The National Lung Screening Trial has achieved a 7% reduction in total mortality with low-dose computed tomography (LDCT) screening as compared with in the chest radiography arm. Other randomized trials are under way, comparing LDCT screening with no intervention. None of these studies was designed to investigate the impact of smoking habits on screening outcome. In the present study, we tested the effect of stopping smoking on the overall mortality of participants undergoing repeated LDCT screening for many years. Between 2000 and 2010, 3381 smokers aged 50 years or older were enrolled in two LDCT screening programs. On the basis of the last follow-up information, subjects were divided into two groups: current smokers throughout the screening period and former smokers. With a median follow-up time of 9.7 years and a total of 32,857 person-years (PYs) of follow-up, a total of 151 deaths were observed in the group of 1797 current smokers (17,846 PYs) versus 109 among 1584 former smokers (15,011 PYs), corresponding to mortality rates of 8.46 and 7.26 for every 1000 PYs, respectively. Compared with current smokers, former smokers had an adjusted mortality hazard ratio of 0.61 (95% confidence interval: 0.44-0.83), with a 39% reduction in mortality. A similar reduction in mortality was observed in the subset of 712 late quitters, with a hazard ratio of 0.65 (95% confidence interval: 0.44-0.96). Stopping smoking significantly reduces the overall mortality of smokers enrolled in LDCT screening programs. The beneficial effect of stopping smoking on total mortality appears to be threefold to fivefold greater than the one achieved by earlier detection in the National Lung Screening Trial.

Electronic cigarettes may be safer than conventional cigarettes as they generate less indoor pollution in terms of particulate matter (PM); however, recent findings in experimental conditions demonstrated that secondhand exposure to PM may be expected from e-cigarette smoking. The aim of the present study was to investigate the emission of PM generated by e-cigarettes and normal cigarettes under real-life conditions. Real-time measurement and comparison of PM and ultrafine particles (UFP) generated by electronic cigarettes with and without nicotine and by normal cigarettes in a 50 m³ office of an Italian comprehensive cancer center was performed. PM mass as PM1, PM2.5, PM7, PM10, total suspended particles (TSP) in μg/m³ and UFP in number of particles per cubic centimeter from 10 to 1,000 nanometers were measured. Outdoor concentrations were measured contemporaneously to compensate for urban background changes. Regardless of their nicotine content, e-cigarettes generated lower PM levels than conventional cigarettes. Notably, nicotine-enriched e-cigarettes produced lower PM levels than their nicotine-free counterparts. E-cigarettes appear to generate less indoor pollution than normal cigarettes and may therefore be safer. Further studies are required to investigate the long-term health-related effects of secondhand e-cigarette exposure.

Aims and Background: The time of lung cancer screening may provide the ideal setting to discuss and initiate a smoking cessation plan that includes pharmacologic aids. No studies to date have fully investigated the potential effectiveness of such combined approach. Methods: We prospectively evaluated the biochemically verified 1-year continuous abstinence rate from smoking of 187 persistent smokers enrolled within the Multicentric Italian Lung Detection Trial (MILD), who received a pharmacologic aid to quit smoking with varenicline along with behavioral counseling. The propensity of study subjects to succeed in smoking cessation was also monitored. Results: At 12 months, the continuous abstinence rate from smoking was achieved in 37 out of 187 patients (19.8%), with a propensity to succeed in smoking cessation for the assisted attempt equal to 1.43, as compared to an unassisted MILD patient. At the end of the third month of therapy, 48.7% of subjects showed a continuous abstinence rate, while only 33.7% of patients were abstinent from smoking at 6 months. At baseline, the subgroup of MILD participants who were originally allocated to lung tomography showed higher smoking intensity than those allocated to no screening. Conclusions: A combined smoking cessation intervention can be implemented with satisfactory results within a lung cancer screening program; this preliminary observation needs to be replicated in a prospective investigation. Clinicians should consider that lung cancer screening may be falsely reassuring for persistent smokers; therefore it should always be coupled with a smoking cessation program.

Purpose: Tobacco control guidelines recommend all healthcare professionals to ask patients about their smoking status and to offer them at least minimal cessation advice. However, few data are available about the daily practice of hospital clinicians who work with smoking cancer patients. This study assesses, in a comprehensive cancer center, the physicians’ smoking habit, their clinical practice in offering a smoking cessation intervention to patients who smoke, and the training they received in this field. Methods: A Web-based survey was sent to 285 physicians. Results: The survey response rate was 75%. Sixty-two percent, 24%, and 14% of responders were never, former, and current smokers, respectively. Six percent of all responding physicians have already participated in smoking cessation training and 43% of them declared their willingness to be trained. Eighty-six percent of all responding physicians asked about the patients’ smoking status, 50% routinely advised patients to quit smoking, and 32% assessed their motivation to do so. Smoking cessation guidelines were not followed mostly for lack of time, fear to increase patients’ stress, and lack of smoking cessation training. Ninety-four percent of responding physicians knew the smoking cessation service for outpatients and 65% referred at least one patient, 66% of responding physicians knew the service for inpatients, and 36% of them asked for at least one intervention in the ward. Conclusions: This study pointed out partial adherence of the physicians working in a leading cancer center to the smoking cessation guidelines. The clinicians’ smoking habits did not influence the training and the clinical practice in offering patients smoking cessation interventions.

Second-hand smoke (SHS) may be significantly elevated outdoors and when adjacent to smoking areas [1, 2]. This is of concern as SHS exposure is linked to adverse health outcomes, including respiratory disorders, cardiovascular diseases, and lung cancer [3–5]. Exposure to cancer-causing chemicals in outdoor areas is likely to occur in the presence of cigarette smoke [6], and worryingly, short periods of exposure to SHS are related to detectable levels of carcinogenic tobacco-specific nitrosamines in nonsmoking subjects [7]. Air quality is worse in a pedestrian area frequented by smokers compared with a high-traffic zone We wish to dedicate this work to Giovanni Invernizzi who strongly contributed to this study before he passed away.