Lung cancer screening and smoking abstinence: 2 year follow-up data from the Dutch-Belgian randomised controlled lung cancer screening trial

Abstract

Background Lung cancer screening may provide a new opportunity for attempts to quit among smokers or might delay smoking cessation, but studies to date failed to provide evidence for this. This study investigated the effect of lung cancer screening on smoking abstinence in male smokers participating in the DutcheBelgian randomised controlled lung cancer screening trial (NELSON trial). Methods In the NELSON trial, 50-to 75-year-old participants at high risk for developing lung cancer were randomised to either lung cancer screening or no screening. Smoking behaviour was evaluated in two random samples of male smokers in the screen (n¼641) and control arm (n¼643) before (T0) and 2 years after randomisation (T1). In addition, the data were also analysed by intention-to-treat (ITT) analysis, as recommended in smoking cessation intervention trials, although non-response in screening trials can also be due to reasons other than continued smoking. Results Almost 17% (16.6%) of the trial participants quit smoking, which is higher than the 3e7% found in the general adult population. However, screening was associated with a lower prolonged abstinence rate (14.5%) compared with no screening (19.1%) (OR 1.40, 95% CI 1.01 to 1.92; p<0.05). No stastistically significant difference was found after performing an ITT analysis. Conclusions This study showed that all trial participants were inclined to stop smoking more than average, which suggests that screening is a teachable moment to improve smoking behaviour. In those who underwent screening the smoking abstinence rate was significantly lower than for the control group, although the difference was modest. After ITT analysis this difference was no longer observed. Clinical trial number ISRCTN63545820.

Can a National Lung Cancer Screening Program in Combination with Smoking Cessation Policies Cause an Early Decrease in Tobacco Deaths in Italy?

“…We did not take into account that participants in CT screening have higher cessation rates than nonparticipants (40). Thus, the introduction of a CT screening program could have a quantifiable and late effect on both lung cancer and all-cause mortality through a reduction in smoking prevalence.…”

Changes in Smoking Behavior of Patients with Pulmonary Nodule Follow-up

“…7,8 Yapılan çalışmalarda, hastaların önemli kısmının malignite riski nedeni ile sigarayı bıraktığı saptanmıştır. 8,9 Çalışmamızda, pulmoner nodül izlemi yapılan hastaların cinsiyet, eğitim ve meslek gibi durumlardan bağımsız olarak yarıya yakının sigarayı bıraktığı belirlenmiştir. van der Aalst ve ark.nın çalışmasında, standart broşür ve anketlerle sigara içen hastalarda kanser taraması yapılan ve yapılmayan kontrol grubu karşılaştırıldığında; kanser taraması yapılan grupta sigara bırakma oranı istatistiksel olarak anlamlı düzeyde yüksek bulunmuştur.…”

“…van der Aalst ve ark.nın çalışmasında, standart broşür ve anketlerle sigara içen hastalarda kanser taraması yapılan ve yapılmayan kontrol grubu karşılaştırıldığında; kanser taraması yapılan grupta sigara bırakma oranı istatistiksel olarak anlamlı düzeyde yüksek bulunmuştur. 9 Argüder ve ark.nın yaptığı çalışmada, hastaların yarısının ileride sağlığının bozulma korkusu nedeni ile sigarayı bırakmak istediği belirlenmiştir. 8 Çalışmamızda, nodülün malignite riski anlatılan hastaların, Argüder ve ark.nın yaptığı çalışmaya paralel olarak %48 oranında sigarayı bıraktığı saptanmıştır.…”

Screening for lung cancer – are we nearly there yet?

“…Data from the NELSON study showed those in the screened and control arms had higher rates of smoking cessation than the background population, suggesting those motivated to participate in the trials may be amenable to health promotion. 12 Studies have also shown that smoking abstinence was increased in those with indeterminate and positive results compared with those with negative results, suggesting fear of a cancer diagnosis may motivate quit attempts. 13 It is therefore imperative in those with normal scans to balance reassurance with the promotion of health-protective behaviours.…”