Adding Smoking Cessation to Lung Cancer Screening Can Reduce Mortality by 14%

WASHINGTON (March 9, 2020) — Including smoking cessation with existing lung cancer screening efforts would reduce lung cancer mortality by 14 percent and increase life-years gained by 81 percent compared with screening alone, according to a study led by researchers at the University of Michigan and Georgetown Lombardi Comprehensive Cancer Center.

The study is published in the current issue of the Journal of Thoracic Oncology, a publication of the International Association for the Study of Lung Cancer.

“The study shows the huge impact that combined screening/smoking cessation programs could have” says senior author Rafael Meza, associate professor of Epidemiology at the School of Public Health, and co-Leader of the Cancer Epidemiology and Prevention Program at the UM Rogel Cancer Center. “Smoking cessation interventions at the point of lung screening could result in many additional lung cancer deaths prevented and considerable life-years gained.”

Georgetown Lombardi’s Kathryn Taylor, professor of oncology and a member of the Georgetown Lombardi Cancer Prevention and Control Program, says the new data should encourage clinics and hospitals to invest in cessation programs.

“For many individuals, undergoing lung cancer screening is a time in which they become very motivated to stop smoking,” Taylor says. “Individuals who are able to quit, sometimes for the first time in their entire lives, have improvements in their quality of life and a sense of satisfaction that comes with gaining control over their smoking.”

Taylor is leading one of the eight randomized clinical trials as part of the National Cancer Institute’s Smoking Cessation at Lung Examination (SCALE) collaboration, in which each trial is testing the effectiveness of different smoking cessation interventions.

Annual lung cancer screening with low-dose computed tomography (LDCT) is recommended for adults aged 55 to 80 with a greater than 30 pack-year smoking history who currently smoke or quit within the previous 15 years.

Since about 50% of screen-eligible individuals are current smokers, cessation interventions at the point of screening are recommended. However, information about the short- and long-term effects of joint screening and cessation interventions is limited.

Meza, Taylor and their colleagues used an established lung cancer simulation model to project the impact of cessation interventions within the screening context on lung cancer and overall mortality for the 1950 and 1960 US birth-cohorts.

Two million individual smoking and life histories were generated per cohort. Simulated individuals were screened annually according to current guidelines and different assumptions of screening uptake rates. The research team then simulated a cessation intervention at the time of the first screen, under a range of efficacy assumptions.

Point-of-screening cessation interventions would greatly reduce lung cancer mortality and delay overall deaths compared to screening alone. For example, under a 30% screening uptake scenario, adding a cessation intervention at the time of the first screen with a 10% success probability for the 1950 birth-cohort would further reduce lung cancer deaths by 14% and increase life-years gained by 81% compared with screening alone.

However, the actual gains are highly sensitive to the variation in screening uptake and cessation probability. Meza said that even mildly effective cessation interventions could greatly enhance the impact of LDCT screening programs. This is because cessation not only reduces the risk of lung cancer, but also would prevent other tobacco-related diseases, such as chronic obstructive pulmonary disease (COPD) and cardiovascular disease.

More work is needed to promote lung cancer screening and facilitate access, particularly for those at highest risk. Meza concludes that effective cessation interventions at the point of screening could greatly enhance the impact of LDCT screening programs, and most of these great benefits won’t be realized unless lung screening uptake is improved.

Further evaluation of specific cessation interventions within lung screening, including costs and feasibility of implementation and dissemination, are needed to determine the best possible strategies and realize the full promise of lung cancer screening.

(Press release courtesy of the Journal of Thoracic Oncology and the University of Michigan.)