Current or former smokers: Who wants to be screened?

Abstract

Background: Lung cancer screening (LCS) with annual low-dose CT scans reduced specific and overall mortality in a selected population (age 55-74 yrs, current or former [quit < 15 yrs ago] smokers [> 30 pack-years]). Participation is key to successful screening programs. We assessed smokers' intention to take part in a hypothetical LCS program for smokers. Method(s): The EDIFICE French nationwide observational surveys assess behavior related to cancer screening programs. EDIFICE 4 was conducted from June 12 to July 10 2014 by phone interviews of a representative sample of 1602 subjects (age 40-75 yrs) using the quota method. To identify explanatory factors associated with the intention to take part in a LCS program, we performed 2 comprehensive multivariate stepwise logistic regression analyses: (i) in current and (ii) in former cigarette smokers (who quit < 15 yrs ago). Result(s): Among those with no personal history of cancer (N = 1463), 263 current and 170 former cigarette smokers were analyzed in the 2 regression models; 36.4% and 26.3% respectively, intended taking part in a LCS program. In current cigarette smokers, the following were explanatory factors of the intention to take part: have been already screened for lung cancer (OR = 2.81; 95% CI [1.37-5.91]; P < 0.01); smokers < 30 pack-years (OR = 2.69 [1.21-6.30], P = 0.02); intention to stop smoking (OR = 1.96 [1.04-3.75], P = 0.04); low EPICE score (no precarity) (OR = 2.15; 95% CI [1.16-4.08], P = 0.02). In contrast, women (OR = 0.28; 95% CI [0.15-0.52], P < 0.01) were less inclined to undergo screening. Participation in other cancer screening programs, the Fagerstrom score, use of e-cigarettes, previous attempts to quit, and eligibility for screening were not significantly explanatory factors. Among former cigarette smokers, those with no comorbidities were less inclined to participate (OR = 0.31; 95% CI [0.11-0.74], P = 0.01) while other variables were not explanatory. Again, eligibility for screening was not significantly explanatory. Conclusion(s): Intending to take part in LCS programs is a complex decision. Explanatory factors differ between current and former smokers but usual eligibility criteria are not significantly explanatory. Among current smokers, intended participation is strongly associated with the intention to quit smoking.