Smoking cessation interventions are a critical component of lung cancer screening (LCS) programs, as they have been shown to reduce smoking-related risks and improve screening outcomes. Evidence increasingly supports the inclusion of high-intensity and opt-out smoking cessation services at the point of screening as having the greatest impact. Despite this, the implementation of cessation support within LCS programs varies widely across countries, influenced by differences in health system structures, funding mechanisms, policy frameworks, and clinical practice models.
National Screening Recommendations
Most global LCS guidelines and documents provide recommendations for integrating smoking cessation interventions, but often lack specific, detailed evidence or clear frameworks for how to implement these interventions within screening programs practically. The gaps generally exist in providing evidence-based protocols, standard practices, and clear funding mechanisms for integration. Table 1 summarizes key recommendations by country in selected published protocols and policy documents.
| Country / Region | Policy / Guideline | Smoking cessation recommendation |
| US | US Preventive Services Task Force (USPSTF)1 | Provide smoking cessation interventions as a part of lung cancer screening for eligible high-risk individuals, including counseling and pharmacotherapy. |
| UK | Standard protocol prepared for the Lung Cancer Screening Program, NHS England2 | Current smokers will be offered smoking cessation Very Brief Advice (VBA) and formal smoking cessation service referral on an opt-out basis. |
| Australia | Australian Lung Cancer Screening Protocol3 | Encourage integration of smoking cessation strategies in lung cancer screening for eligible individuals, including referral to cessation programs. |
| Canada | Canadian Task Force on Preventive Health Care (CTFPHC)4 | Include smoking cessation counseling and pharmacotherapy as part of lung cancer screening efforts, ensuring long-term follow-up for cessation. |
| EU | European Position Statement on Lung Cancer Screening5 | Recommend the inclusion of smoking cessation as a key component of lung cancer screening, ensuring individuals receive counseling and support. |
| South Korea | The Korean Guideline for Lung Cancer Screening6 | Education and actions to stop smoking must be offered to individuals who currently smoke. |
Smoking Cessation Interventions
Smoking cessation interventions in LCS programs have been integrated in various ways. These include embedding cessation support directly into the screening workflow (for example, on-the-spot counseling and pharmacotherapy); using referral systems to external services like quitlines; or providing digital support through apps and web platforms. Nurse- or navigator-led models, where dedicated staff deliver personalized cessation support, are also common. In some cases, pharmacotherapy is offered onsite during screening visits, and motivational interviewing is used to tailor interventions based on readiness to quit. Community-based models, often seen in lower-resource settings, involve local health workers or non-government organizations offering cessation support linked to regional or mobile screening programs. Follow-up support, such as scheduled calls or text reminders, is also an important component of comprehensive programs.
Funding Models
Although integration of smoking cessation into LCS programs globally is a crucial step in reducing the long-term burden of lung cancer, the funding models for such integration vary significantly across regions. This depends on healthcare infrastructure, funding availability, and the approach to smoking cessation. Table 2 includes a summary of some funding models that have been employed or proposed for integrating smoking cessation into LCS programs.
| Model | Description | Countries using this model |
| Public Health Insurance | National insurance covers both lung cancer screening and cessation services | US: Medicare/Medicaid cover LCS and smoking cessation. South Korea: National Health Insurance supports integrated cessation. Taiwan: Smoking cessation covered for high-risk individuals. |
| National Health System (Tax-funded) | Tax-funded health systems (e.g., NHS) provide free or low-cost smoking cessation services integrated into LCS | UK: NHS provides fully integrated services. Canada: Provincial systems fund integration. Australia: Medicare supports cessation as part of LCS pathway. |
| Mixed Public-Private Insurance Models | Both government and private insurers contribute to funding; cessation coverage may depend on insurance provider and policy. Some plans cover full cessation support, others only limited counseling or medications. | US: Private plans vary in coverage scope. Netherlands, France: Use mixed systems with varying levels of integration |
| Dedicated Tobacco Control or Public Health Funds | Cessation services are funded by government tobacco control programs, often outside the core healthcare financing system. Public education, quitlines, cessation clinics; may be indirectly linked to LCS | China: Local governments use tobacco control budgets. India: Cessation integrated in pilot programs via national tobacco control funds |
| Regional / International Public Health Grants | Funding from regional bodies (e.g., EU) or global initiatives supports integration within national programs. Project-based, often limited to pilots or scale-up phases. | EU: Funding via Europe’s Beating Cancer Plan. |
| Research Grants and NGO Support | Integration efforts are supported through grants from academic institutions, international donors, or NGO. Often used for pilot programs, feasibility studies, and proof-of-concept models. | Variable low- and middle-income countries |
Evidence on Optimal Delivery
The evidence base for effective smoking cessation intervention has much expanded in recent years. Despite considerable variation across research studies in terms of study design and type, intensity and timing of intervention delivery, we are now closer to reaching consensus on the optimal approach to providing support in LCS settings.
