Lung cancer screening abnormalities prompted smoking cessation

Smokers who received abnormal or suspicious lung cancer screening results were less likely to still smoke at the time of the next year’s screen, according to study results.

Martin C. Tammemägi, PhD, of the department of health sciences at Brock University in Ontario, Canada, and colleagues reviewed National Lung Screening Trial (NLST) data on 14,692 adults who were current smokers at baseline and did not develop lung cancer during follow-up. The median age of patients was 60.6 years; a majority were men (58.7%) and non-Hispanic white (89.5%).

During baseline screenings, 18.6% of participants received positive results, meaning they were new, stable or unstable findings suspicious for lung cancer. Another 7.2% received results that were negative for lung cancer but which revealed another clinically significant abnormality. During screenings at 1 year, 18.1% of participants received positive results and 3.8% had another abnormality. At 2 years, 10.8% of participants had screens positive for lung cancer and 3.7% had another abnormality.

Multivariate analyses indicated smoking cessation was significantly associated with the previous year’s screening result (P˂.0001).

Participants who had a non-lung cancer major abnormality were less likely to still smoke at subsequent screenings compared with participants who had a normal screen (OR=.811; 95% CI, 0.722-0.912).

Participants with screens suspicious for lung cancer — including those for whom findings were stable from previous screens (OR=0.785; 95% CI, 0.706-0.872) and those for whom the findings were new or changed (OR=0.663; 95% CI, 0.607-0.724) from prior screens — also were less likely to still smoke at the time of their next screen compared with those who received normal scans.

Researchers noted the association between abnormal scans and smoking cessation endured for 5 years after the last screening.

Results of a multivariable model indicated sex, Hispanic ethnicity, comorbidities and assignment in the intervention arm of the NLST had no significant impact on smoking cessation.

“Our study findings suggest that if lung cancer screening programs are implemented, there may be additional health benefits to some participants beyond those directly related to early detection of lung cancer,” Tammemägi told HemOnc Today. “The smoking cessation associated with screening results can lead to health improvements in multiple organ systems, and some of these changes can occur in relatively short order.”

Stephen A. Deppen

Although Tammemägi and colleagues did not evaluate whether normal scans encouraged greater smoking rates, smoking cessation in real-world screening programs is likely to be more robust than that seen in the NLST, Stephen A. Deppen, PhD, of the Vanderbilt University Medical Center, and colleagues wrote in an invited commentary.

“A population interested in screening for lung cancer has already expressed a motivation for better health. The integration of a smoking cessation intervention within the context of a screening program should increase the rates of successful smoking cessation above that observed by Tammemägi et al. and should be rigorously implemented as suggested in published screening guidelines,” Deppen and colleagues wrote. “As screening programs are being initiated across the country, they offer unique opportunities to conduct smoking cessation research to investigate the prevalence of the health-certificate effect and the intervention intensity required to achieve the maximum smoking cessation.”

For more information:

Deppen SA. J Natl Cancer Inst. 2014;doi:10.1093/jnci/dju122.
Tammemägi MC. J Natl Cancer Inst. 2014;doi:10.1093/jnci/dju084.

Disclosure: The researchers report no relevant financial disclosures.