ES01.03 Integration of Cessation Services in Low Dose CT Screening

Abstract

Lung cancer screening with low dose computed tomography (LDCT) of the chest has picked up momentum over the last decade. The publication of results from the National Lung Screening Trial (NLST) in 2011 confirmed the mortality benefit of this intervention in high-risk tobacco smokers. Nearly a decade later, this was supported by the results of the NELSON study. Subsequent analyses have showed that in these high-risk candidates, the impact of smoking cessation could be profound. In people who already have a diagnosis of lung cancer, smoking cessation can improve outcomes. This includes prolonged survival across all stages of cancer as well as a reduction in the development of second primary lesions. Data from the NLST have shown that in those candidates who stopped smoking, the risk of dying from lung cancer fell. This reduction matched the benefit of CT screening by seven years of abstinence. The mortality benefit of LDCT screening was nearly doubled in candidates who achieved fifteen years of smoking abstinence. Despite the high impact of smoking cessation, the best way to achieve this in LDCT screening candidates has not yet been established. Many studies are now investigating this, in countries that have formally instituted lung cancer screening such as the United States and in those where national screening programs remain under consideration. In the United States, eight studies form the SCALE Collaboration (Smoking Cessation within the Context of Lung Cancer Screening) across a range of sites and institutions. Strategies include digital advice, comparisons of behavioural interventions and various nicotine replacement regimens among several thousand screening candidates. In the United Kingdom, the Yorkshire Enhanced Stop Smoking (YESS) study will test the impact of personalized interventions in screening candidates, including the use of incidental CT findings and matched CT imagery. Data from previous lung cancer screening studies support the addition of specific smoking cessation intervention in eligible candidates, including the Danish Lung Cancer Screening Trial and the UK Lung Cancer Screening Trial as well as the NLST and the NELSON. Screening candidates often have high rates of motivation to quit, higher quit rates than the background smoking population and respond to CT abnormalities with greater smoking abstinence. Smoking cessation as part of LDCT screening contributes significantly to cost-effectiveness of screening programs. In general, LDCT screening guidelines strongly support smoking cessation as part of screening programs but refrain from making specific recommendations on detailed cessation interventions. As jurisdictions around the world move to introduce formal lung cancer screening, the impact of rigorous, specific smoking cessation interventions will grow. Implementation research programs that help LDCT screening candidates quit smoking represent a major opportunity to enhance screening success.