This approach could cut lung cancer deaths by 14%

Lung cancer screenings combined with programs to help smokers kick the habit could lead to a 14% reduction in lung cancer deaths, researchers say.

“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 University of Michigan 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.”

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

Since about 50% of screen-eligible individuals still smoke, 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 and 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.

The study generated two million individual smoking and life histories per cohort, screening simulated individuals annually according to current guidelines and different assumptions of screening uptake rates. Meza’s 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 14% and increase life-years gained 81% compared with screening alone.

However, the actual gains are highly sensitive to the variation in screening uptake and cessation probability.

Even mildly effective cessation interventions could greatly enhance the impact of LDCT screening programs, Meza says. 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 and cardiovascular disease.

Researchers need to do more work to promote lung cancer screening and facilitate access, particularly for those at highest risk, says first author Pianpian Cao, a doctoral student.

Effective cessation interventions at the point of screening could greatly enhance the impact of LDCT screening programs but most of these great benefits won’t happen unless lung screening uptake improves, Meza says.

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

The study appears in the Journal of Thoracic Oncology. Additional coauthors are from Georgetown University and the University of Michigan.

Source: University of Michigan

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