A previous systematic review of studies published to July 2022 reported findings from studies conducted in Australia, Belgium, Canada, Germany, Italy, the UK, and the US. The review concluded that there was moderate quality evidence to support the delivery of stop smoking interventions within LCS. Further, there was high-quality evidence that more intensive interventions were more likely to be effective.7
As described previously in ILCN, the SCALE collaboration of eight clinical trials examining key components and characteristics of smoking cessation intervention within LCS has reported variable quit rates. Overall, findings from the SCALE collaboration support the notion that more intensive interventions are more efficacious. For example, an intervention comprising a 12-week prescription of nicotine replacement therapy or prescription pharmacotherapy plus counseling provided by tobacco treatment specialists within the LCS setting realized 7-day point prevalent quit rates of up to 32.4% reported at the 6-month follow-up.8
Since the most recent review, several other studies have also been published, which are contributing to the growing consensus of the benefit of intensive stop smoking intervention. In the UK, the Yorkshire Lung Screening Trial embedded opt-out, co-located stop smoking support provided by trained stop smoking practitioners at the time of LCS. The study found that a high proportion of LCS attendees accepted a consultation (89%), with 75% accepting ongoing support and 12.4% of the eligible population achieving a validated 4-week quit.9 Individuals who accepted stop smoking support were offered enrollment into the Yorkshire Enhanced Stop Smoking (YESS) study, which tested ongoing delivery of behavioral support plus nicotine replacement therapy, e-cigarettes and/or pharmacotherapy for up to 12 weeks (control group) or the addition of a personalized booklet containing images of participants’ own heart and lungs, captured during the LDCT scan (intervention group). Validated 7-day point prevalent quit rates were 30% in the control group and 32.6% in the intervention group at 3 months, and 28.6%/29.2% respectively at 12 months.10 While the addition of personalized images was not efficacious, both arms were relatively high intensity, again fitting with prior evidence regarding the efficacy of more intensive interventions.
The QuLIT studies tested the offer of immediate stop smoking support either face to face (QuLIT1) or by telephone (QuLIT2) plus pharmacotherapy compared to signposting to stop smoking services attended at a UK LCS service. Self-reported 7-day point prevalent quit rates were higher in the intervention group (20% vs. 12.8%) at 12-month follow-up.11
In addition to the above, there are several studies currently underway that will further contribute to the evidence base. Interventions not currently widely tested in the LCS-eligible population include mobile apps, financial incentives, stepped care interventions; as well as further research of patient navigation, telephone support, quitlines, and nicotine replacement therapy in general and in specific populations, including LGBTQ participants and patients with HIV.
What remains clear is that LCS is a prime opportunity to provide smoking cessation support to attendees who currently smoke. Despite existing and emerging evidence as to the optimal mode of delivery, a lack of clear guidelines, policy indicators, and quality standards means this opportunity is often being missed. Regardless of the stage of implementation of LCS, healthcare system, or funding model, countries should prioritize providing clear guidelines for the provision of smoking cessation provision in LCS, appropriate for the country-specific situation.
References
- 1. U. S. Preventive Services Task Force. Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2021;325(10):962-70.
- 2. NHS England. Targeted screening for lung cancer with low radiation dose computed tomography. Standard protocol prepared for the Lung Cancer Screening Programme V.3. Available from: https://www.england.nhs.uk/wp-content/uploads/2019/02/PRN01867i-standard-protocol-prepared-for-the-lung-cancer-screening-programme-v3.pdf
- 3. Australian Government Department of Health and Aged Care. National Lung Cancer Screening Program – Guidelines. Available from: https://www.health.gov.au/sites/default/files/2025-04/national-lung-cancer-screening-program-guidelines.pdf
- 4. Canadian Task Force on Preventive Health C. Recommendations on screening for lung cancer. CMAJ. 2016;188(6):425-32.
- 5. Oudkerk M, Devaraj A, Vliegenthart R, Henzler T, Prosch H, Heussel CP, et al. European position statement on lung cancer screening. Lancet Oncol. 2017;18(12):e754-e66.
- 6. Jang SH, Sheen S, Kim HY, Yim HW, Park BY, Kim JW, et al. The Korean guideline for lung cancer screening. jkma. 2015;58(4):291-301.
- 7. Williams PJ, Philip KE, Alghamdi SM, Perkins AM, Buttery SC, Polkey MI, et al. Strategies to deliver smoking cessation interventions during targeted lung health screening – a systematic review and meta-analysis. Chron Respir Dis. 2023;20:14799731231183446.
- 8.Cinciripini PM, Minnix JA, Kypriotakis G, Erasmus J, Beneventi D, Karam-Hage M, et al. Smoking Cessation Interventions in the Lung Cancer Screening Setting: A Randomized Clinical Trial. JAMA Intern Med. 2025;185(3):284-91.
- 9. Murray RL, Alexandris P, Baldwin D, Brain K, Britton J, Crosbie PAJ, et al. Uptake and 4-week quit rates from an opt-out co-located smoking cessation service delivered alongside community-based low-dose computed tomography screening within the Yorkshire Lung Screening Trial. Eur Respir J. 2024;63(4).
- 10. Murray R.L. BD, Brain K., Britton J., Chalitsios C., Crosbie P. et al,,. The Yorkshire Enhanced Stop Smoking (YESS) Study: A Randomised Trial of Adding Co-Located, Personalised Stop Smoking Support to a Lung Cancer Screening Programme [Preprint]. Available at http://dxdoiorg/102139/ssrn4835933.
- 11. Williams PJ, Philip KEJ, Buttery SC, Perkins A, Chan L, Bartlett EC, et al. Immediate smoking cessation support during lung cancer screening: long-term outcomes from two randomised controlled trials. Thorax. 2024;79(3):269-73.
