Leveraging the "Teachable Moment": Impact of LDCT findings and counseling on smoking behavior

Low-dose computed tomography (LDCT) lung cancer screening is recognized as a "teachable moment" for smoking cessation. However, evidence of its impact on smoking behavior is inconsistent, with limited research on incidental smoking-related findings, such as coronary artery calcification (CAC) or emphysema, and on sustained abstinence among former smokers. We comprehensively evaluated the effects of LDCT findings and physician counseling on smoking behaviors in both current and former smokers.

A retrospective cohort study was conducted on 763 individuals who underwent national lung cancer screening at the Korean National Cancer Center between 2019 and 2021. Smoking status was assessed at a 2-year follow-up. Multivariable logistic regression was used to assess the association of CT findings and physician counseling with smoking cessation initiation (current smokers) and abstinence maintenance (former smokers).

Among current smokers, higher Lung Imaging Reporting and Data System (Lung-RADS) categories (aOR = 18.84), moderate-to-severe CAC (aOR = 2.18), and emphysema (aOR = 1.95) were significantly associated with increased odds of quitting. Similarly, these findings significantly predicted sustained abstinence in former smokers, with CAC showing a particularly strong effect (aOR = 5.30). Physician counseling independently increased the odds of cessation in current smokers (odds ratio = 2.04) and abstinence maintenance in former smokers (odds ratio = 5.38). The effect of counseling did not significantly differ by the severity of low-dose computed tomography (LDCT) findings.

Incidental smoking-related LDCT findings, particularly CAC and emphysema, are potent predictors of smoking behavior change. Physician counseling further enhances cessation outcomes, underscoring the value of integrating comprehensive counseling based on all relevant radiological findings into screening protocols.

This study demonstrates that incidental smoking-related Low-dose computed tomography findings, such as coronary artery calcification and emphysema, strongly influence both smoking cessation in current smokers and sustained abstinence in former smokers, independent of malignant findings. Physician counseling significantly enhances these behavioral changes regardless of CT result severity. By highlighting the additive value of integrating structured smoking cessation counseling with interpretation of all salient radiological findings, the results support expanding lung cancer screening programs beyond cancer detection to serve as effective interventions for tobacco control, ultimately improving long-term health outcomes.