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29/05/2026 - Events

Chronic smokers are not prepared to quit smoking

• A study published in Archivos de Bronconeumologia highlights that three out of four people selected to participate in a lung cancer screening programme because they were at high risk of developing the disease want to quit smoking, but almost 80% rule out quitting if the test result is negative. This shows that the intention to give up the habit does not mean being prepared to do so.
• They also have a low perception of their risk of developing lung cancer, and 40% do not agree with being considered people at risk of this disease.
• The work highlights the importance of combining smoking cessation programmes with population screening, so that screening can reach its full potential to reduce lung cancer mortality.

Chronic smokers are not fully aware of their risk of developing lung cancer, despite their long history of tobacco use. Those who accept participation in a lung cancer screening programme take a first step towards caring for their health, but they underestimate the real risk associated with their habit and need additional support to stop smoking. In fact, almost 80% rule out quitting smoking if they receive a negative screening result, according to a study carried out by researchers from Hospital del Mar, the Jordi Gol Primary Care Research Institute (IDIAPJGol), the Bellvitge Biomedical Research Institute (IDIBELL), and Erasmus MC-University Medical Center in Rotterdam, the Netherlands. The work, the first of its kind carried out in Spain, has been published as a letter to the editor in the journal Archivos de Bronconeumología.

The study selected 245 people invited to take part in the European multicentre 4-IN-THE-LUNG-RUN (4ITLR) lung cancer screening project, in which Hospital del Mar and Bellvitge Hospital collaborate. Their average age was 66 years, with 88% smokers and an average tobacco consumption of 45 pack-years, with a maximum of 177 pack-years. Project participants are referred from primary care to undergo a follow-up CT scan (computed tomography) at a healthcare centre. The people selected for the study had a high risk of developing lung cancer, with tobacco consumption of at least 35 pack-years, before undergoing screening.

Xavier Castells, Roberto Chalela, Jose Maria Maiques, Adria Moncusi, Maria Sala and Andrea Buron.

Low risk perception

Participants completed a seven-item questionnaire after undergoing the diagnostic test and before receiving the result. The survey results show that 75% intended to quit smoking, but when asked whether they would do so if the test result was negative, the answer changed drastically. In this case, almost 8 out of 10 said that if the test showed they did not have lung cancer, they would not give up tobacco. According to Adrià Moncusí, associate epidemiologist in the Cancer Prevention and Registry Unit of the Epidemiology and Evaluation Department and researcher at Hospital del Mar Research Institute (HMRIB) and the Network for Research in Chronicity, Primary Care and Health Promotion (RICAPPS), these results "show that wanting to stop smoking does not mean being prepared to do so, either because a negative result is interpreted as permission to continue smoking, or because long-term nicotine dependence makes it difficult to take the step".

Overall, participants' perception of their risk of developing lung cancer was low. Only 35% considered themselves at risk, while 40% disagreed with being considered at-risk individuals. In fact, 62% were little or not at all concerned about the possibility of developing the disease. This perception was more marked among men than among women and was heightened among people with a lower level of education. According to the researchers, this disconnect between objective risk and personal perception among people at high risk of developing lung cancer is an opportunity to improve risk communication in a clear way adapted to each profile, which is key to strengthening their motivation to quit smoking.

One of the points highlighted by Dr Xavier Castells, Professor of Public Health at Pompeu Fabra University and researcher at Hospital del Mar, HMRIB and RICAPPS, from the study conclusions is that smoking cessation programmes must be strengthened to ensure the success of screening programmes. "Lung cancer screening without the systematic integration of strategies to help smokers quit tobacco cannot achieve its maximum impact in reducing mortality from this disease", he says.

In this regard, Dr Roberto Chalela, attending physician in the Pneumology Department at Hospital del Mar, notes that "lung cancer screening is not just about carrying out a CT scan; it is a unique opportunity to coordinate primary care, hospital care and public health to reduce tobacco use, detect cancer early and properly address the multiple incidental findings that heavy smokers accumulate. Without this comprehensive and multidisciplinary approach, its real impact on population health remains limited". Dr Jose María Maiques, head of the Diagnostic Imaging Department at Hospital del Mar, integrated into dibi, the biomedical and imaging diagnostics network, explains that "for radiology service professionals, the experience with the lung cancer screening programme has been very gratifying, because of the cordiality and willingness of people to ensure that the low-dose chest CT scan goes well, even though paradoxically they do not later recognise themselves as an at-risk population".

This work is funded by grants from the Department of Health-PERIS, project 'Assessment of the capacity of Primary Care to identify and encourage the participation of the at-risk population in lung cancer screening' (SLT021/21/000044), from the Jordi Gol University Institute for Research in Primary Care (IDIAP Jordi Gol), and by European Union Horizon 2020 grants (4-IN-THE-LUNG-RUN).

Reference article

Moncusí A, Burón A, Lugon G, Macià F, Cabrera-Godoy MO, Espinàs JA, Chalela R, Marzo-Castillejo M, Maiques JM, Sala M, van der Aalst CM, Castells X. Risk Perception and Intention to Quit Smoking Among High-Risk Participants Enrolled in a European Lung Cancer Screening Trial in Spain. Arch Bronconeumol. 2026 Apr 26:S0300-2896(26)00165-1. English, Spanish. doi: 10.1016/j.arbres.2026.04.013. Epub ahead of print. PMID: 42106283.

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