Helping smokers quit during Lung Cancer Awareness Month

Smoking causes the majority of lung cancers — both in smokers and in people exposed to secondhand smoke. To mark Lung Cancer Awareness Month, Nicotine & Tobacco Research Editor David J. K. Balfour, D.Sc., has selected a few related articles, which can be read in full and for free on the journal’s website. He also invited Elyse R. Park, PhD, MPH, to share what really helps smokers quit.

Every year over 220,000 Americans are diagnosed with lung cancer, and unfortunately most of these cases are found when the cancer is in later stages. A promising advance in lung cancer detection is a new screening test, the low-dose computed tomography, which provides a high-resolution 3D picture and so picks up lung cancer earlier. The National Cancer Institute (NCI) funded the National Lung Screening Trial (NLST) to compare this new screening to chest x-rays among people who had heavy smoking histories. The NCI found that it showed promising results in detecting lung cancer earlier and in significantly decreasing lung cancer deaths.

Since this NCI trial, there has been a lot of talk about lung screening. Many cancer organizations are recommending lung screening, and the U.S. Preventive Services Task Force drafted recommendations that people with a heavy smoking history get annual lung screens. Many researchers and cancer advocates are also talking about the importance of pairing smoking cessation with lung screening, so that smokers who are getting lung screening are also getting support and encouragement to quit smoking. If smokers quit smoking after getting screening, this would increase the benefit of lung screening.

However, I have studied some smokers who participated in the NLST and found, despite the fact that many of them understood that continuing to smoke put them at high risk for lung cancer and smoking related diseases, and that many of them intended to quit smoking when they started the trial, most did not quit (Annals of Behavioral Medicine 37:268-79). At one year after their first screen most of these participants hadn’t quit smoking, although some tried to do so (Cancer 119:1306-13). Unfortunately, having a lung screening test didn’t really change the way that they felt or thought about smoking. I describe participants’ answers in qualitative interviews, which were recently published in Nicotine & Tobacco Research. So what could help these smokers quit?

I have also studied what happened when smokers saw their primary care doctors after getting lung screening, and these results were recently presented at the 2013 annual meeting of the American Society for Clinical Oncology. If physicians just ask these smokers about smoking and advise them to quit, they are not likely to quit. What helps smokers quit is if physicians actually assist patients to quit – by giving them a counseling referral, a stop smoking medication prescription, or following-up to see how they are doing.

So if you have or know someone with a history of heavy smoking and want to find out more about lung screening, consult the American Lung Association guidelines and the American Cancer Society guidelines. Please also remember to talk to your doctor about getting help to quit.

Elyse R. Park, PhD, MPH, is Director of Behavioral Science Research for the Tobacco Treatment Center at the Massachusetts General Hospital and an Associate Professor of Psychology at Harvard Medical School.

November is officially Lung Cancer Awareness Month. To mark this, Nicotine & Tobacco Research joins the lung cancer community in highlighting the health risks associated with tobacco use. The Editor-in-Chief, David J. K. Balfour, has selected a collection of recent, topical articles which have been made free until the end of 2013.

Nicotine & Tobacco Research is one of the world’s few peer-reviewed journals devoted exclusively to the study of nicotine and tobacco. It aims to provide a forum for empirical findings, critical reviews, and conceptual papers on the many aspects of nicotine and tobacco, including research from the biobehavioral, neurobiological, molecular biologic, epidemiological, prevention, and treatment arenas. It is published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.

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