The First National Framework in Central and Eastern Europe
Smoking remains the leading cause of lung cancer worldwide, responsible for nearly 90% of cases. In Poland, with a population of nearly 37 million, lung cancer accounts for 23 000 deaths, representing more than a quarter of all cancer deaths. Furthermore, smoking prevalence remains high, with nearly 29% of adults reporting daily smoking.
Recognizing the urgent need to combine early detection with effective prevention, a multidisciplinary panel of experts developed the Polish Consensus on Smoking Cessation Intervention within Lung Cancer Screening (LCS).1 This is the first national document in Central and Eastern Europe to define evidence-based strategies for embedding smoking cessation services into organized screening programs.
The Dual Mission of Lung Cancer Screening
Low-dose computed tomography (LDCT) screening has proven effective in reducing lung cancer mortality by more than 20%, as shown in the National Lung Screening Trial (NLST)2 and the Dutch-Belgian Randomized Lung Cancer Screening Trial (NELSON).3
Yet its full preventive potential can only be achieved when coupled with active smoking cessation support. Since 2013, major international frameworks have recognized smoking cessation as a core component of lung cancer screening programs, following the US Preventive Services Task Force (USPSTF) and Centers for Medicare & Medicaid Services (CMS) decisions.4,5
A Comprehensive Polish Framework
The Polish consensus—developed by experts in epidemiology, public health, radiology, thoracic surgery, pneumonology, and oncology—was prepared through a two-stage process in 2023–2024. It integrates data from more than 30 clinical trials and meta-analyses and aligns with European policy objectives on early cancer detection. Key recommendations include:
- Comprehensive assessment of smoking habits (including biochemical validation)
- Cognitive-behavioral counseling and motivational interviewing delivered at the screening site
- Pharmacotherapy (e.g., nicotine replacement therapy, cytisine, varenicline, or bupropion) tailored to patient needs
- Educational materials and follow-up teleconsultations to support sustained abstinence
- Systematic documentation of cessation interventions as part of the LCS protocol
- Discouragement of alternative nicotine products (e-cigarettes, heated tobacco, nicotine pouches)
These interventions will be embedded in Poland’s nationwide LCS program, scheduled to launch in 2026, following a multi-center pilot conducted between 2020 and 2023.
European and Global Context
Poland’s initiative aligns with broader European efforts to integrate smoking cessation into screening. The United Kingdom (UK) has led this approach through its Targeted Lung Health Checks (TLHC) program,6,7 where cessation support is embedded at every stage of screening. The UK National Screening Committee mandates that smoking cessation services be offered to all participants, and evaluations confirm that this integration improves both quit rates and program cost-effectiveness.
In Portugal, a 2024 national consensus emphasized combining LDCT screening with structured cessation programs as part of a comprehensive prevention strategy.8 At the European level, the Council Recommendation on Strengthening Prevention through Early Detection and Europe’s Beating Cancer Plan9 jointly call for coordinated implementation of LDCT screening with integrated smoking cessation and primary prevention measures across member states.
Poland also participates in the SOLACE project,10 an EU4Health-funded initiative testing real-world LCS implementation in 12 countries, supported by the European Respiratory Society (ERS) and European Society of Radiology (ESR). Most SOLACE sites include smoking cessation as an embedded service.
From Consensus to Implementation
The Polish consensus notes that roughly half of those eligible for screening are active smokers. The key question, therefore, is not whether cessation support should be offered, but how to implement it effectively and sustainably. The proposed model emphasizes scalability—combining in-person and remote counseling, pharmacotherapy, and follow-up within existing healthcare structures.
The following statements were provided by co-authors of the consensus, reflecting both clinical and public health perspectives.
Prof. Witold Rzyman, thoracic surgeon, says: “Lung cancer screening is a unique teachable moment. When participants realize they are at increased risk, they are more receptive than ever to quitting. We must use this opportunity effectively.”
Prof. Łukasz Balwicki, public health specialist, adds: “This consensus bridges prevention and early detection. Smoking cessation is not an optional add-on—it is a fundamental component of screening that transforms diagnosis into a moment of behavioral change.”
Prof. Jacek Jassem, oncologist, emphasizes: “Screening without a cessation intervention may be viewed as a licence to continue smoking. We must ensure that detection and prevention go hand in hand.”
Toward a Smoke-Free Future
The consensus concludes that active cessation support within LCS enhances preventive impact and is cost-effective. By combining early detection with behavioral and pharmacological interventions, Poland aims to reduce lung cancer mortality while addressing one of the nation’s most persistent health challenges—tobacco addiction.
The Polish model may serve as a prototype for other European countries implementing the EU’s recommendations, offering a dual-benefit strategy: saving lives through early cancer detection and preventing future disease by tackling tobacco dependence.
References
- 1. Balwicki Ł, Klimiuk KF, Miller m, et. al. Polish Consensus on Smoking Cessation Intervention within Lung Cancer Screening. Arch Med Sci. 2025, DOI: https://doi.org/10.5114/aoms/214091.
- 2. Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening: the National Lung Screening Trial (NLST). N Engl J Med. 2011;365:395–409.
- 3. de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung-cancer mortality with volume CT screening in the NELSON trial. N Engl J Med. 2020;382:503–513.
- 4. Centers for Medicare & Medicaid Services. Decision Memo for Screening for Lung Cancer with Low Dose Computed Tomography (CAG-00439N). 2015.
- 5. U.S. Preventive Services Task Force. Screening for Lung Cancer: Recommendation Statement. Ann Intern Med. 2013;160:330–338.
- 6. UK National Screening Committee. Lung cancer – targeted screening recommendation including integrated smoking cessation service provision. Available at: https://view-health-screening-recommendations.service.gov.uk/lung-cancer/ (accessed Oct 22, 2025).
- 7. UK Government. Equality impact assessment: screening for lung cancer—smoking cessation embedded in the programme. Available at: https://www.gov.uk/government/publications/lung-cancer-screening-equality-impact-assessment (published Jul 24, 2025; accessed Oct 22, 2025).
- 8. Portuguese Society of Pulmonology and Portuguese Lung Cancer Study Group. National Consensus on Implementation of Lung Cancer Screening in Portugal. Pulmonology. 2024;30(3):161–167.
- 9. European Commission. Council Recommendation on Strengthening Prevention through Early Detection: Cancer Screening; and Europe’s Beating Cancer Plan. Brussels: European Commission; 2021–2022.
- 10. European Commission. SOLACE Project (EU4Health). 2024.
