Impact of Low-Dose Computed Tomography Findings on Cigarette Smoking Cessation Among High-Risk Adults Participating in Lung Cancer Screening.

Abstract

Introduction: Integrating effective smoking cessation strategies for individuals undergoing lung cancer screening stands to significantly increase the impact of lung screening programmes. We assessed the impact of low-dose computed tomography (LDCT) findings on smoking cessation among high-risk adults who currently smoked.

Aims and methods: 13 035 individuals, aged 55-77 years, attended a lung health check appointment, as part of a prospective observational cohort study (the SUMMIT Study), prior to undergoing a baseline LDCT scan. Logistic regressions examined the likelihood of smoking cessation at a 1-year follow-up appointment and its association with LDCT findings.

Results: 12.6% (n = 647/5135) of individuals self-reported smoking cessation at 1-year follow-up. Higher odds of quitting were found in those receiving indeterminate pulmonary nodule findings requiring a 3-month interval LDCT (aOR = 1.27; 1.01, 1.61), those with urgent findings requiring referral to secondary care (aOR = 1.55; 1.05, 2.32), and those with a possible new chronic obstructive pulmonary disease diagnosis (aOR = 1.60; 1.23, 2.06), compared to those receiving no actionable LDCT findings. Older age, Asian ethnic background, current high smoking intensity, motivation and number of quit attempts, and low nicotine dependence were associated with increased odds of quitting.

Conclusions: Individuals currently smoking, at high lung cancer risk, participating in LDCT screening, and receiving incidental findings requiring a 1-year interval LDCT or primary care follow-up might therefore need additional behavioral support to quit. Tailored communication strategies depending on the severity of the LDCT findings, including additional behavioral support for those with less clinical concerning or negative findings, could increase quit rates and reduce smoking-related morbidity.

Implications: This study reports high odds of self-reported complete smoking cessation in adults who currently smoked after receiving their LDCT findings. Though the impact of specific types of LDCT findings on smoking cessation was positive for high lung cancer risk individuals, reception of incidental findings could potentially be perceived as less severe to encourage individuals who currently smoked to quit. Clearly communicating the severity of LDCT findings along with the delivery of behavioral smoking cessation support targeted to high-risk individuals may increase their chances of complete smoking cessation and reduce lung cancer mortality.