What are the recommendations for smoking cessation to reduce the risk of developing lung cancer?

From the Guidelines

To reduce the risk of developing lung cancer, complete smoking cessation is strongly recommended as the most effective strategy. Quitting smoking at any age provides significant health benefits, with risk reduction beginning immediately and increasing over time. Several evidence-based approaches can help with cessation:

• nicotine replacement therapy (NRT) in forms such as patches, gum, lozenges, inhalers, or nasal sprays
• prescription medications including varenicline (Chantix) or bupropion (Zyban)
• behavioral support through counseling, support groups, or quitlines (1-800-QUIT-NOW) 1. Combining medication with behavioral support significantly increases success rates. Creating a specific quit plan with a target date, identifying triggers, removing smoking paraphernalia, and enlisting social support are important practical steps. Even after quitting, avoiding secondhand smoke exposure is important as it also contributes to lung cancer risk. The risk reduction occurs because cessation stops the ongoing damage to lung tissue from carcinogens in tobacco smoke, allowing the body to begin repairing damaged cells and reducing inflammation. A minimum of 12 weeks of combination NRT or varenicline is recommended for the initial quit attempt, with therapy potentially extended to promote continued cessation 1. Follow-up is recommended within 2 weeks after starting pharmacotherapy, with additional periodic follow-up during therapy and after completion of therapy 1. Smoking cessation substantially reduces a person's risk for developing and dying of lung cancer, with the greatest benefit seen in those at highest risk due to additional risk factors or greater cumulative exposure to tobacco smoke 1. Current smokers should be informed of their continuing risk for lung cancer and offered cessation treatments, with screening with low-dose computed tomography (LDCT) viewed as an adjunct to tobacco cessation interventions 1. The American Cancer Society recommends that clinicians initiate a discussion about lung cancer screening with patients aged 55 years to 74 years who have at least a 30-pack-year smoking history, currently smoke, or have quit within the past 15 years, and who are in relatively good health, emphasizing the benefits, uncertainties, and harms of screening 1.

From the FDA Drug Label

Begin varenicline tablets dosing one week before the date set by the patient to stop smoking. Alternatively, the patient can begin varenicline tablets dosing and then quit smoking between days 8 and 35 of treatment. Consider a gradual approach to quitting smoking with varenicline tablets for patients who are sure that they are not able or willing to quit abruptly. Provide patients with appropriate educational materials and counseling to support the quit attempt.

The recommended approach to smoking cessation using varenicline tablets is to either start dosing one week before quitting or to begin dosing and then quit between days 8 and 35 of treatment. For patients who cannot quit abruptly, a gradual approach to quitting is suggested, with the goal of reducing smoking by 50% within the first four weeks and continuing to reduce until complete abstinence is reached by 12 weeks. Counseling and educational materials should be provided to support the quit attempt. Treatment can be continued for an additional 12 weeks for a total of 24 weeks to increase the likelihood of long-term abstinence 2.

From the Research

Smoking Cessation Recommendations

To reduce the risk of developing lung cancer, several recommendations for smoking cessation have been identified:

• All patients, including school-aged children and adolescents, should be asked if they smoke and offered evidence-based treatments for smoking cessation 3
• The 5 A's framework (ask, advise, assess, assist, arrange) can help clinicians promote smoking cessation 3
• Combining pharmacotherapy with effective behavior strategies is significantly more effective than either approach alone 3
• Pharmacotherapies approved by the U.S. Food and Drug Administration for smoking cessation include nicotine replacement therapy, bupropion, and varenicline 3, 4
• Extended use (greater than 12 weeks) of a controller therapy (varenicline, bupropion, or nicotine patch) is associated with significantly higher sustained quit rates and lower relapse rates than standard use (six to 12 weeks) 3

Benefits of Smoking Cessation

The benefits of smoking cessation for lung cancer patients include:

• Reduced risk of dying from lung cancer 5
• Less effective treatment and poorer prognosis for those who continue to smoke after diagnosis 5
• Improved cancer treatments and survival rates 5
• Reduced risk of all-cause mortality and lung cancer-specific mortality 6
• Later age at onset of lung cancer 6

Target Population for Smoking Cessation

Smoking cessation is recommended for:

• All smokers, regardless of age 3, 6
• Lung cancer patients, including those who have been diagnosed with early-stage lung cancer 5
• Former smokers who have quit smoking for more than 15 years 6
• Individuals over 60 years old, who can still benefit from smoking cessation to prolong the age at onset of lung cancer 6