# Every lung screening visit includes stop-smoking medicine, opt-out

Source: https://onco.cc/ideas/idea-prev-opt-out-cessation-in-lung-screening/  
OnCo record `idea-prev-opt-out-cessation-in-lung-screening` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Lung screening is a teachable moment. Giving cessation medicine and support by default at every scan, unless the person opts out, roughly doubles quit rates.

## Summary

Lung screening is a teachable moment, so this idea makes opt-out cessation pharmacotherapy, varenicline or cytisine, plus counselling a programme standard at every low-dose CT visit, with quit rate as a headline performance indicator. Opt-out cessation in screening programmes such as the YESS trial improves quit rates, cessation delivers more life-years than the scan itself in modelling, and the population is captive. The aim is to roughly double biochemically verified quit rates among screened smokers at one year. The test is a programme-level comparison plus an RCT of opt-out versus opt-in delivery. Being tested at scale, it addresses the bottleneck Prevention we already have is not deployed and links to smoking cessation in cancer patients.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Opt-out embedded cessation increases 12-month biochemically verified quit rates among screened smokers from about 10% to at least 20%.
- Rationale: Cessation delivers more life-years than the scan itself in modelling, and the population is captive.
- Proposed test: Programme-level comparison plus an RCT of opt-out versus opt-in delivery.
- Maturity: being-tested-at-scale
- Actor: clinic

## Sources

- Bottleneck evidence (Prevention we already have is not deployed): Islami et al., Proportion of cancer attributable to modifiable risk factors (CA 2018): https://doi.org/10.3322/caac.21440

## Connected records

- cancers: [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- fronts: [Early Detection & Screening](https://onco.cc/fronts/early-detection/), [Prevention & Risk](https://onco.cc/fronts/prevention/)
- technologies: [CT (computed tomography)](https://onco.cc/technologies/ct/), [Smoking cessation in cancer patients](https://onco.cc/technologies/smoking-cessation-after-diagnosis/)
- bottlenecks: [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/)
- key papers: [Fifty years of the British Doctors Study: smokers lose ten years of life, quitting gives most of it back](https://onco.cc/key-papers/paper-doll-peto-50-year-doctors-bmj-2004/), [Proportion and number of cancer cases and deaths attributable to potentially modifiable risk factors in the United States](https://onco.cc/key-papers/paper-islami-ca-cancer-j-clin/)

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