Reducing Lung Cancer Mortality by Providing Smoking Cessation Support in the Lung Cancer Screening Setting: Missed Opportunities and Lessons Learned on Both Sides of the Atlantic

Abstract

National guidelines for the implementation of lung cancer screening (LCS) for high-risk older adults have been issued by several countries, largely in Europe, North America, and Australia. Typically, these guidelines recommend but do not specify how smoking cessation support (SCS) should be provided to patients undergoing LCS who currently smoke. As LCS implementation progresses, delivering screening to the millions of eligible individuals around the world, the lack of best practice guidelines for SCS in the LCS setting is resulting in a growing missed opportunity to reduce persistent tobacco and lung cancer-related disparities in incidence and mortality.

Quitting smoking at older ages reduces lung cancer risk and increases life expectancy. Compelling evidence from clinical trials and modeling studies has shown that, even with modest cessation rates, SCS delivered in the LCS setting can considerably reduce lung cancer mortality, with the potential to reduce global, racial, economic, and geographic disparities in lung cancer. Moreover, SCS interventions are cost-effective and can lead to significant cost savings for the health system.

On the basis of the evidence and lessons learned in the United Kingdom, Canada, and the United States, we propose a set of priorities for health systems to consider when developing or expanding SCS programs in the LCS setting. We argue that the system and policy changes needed to maintain SCS as a standard component of LCS are essential to capitalize on this important opportunity to integrate disease prevention with early detection, thereby maximizing the mortality benefit of LCS worldwide.