"Risk homeostasis"or "teachable moment"? the interaction between smoking behavior and lung cancer screening in the Mayo Lung Project.
The chest X-ray lung cancer screening program of Mayo Lung Project (MLP) yielded mixed results of improved lung case survival but no improvement in lung cancer mortality. This paper analyzes the smoking patterns of study participants in order to examine possible behavioral ramifications of periodic lung cancer screening. Using a longitudinal difference-of-difference model, we compared the smoking behavior, in terms of current smoker status among all subjects and the intensity of smoking among those continuing smokers, between those who received periodic lung cancer screening and those who received usual-care. In both arms of this lung cancer screening trial, there was a sizable decline in cigarette smoking one year after participants received baseline prevalence screening. There was no significant difference in current smoker status between the intervention group receiving periodic X-ray screening and the control group receiving usual care. While we detect that the continuing smokers in the intervention group smoked more than their counterparts in the control group, the magnitude of the difference is not sufficient to explain a substantial difference in lung cancer incidence between the two groups. Our study shows that periodic lung screening in MLP did not decrease smoking behavior beyond the observed decline following the initial prevalence screening conducted at baseline for both the intervention and control groups. Our results also indicate, paradoxically, that participants assigned to the intervention group smoked more cigarettes per day on average than those in the control group. Lung cancer screening programs need additional cessation components to sustain the abstinence effect typically observed following initial lung screening.
Department of Health Services, 650 Charles E, Young Drive S, 61-253 CHS, Los Angeles, CA 90099, USA. lushi.pku@gmail.com.
Lu
L
Shi
Martin Y
MY
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Cancer. 1993 Sep 1;72(5):1573-80
8394199
Tob Control. 2007 Dec;16 Suppl 1:i3-8
18048627
J Pharmacol Exp Ther. 1988 Aug;246(2):619-27
3404450
J Health Econ. 1996 Oct;15(5):609-39
10164045
Cancer. 2000 Dec 1;89(11 Suppl):2352-5
11147611
JAMA. 1997 Mar 5;277(9):715-21
9042843
Tob Control. 2007 Dec;16 Suppl 1:i53-9
18048633
Lung Cancer. 2007 Apr;56(1):125-34
17196298
Cancer. 2003 Dec 1;98(11):2495-501
14635086
Cochrane Database Syst Rev. 2005 Apr 18;(2):CD001292
15846616
Prev Med. 2001 Dec;33(6):613-21
11716658
BMJ. 2000 Aug 5;321(7257):323-9
10926586
J Natl Cancer Inst. 2006 Jun 7;98(11):748-56
16757699
Cancer. 2006 Jan 1;106(1):17-27
16311986
N Engl J Med. 2006 Oct 26;355(17):1763-71
17065637
Am J Public Health. 1995 Feb;85(2):231-5
7856783
J Clin Oncol. 2002 Aug 15;20(16):3461-9
12177107
Cancer. 2005 May 15;103(10):2154-62
15825210
Nicotine Tob Res. 2005 Apr;7(2):269-76
16036284