LUNG cancer remains the leading cause of cancer-related deaths in the UK, claiming nearly 35,000 lives annually. Early detection through low-dose CT (LDCT) screening can significantly reduce mortality among high-risk individuals by enabling diagnosis at earlier, more treatable stages. In 2022, the UK National Screening Committee recommended targeted screening for those most at risk, particularly individuals with a history of tobacco smoking, which is responsible for approximately 86% of lung cancer deaths in the UK.
Lung cancer screening (LCS) presents a crucial opportunity to address tobacco dependence, as participation is associated with increased motivation to quit smoking. However, the most effective method of delivering smoking cessation interventions within this setting remains unclear. Recent evidence suggests that an ‘opt-out’ referral approach – where all eligible individuals are automatically referred unless they decline – can significantly enhance engagement with stop-smoking services (SSSs).
The SUMMIT study, a UK-based trial, demonstrated the effectiveness of this proactive strategy. Approximately 33.7% of eligible individuals consented to an automatic referral, with a 4-week quit rate of 17.8% among those referred and 37% among those who engaged with cessation support. However, challenges remain, with over 40% of participants unable to be referred due to a lack of local SSS availability, highlighting the need for improved access.
Providing specialist, on-site cessation support during LCS appointments appears particularly effective, capitalising on the ‘teachable moment’ when individuals are more receptive to quitting. Socioeconomic factors also play a role, with individuals from more deprived areas less likely to accept referrals, indicating the need for more targeted interventions.
In conclusion, integrating proactive smoking cessation strategies within LCS programmes can enhance quit rates, particularly when combined with accessible, on-site specialist support. Expanding service availability and addressing socioeconomic barriers will be essential to maximise the public health benefits of lung cancer screening in the UK.
Katie Wright, EMJ
Reference
Bhamani A et al. Uptake and 4-week outcomes of an ‘opt-out’ smoking cessation referral strategy in a London-based lung cancer screening setting. BMJ Open Respir Res. 2025;12(1):e002337.
