CT lung screening, smoking cessation doesn't have to be an either/or proposition

Several weeks ago when the Medicare Evidence Development and Coverage Advisory Committee voted not to support Medicare coverage for CT lung cancer screening, several panel members suggested that providers might be better off investing more money into smoking cessation than CT screening.

Steven H. Woolf, M.D., director of the Center on Society and Health at Virginia Commonwealth University, talked about the "prudent use of resources" while pointing out that the every year the Centers for Disease Control and Prevention reports that that not enough money is being sent to the states for tobacco control efforts. Wouldn't it make more sense, Woolf wondered, "to allocate our resources directly at tobacco control interventions?"

There also have been arguments raised that lung cancer screening programs can complicate efforts to get smokers to quit smoking. For example, the argument goes, since most smokers will get "good news" in the sense that their screening exams will be negative, will that reduce their motivation to stop smoking?

Still, there are plenty of counter-arguments about the value of CT lung cancer screening when it comes to smoking cessation. For example, a large-scale screening program will give health authorities unparalleled access to smokers who have a lengthy history of tobacco use.

And now, a study in the Journal of the National Cancer Institute shows that CT lung cancer screening has a significant effect on smoking cessation when the news from a screening exam is particularly alarming. In a study of more than 15,000 participants in the National Lung Screening Trial, researchers found that smokers quit in large numbers when the results of a screening exam are bad--such as when they show a large nodule suspicious for lung cancer--but are less likely to quit smoking if the results of an exam are positive but aren't suspicious for lung cancer.

Those with abnormal results suspicious for lung cancer reported about a 6 percent lower rate of smoking compared to those with normal results. This means, according to the researchers, that screening results could provide a "teachable moment" during which it might be possible to change smoking habits.

The idea that lung cancer screening can create these "teachable moments' has been embraced by healthcare providers. For example, at Georgetown University Medical Center, Kathryn Taylor, Ph.D., has launched a pilot program designed to pair smoking cessation counseling with lung cancer screening.

If smoking cessation programs and CT lung cancer screening can be used in conjunction to both modify smoking behavior and reduce lung cancer mortality rates--and studies like the one in JNCI suggest that they can--then the use of each doesn't have to be an either/or proposition. - Mike (@FierceHealthIT)

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