The new US Preventive Services Task Force (USPSTF) lung cancer screening guidelines have been positively viewed by many – earlier routine screening of high-risk individuals will discover more tumors in the earlier stages, providing for better prognosis. It is also believed that when people who smoke are confronted with the very real possibility of lung cancer as they go through the screening process that they may rethink their smoking habit and consider smoking cessation.
The new guidelines recommend low-dose computed tomography (CT) annual lung cancer screening for current smokers, aged 55 to 80 years, who have a 30-pack per year smoking history and for former smokers who have quit within the past 15 years.1 The American College of Chest Physicians and American Thoracic Society issued a joint policy statement, agreeing that these guidelines would result in more benefit than harm.2 However, researchers have come across an issue that may result in smokers feeling that they no longer have to stop smoking, precisely because of the new screening guidelines.3
Researchers performed an ancillary study to the launch of a lung cancer screening program at seven sites in the Veterans Health Administration. Using semi-structured qualitative interviews about health beliefs related to smoking and lung cancer screening, they sought to determine how people saw smoking cessation in the context of being offered routine lung cancer screening. What the researchers found were surprising.
Of the 35 participants who completed the telephone survey, 17 (49%) said that the screening lowered their motivation for smoking cessation because the screening gave the same benefits as they would have if they stopped smoking. Other misconceptions related to the screening included:
- Screening and repeat screens offers protection from lung cancer.
- Screenings that have indeterminate findings can result in monitoring rather than immediate treatment.
- Individuals who have negative screening tests are among the lucky ones who will avoid the harms of smoking.
Given that these beliefs can result in more and continued smoking, which may further raise the risks of lung cancer and smoking-related illnesses, it’s important that these messages be acknowledged and reversed by healthcare professionals who work with this target population.
“To promote cessation, discussions should focus on the emotional response to screening rather than clinical details (e.g., nodule size) and address misconceptions about the value of early detection so that screening does not lower motivation to quit smoking,” the authors wrote.
Are your patients less motivated to quit smoking with the implementation of the new lung cancer screening guidelines?
- U.S. Preventive Services Task Force. (2013). Final Recommendation Statement Lung Cancer: Screening, December 2013.
- Mazzone P, Powell CA, Arenberg D, et al. (2015). Components necessary for high-quality lung cancer screening: American College of Chest Physicians and American Thoracic Society Policy Statement. Chest, Feb;147(2):295-303.
- Zeliadt SB, Heffner JL, Sayre G, et al. (2015). Attitudes and Perceptions About Smoking Cessation in the Context of Lung Cancer Screening. JAMA Internal Medicine.