BACKGROUND Annual lung cancer screening with low-dose computed tomography is recommended for adults aged 55-80 with a ≥30 pack-year smoking history that currently smoke or quit <15-years ago. The 50% who are current smokers should be offered cessation interventions, but information about the impact of adding cessation to screening is limited. METHODS We used an established lung cancer simulation model to compare the effects on mortality of a hypothetical one-time cessation intervention and annual screening vs. annual screening only among screen-eligible individuals born in 1950 or 1960. Model inputs were derived from national data and included smoking history, probability of quitting with and without intervention, lung cancer risk and treatment effectiveness, and competing tobacco-related mortality. We tested the sensitivity of results to different assumptions about screening use and cessation efficacy. RESULTS Smoking cessation reduces lung cancer mortality and decreases overall deaths vs. screening only across all assumptions. For example, if screening was used by 30% of screen-eligible individuals born in 1950, adding an intervention with a 10% quit probability reduces lung cancer deaths by 14% and increases life-years gained by 81% compared to screening alone. The magnitude of cessation benefit varied by screening uptake rates, cessation effectiveness, and birth cohort. CONCLUSIONS Smoking cessation interventions have the potential to greatly enhance the impact of lung cancer screening programs. Evaluation of specific interventions, including costs and feasibility of implementation and dissemination, are needed to determine the best possible strategies and realize the full promise of lung cancer screening.

中文翻译：

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肺癌筛查时戒烟干预对美国肺癌和总体死亡率的潜在影响


背景 建议对 55-80 岁、有≥30包年吸烟史、目前吸烟或 15 年前戒烟的 55-80 岁成年人每年进行一次低剂量计算机断层扫描肺癌筛查。应向 50% 的当前吸烟者提供戒烟干预措施，但有关将戒烟纳入筛查的影响的信息有限。方法 我们使用已建立的肺癌模拟模型来比较假设的一次性戒烟干预和年度筛查与仅在 1950 年或 1960 年出生的符合筛查资格的个体中进行年度筛查对死亡率的影响。模型输入来自国家数据和包括吸烟史、有或没有干预的戒烟概率、肺癌风险和治疗效果，以及与烟草相关的死亡率。我们测试了结果对筛查使用和戒烟效果的不同假设的敏感性。结果 与仅针对所有假设进行筛查相比，戒烟可降低肺癌死亡率并降低总体死亡率。例如，如果 1950 年出生的符合筛查条件的个体中有 30% 使用了筛查，那么与单独筛查相比，添加戒烟概率为 10% 的干预措施可将肺癌死亡率降低 14%，延长寿命年数 81%。戒烟获益的大小因筛查率、戒烟效果和出生队列而异。结论 戒烟干预措施有可能大大增强肺癌筛查计划的影响。需要对具体干预措施进行评估，包括实施和传播的成本和可行性，以确定最佳策略并实现肺癌筛查的全部承诺。