Opportunities and Challenges in Tobacco Treatment
Mené aux Etats-Unis sur 3 220 fumeurs actifs résidant en zone rurale ou issus d'un milieu socio-économique défavorisé et orientés vers un dépistage du cancer du poumon par tomodensitométrie (âge médian : 61,1 ans ; 60,3 % de femmes), cet essai randomisé multicentrique compare l'efficacité de quatre stratégies pour favoriser le sevrage tabagique (soins et conseils habituels seuls ou associés à un substitut nicotinique gratuit, des incitations financières et/ou un outil de planification par SMS)
Evidence-based treatments and comprehensive tobacco control policies have driven a marked decline in cigarette smoking among US adults over time. Approximately 25 million adults in the US continue to smoke, a prevalence of 9.9%. The declines in cigarette smoking have not been evenly distributed, with higher smoking rates, reduced access to cessation support, and higher tobacco-related mortality among individuals with lower socioeconomic status, certain racial and ethnic minority populations, and those with mental health and/or substance use disorders.Lung cancer screening with low-dose computed tomography for high-risk individuals (aged 50-80 years with at least a 20 pack-year smoking history who currently smoke or quit within the past 15 years) has emerged as a cornerstone of cancer prevention, reducing lung cancer mortality by approximately 20% to 25% among screening-eligible individuals. Lung cancer screening also provides a critical opportunity to deliver evidence-based tobacco treatment, and the full potential of lung cancer screening depends not only on early detection, but on whether it also promotes sustained smoking cessation. Approximately 50% to 60% of individuals who undergo lung cancer screening regularly smoke at the time of screening and many continue to smoke afterward, underscoring lung cancer screening as a key opportunity to engage patients in tobacco treatment. Smoking cessation further enhances the lifesaving effects of lung cancer screening, with modeling studies demonstrating that even modest increases in abstinence can substantially reduce lung cancer mortality and yield large gains in life expectancy compared with lung cancer screening alone.
JAMA , éditorial, 2026