Jacek Jassem, MD

Abstract discussant, Jacek Jassem, MD, of the Medical University of Gdansk, in Poland, underscored smoking as the most important cause of lung cancer, noting that between 85% and 90% of patients with lung cancer are current or former smokers.

“Lung cancer screening, which has recently become standard of care, reduces lung cancer mortality by 20% to 30%, but smoking cessation is still the most effective lung cancer prevention,” he said.

According to Dr. Jassem, combining both screening and smoking cessation may increase this effect up to 40%, but optimal cessation interventions remain undefined.

With respect to the YESS study, Dr. Jassem noted the high rates of durable, validated abstinence—32% at 3 months and 30% at 12 months—and the lack of effect that personalized support had on abstinence rate.

“Perhaps people were not sufficiently worried about the status of their hearts or lungs, or the cessation support was very efficient, even in the control arm,” he hypothesized.

Dr. Jassem also noted the apparent benefit of personalized support in women and the fact that abstinence rates in women were significantly lower than in men.

“In our future efforts, we need to consider the need for a gender-adopted approach,” he said.

Finally, Dr. Jassem highlighted some limitations of the study, including the potential selection bias of the less than 50% of screening attendees who chose to participate. Given the lack of abstinence data for the population who declined to participate, there is a question about whether we can generalize these results, he said.

Nevertheless, Dr. Jassem was strongly emphatic about the need to combine lung cancer screening efforts with smoking cessation support.

“All cancer screening programs should include best available and ongoing cessation support,” Dr. Jassem concluded. “Screening without smoking cessation support is unethical.” 

DISCLOSURE: Dr. Jassem reported no potential conflicts of interest.