Chest
Original Research: Lung CancerTobacco Dependence Predicts Higher Lung Cancer and Mortality Rates and Lower Rates of Smoking Cessation in the National Lung Screening Trial
Section snippets
Subjects and Methods
This study was approved by the Medical University of South Carolina Institutional Review Board (No. 00054733). It is a secondary analysis of subjects from the American College of Radiology Imaging Network (ACRIN) arm of the NLST randomized controlled trial.
Participant Demographic Characteristics
Of the 7,057 current smokers, 3,504 underwent spiral CT imaging, and 3,553 underwent radiography. Participant demographic characteristics are presented in Table 1. Approximately one half of the current smokers were female (45.9%), and the majority were white (89.8%), with a mean 55.2 ± 22.0 pack-year history of smoking. Lung nodules were detected in 19.5% of the current smokers (across 3 years of annual screening). The mean FTND score was 6.1 ± 2.3, and the mean HSI score was 4.2 ± 1.4,
Discussion
Successful tobacco cessation is critical within the context of lung cancer screening, but how best to implement tobacco treatment has yet to be determined. To our knowledge, our study is the first to investigate the relationship between degree of nicotine dependence and both likelihood to quit smoking and clinical cancer and mortality outcomes in a cohort of screened patients. It found that current smokers participating in lung cancer screening are more dependent on tobacco compared with the
Conclusions
Current smokers presenting for lung cancer screening have varying levels of tobacco dependence that predicts both ability to quit and clinical outcomes of lung cancer diagnosis, all-cause mortality, and lung cancer-specific mortality. Identifying individuals with higher levels of nicotine dependence through the use of the TTFC, which is a single-question assessment, at the time of screening has the potential to influence tobacco treatment efforts and increase cessation success within the
Acknowledgments
Author contributions: A. M. R. had full access to the study data and takes responsibility for the integrity of the data and the accuracy of the analyses. A. M. R., N. T. T., J. G. R., G. A. S., and B. A. T. were responsible for conception, design, interpretation, and drafting of the manuscript. L. D. and M. G. were responsible for design, analysis, interpretation, and drafting of the manuscript.
Financial/nonfinancial disclosures: The authors have reported to CHEST the following: B. A. T.
References (42)
- et al.
Components necessary for high-quality lung cancer screening: American College of Chest Physicians and American Thoracic Society policy statement
Chest
(2015) - et al.
Predicting smoking cessation with self-reported measures of nicotine dependence: FTQ, FTND, and HSI
Drug Alcohol Dependence
(1994) - et al.
Time to first cigarette and lung cancer risk in Japan
Ann Oncol
(2013) - et al.
Potential impact of including time to first cigarette in risk models for selecting ever-smokers for lung cancer screening
J Thoracic Oncol
(2017) - et al.
Preliminary evaluation of a telephone-based smoking cessation intervention in the lung cancer screening setting: a randomized clinical trial
Lung Cancer
(2017) - et al.
Stopping smoking reduces mortality in low-dose computed tomography screening participants
J Thoracic Oncol
(2016) Reports of the Surgeon General. The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General
(2014)Screening for Lung Cancer: U.S. Preventive Services Task Force Recommendation Statement
Ann Intern Med
(2014)Reduced lung-cancer mortality with low-dose computed tomographic screening
N Engl J Med
(2011)- et al.
Smoking cessation and relapse during a lung cancer screening program
Cancer Epidemiol Biomarkers Prev
(2009)
Effect of CT screening on smoking habits at 1-year follow-up in the Danish Lung Cancer Screening Trial (DLCST)
Thorax
Impact of lung cancer screening results on smoking cessation
JNCI
Attitudes and perceptions about smoking cessation in the context of lung cancer screening
JAMA Intern Med
Treating Tobacco Use and Dependence 2008 Update: Clinical Practice Guideline
Time to first cigarette in the morning as an index of ability to quit smoking: implications for nicotine dependence
Nicotine Tobacco Res
The Fagerström Test for Nicotine Dependence as a predictor of smoking abstinence: a pooled analysis of varenicline clinical trial data
Nicotine Tobacco Res
The Fagerström Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire
Br J Addiction
Lung cancer risk measured by the Fagerstrom Test for Nicotine Dependence?
Nicotine Tobacco Res
Time to smoke first morning cigarette and lung cancer in a case-control study
J National Cancer Institute
Nicotine dependence phenotype and lung cancer risk
Cancer
The National Lung Screening Trial: overview and study design
Radiology
Cited by (44)
Lung Cancer Screening in Asia: An Expert Consensus Report
2023, Journal of Thoracic OncologyImplication of bronchopulmonary cancer patients in thoracic oncology
2021, Revue des Maladies RespiratoiresAssociations between chronic cigarette smoking and taste function: Results from the 2013–2014 national health and nutrition examination survey
2021, Physiology and BehaviorCitation Excerpt :Smokers, particularly those with more dependence, are more likely to be of lower socioeconomic status and less skilled labor [104], which may indicate less access to healthcare (including dental care) and greater risk of exposures in workplaces or living environments. More dependent smokers also have poorer health outcomes than nonsmokers and lower rates of smoking cessation compared to less dependence smokers [105]. Current smokers in the NHANES dataset were significantly more likely to have a high school or less education, lower income-to-poverty income, report fair/poor health, as well as have a greater chemosensory risk score (including sinonasal symptoms, xerostomia, history of tonsillectomy, and history of serious head/face injury).
FUNDING/SUPPORT: This study was supported in part by National Cancer Institute (NCI) [Grants K07CA214839, R01-CA207229, and P50-CA196530] and Hollings Cancer Center’s Cancer Center [Grant P30-CA138313] at the Medical University of South Carolina. This research is also supported in part by American Cancer Society Mentored Research Scholar [Grant MRSG-15-028-01-CPHPS to Dr Tanner]. Original data collection for ACRIN 6654 (National Lung Screening Trial) was supported by NCI Cancer Imaging Program grants.