The Relations Between False Positive and Negative Screens and Smoking Cessation and Relapse in the National Lung Screening Trial: Implications for Public Health

Abstract

Introduction: Lung screening is an opportunity for smoking cessation and relapse prevention, but smoking behaviors may differ across screening results. Changes in smoking were evaluated among 18 840 current and former smokers aged 55-74 scheduled to receive three annual lung screenings.

Methods: Participants were randomized to low-dose computed tomography or single-view chest radiography in the American College of Radiology/National Lung Screening Trial. Outcome measures included point and sustained (6-month) abstinence and motivation to quit among smokers; and relapse among smokers who quit during follow-up, recent quitters (quit < 6 months), and long-term former smokers (quit ≥ 6 months).

Results: During five years of follow-up, annual point prevalence quit rates ranged from 11.6%-13.4%; 48% of current smokers reported a quit attempt and 7% of long-term former smokers relapsed. Any false positive screening result was associated with subsequent increased point (multivariable hazard ratio HR = 1.23, 95% CI = 1.13, 1.35) and sustained (HR = 1.28, 95% CI = 1.15, 1.43) abstinence among smokers. Recent quitters with ≥1 false positive screen were less likely to relapse (HR = 0.72, 95% CI = 0.54, 0.96). Screening result was not associated with relapse among long-term former smokers or among baseline smokers who quit during follow-up.

Conclusions: A false positive screen was associated with increased smoking cessation and less relapse among recent quitters. Consistently negative screens were not associated with greater relapse among long-term former smokers. Given the Affordable Care Act requires most health plans to cover smoking cessation and lung screening, the impact and cost-effectiveness of lung screening could be further enhanced with the addition of smoking cessation interventions.

Trial registration: ClinicalTrials.gov NCT00047385.

Figure 1.

Flow diagram of participants in the National Lung Screening Trial (NLST-ACRIN)

Figure 2.

(a) Cox Regression estimates of time until baseline smokers made a quit attempt of any length by screening result. (b) Cox Regression estimates of time until baseline smokers made a quit attempt of 6 months or longer by screening result. (c) Cox Regression estimates of time until former smokers who quit ≤ 6 months prior to randomization (eg, recently quit former smokers) relapsed. (d) Cox Regression estimates of time until former smokers who quit >6 months prior to randomization (eg, long term former smokers) relapsed.