Department of Cancer Epidemiology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Tianjin Key Laboratory of Lung Cancer Metastasis and Tumor Microenvironment, Tianjin Lung Cancer Institute, Tianjin Medical University General Hospital, Tianjin, China.
Cancer Med. 2023 Feb;12(4):4667-4678. doi: 10.1002/cam4.5073. Epub 2022 Jul 27.
Lung cancer screening may provide a "teachable moment" for the smoking cessation and relapse prevention. However, the impact of lung cancer screening on smoking initiation in non-smokers has not been reported.
A baseline smoking behavior survey was conducted in 2000 participants who were screened by low-dose computed tomography (LDCT) from 2014 to 2018. All participants were re-surveyed on their smoking behavior in 2019. Of these, 312 participants were excluded, leaving 1688 participants in the final analysis. The smoking initiation rate in baseline non-smokers, the relapse rate in baseline former smokers, and the abstinence rate in baseline current smokers were calculated, respectively. The associations between screening results, demographic characteristics, and smoking behavior change were analyzed using multivariable logistic regression.
From 2014 to 2019, smoking prevalence significantly decreased from 52.6% to 49.1%. The prevalence of smoking initiation, relapse, and abstinence in baseline non-smokers, former, and current smokers was 16.8%, 22.9%, and 23.7%, respectively. The risk of smoking initiation in baseline non-smokers was significantly higher in those with negative screening result (adjusted OR = 2.97, 95% CI: 1.27-6.94). Compared to smokers who only received baseline screening, the chance of smoking abstinence in baseline current smokers was reduced by over 80% in those who attended 5 rounds of screening (adjusted OR = 0.15, 95% CI:0.08-0.27). No significant associations were found between smoking relapse and prior screening frequency, with at least one positive screening result. Age, gender, occupational exposure, income, and smoking pack years were also associated with smoking behavior changes.
The overall decreased smoking prevalence indicated an overwhelming effect of "teachable moment" on "license to smoke." A tailored smoking cessation strategy should be integrated into lung cancer screening.
肺癌筛查可能为戒烟和复吸预防提供一个“教育时刻”。然而，肺癌筛查对非吸烟者开始吸烟的影响尚未有报道。
我们对 2014 年至 2018 年期间通过低剂量计算机断层扫描（LDCT）进行筛查的 2000 名参与者进行了基线吸烟行为调查。所有参与者于 2019 年再次接受吸烟行为调查。其中，312 名参与者被排除，最终有 1688 名参与者纳入最终分析。分别计算基线非吸烟者的吸烟起始率、基线前吸烟者的复吸率和基线现吸烟者的戒烟率。使用多变量逻辑回归分析筛查结果、人口统计学特征与吸烟行为改变之间的关联。
2014 年至 2019 年期间，吸烟率从 52.6%显著下降至 49.1%。基线非吸烟者、前吸烟者和现吸烟者的吸烟起始、复吸和戒烟率分别为 16.8%、22.9%和 23.7%。在基线非吸烟者中，阴性筛查结果者的吸烟起始风险显著更高（调整后的比值比[OR]：2.97，95%置信区间[CI]：1.27-6.94）。与仅接受基线筛查的吸烟者相比，在基线现吸烟者中，接受 5 轮筛查者的戒烟机会减少了 80%以上（调整后的 OR：0.15，95%CI：0.08-0.27）。至少有一次阳性筛查结果者的吸烟复吸与既往筛查频率之间未见显著关联。年龄、性别、职业暴露、收入和吸烟包年数也与吸烟行为改变相关。
整体吸烟率下降表明“教育时刻”对“吸烟许可”产生了压倒性的影响。应将有针对性的戒烟策略纳入肺癌筛查。
