001). Differences in smoking prevalence were present up to 5 years after the last screen.

Conclusions: Smoking cessation is statistically significantly associated with screen-detected abnormality. Integration of effective smoking cessation programs within screening programs should lead to further reduction in smoking-related morbidity and mortality.

Figure 1.

Proportion of National Lung Screening Trial (NLST) Lung Screening Study (LSS) baseline current smokers smoking at follow-up by screening result lagged to the preceding screen. The numbers and proportions corresponding to the line points in this figure are presented in Table 2. Proportion smoking at year 1 was classified by the baseline screening result, proportion smoking at year 2 was classified by year 1 screening result, proportion smoking at years 3 through 7 were classified by the last screen result, which occurred in study year 2. LCa, lung cancer; NotLCa, not suspicious for lung cancer.