Review identifies what’s needed to sustain quit smoking support in lung cancer screening programs
Researchers from Flinders University say that building lung cancer screening programs that include strong, consistent and long‑term quit‑smoking support could play a crucial role in preventing smoking‑related deaths.
A new review published in JNCI: Journal of the National Cancer Institute shows that although many screening programs are beginning to offer smoking cessation assistance, most are not yet designed to deliver the full benefit.
Lead author Nathan Harrison, a researcher from the Flinders Health and Medical Research Institute (FHMRI), says lung cancer screening presents an ideal opportunity to help people quit smoking because many participants are already thinking about their health and cancer risk.
“We can see the potential that lung cancer screening programs could have in reducing smoking but our findings show that we’re not yet able to make the most of it,” says Mr Harrison.
The findings come as the first year of Australia’s National Lung Cancer Screening Program continues for high-risk individuals, and other countries including England prepare to roll out a national targeted screening program. These programs focus on screening for people with a history of smoking.
Lung cancer remains the most common cancer worldwide and often shows no early symptoms. It is responsible for almost one in five cancer deaths in Australia. Smoking is still the leading risk factor, and screening alone cannot replace the substantial health benefits of quitting.
The study reviewed real‑world evidence from global programs and found that despite widespread recommendations for cessation support, many services still do not offer structured, sustained assistance.
Using the RE‑AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) to bring together 55 different studies from overseas, the research team assessed how intervention programs are delivered, how participants engage, and how consistently services are maintained over time.
“We found that although lots of approaches are being tried, most research still looks only at how well individuals quit smoking, not how well the whole program works or what’s required to keep these services running long term,” says Mr Harrison.
“Important details like whether staff are prepared to deliver quit support, how much it costs, or how programs function over time are often missing.”
This lack of reporting on staff readiness, program costs and long‑term delivery models leaves governments and health services at risk of scaling approaches that cannot be sustained beyond short‑term trials.
Across international studies, behavioural support such as counselling was the most common intervention, and many participants were willing to engage. Opt‑out referral systems – where participants are automatically connected to cessation support unless they decline – showed particularly high uptake.
More intensive interventions such as group counselling tended to produce stronger quit outcomes, although they require greater staff time and investment, and few programs report how these services are funded or maintained.
Senior author and Director of FHMRI, Professor Billie Bonevski, says one of the biggest challenges is translating evidence from controlled trials into busy, real‑world clinical environments.
“Trial settings often have more staff resources and structure than real‑world programs can replicate. As a result, many programs default to brief conversations or simple advice, even though stronger interventions may achieve better long‑term results,” says Professor Bonevski.
“Integrating effective smoking cessation support into lung cancer screening is essential to reducing preventable deaths. Screening should not be viewed as separate from prevention, and every appointment is an opportunity to support long‑term behaviour change.”
The study also highlights the importance of addressing the needs of priority groups. Several countries identify Indigenous peoples, rural communities and people experiencing disadvantage as key populations for screening outreach, yet the review found limited evidence on how cessation support is tailored for these groups.
“This is a major gap that needs attention. Communities with the highest smoking prevalence also face the greatest lung cancer burden and would benefit from well‑designed, culturally informed approaches,” says Professor Bonevski.
The researchers say health systems now need more comprehensive real‑world evidence to guide the design of new and expanding screening programs.
They argue that strategies must be scalable, sustainable and adaptable to local contexts, and that integrating smoking cessation into screening is not an optional add‑on but central to delivering the best possible public health outcomes.
The paper, ‘Implementation of smoking cessation interventions in real-world lung cancer screening: A RE-AIM-guided scoping review’, by Mr Nathan J. Harrison, Professor Nicole M. Rankin (University of Melbourne), Professor Christine L. Paul (University of Newcastle), Professor Jacqueline A. Bowden, Dr Hollie Bendotti (University of Queensland), Dr Jacqueline Roseleur, Ms Georgia E. Bartlett (University of Melbourne), Associate Professor Henry M. Marshall (University of Queensland), Professor Emily Stone (UNSW Sydney), Ms Stacey Allerton and Professor Billie Bonevski was published in JNCI: Journal of the National Cancer Institute. https://doi.org/10.1093/jnci/djag102
Acknowledgements:
This work was supported (N.J.H.) by a PhD scholarship at Flinders University, provided through grants from the Medical Research Future Fund [2008603] and the National Health and Medical Research Council [GNT1160245, GNT1198301].
