Chronic smokers are not fully aware of their risk of developing lung cancer, despite their long history of tobacco use. Among those who agree to participate in a lung cancer screening programme, although they take a first step towards improving their health, they tend to underestimate the real risk associated with smoking and require additional support to quit. In fact, nearly 80% would not stop smoking if they received a negative screening result, according to a study conducted 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 Rotterdam, in the Netherlands. The study, the first of its kind conducted in Spain, has been published as a Letter to the Editor in Archivos de Bronconeumología.
The study included 245 individuals invited to participate in the European multicentre lung cancer screening project 4-IN-THE-LUNG-RUN (4ITLR), in which Hospital del Mar and Bellvitge University Hospital are collaborating. Participants had a mean age of 66 years; 88% were current smokers, with an average tobacco exposure of 45 pack-years and a maximum of 177 pack-years. Participants were referred from primary care to undergo a low-dose computed tomography (CT) scan at a healthcare centre. Those selected for the study were at high risk of developing lung cancer, having smoked at least 35 pack-years before undergoing screening.
Low risk perception
Participants completed a seven-item questionnaire after undergoing the diagnostic test and before receiving the results. Survey findings showed that 75% intended to quit smoking. However, when asked whether they would do so if the test result was negative, their answers changed dramatically. In that scenario, almost eight out of ten stated that they would not quit smoking if the screening showed that they did not have lung cancer.
According to Adrià Moncusí, Associate Epidemiologist at the Cancer Prevention and Registry Unit of the Epidemiology and Evaluation Department and researcher at the Hospital del Mar Research Institute (HMRIB) and the Network for Research on Chronicity, Primary Care and Health Promotion (RICAPPS), these findings “reflect that wanting to quit smoking does not necessarily mean being ready 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 final step.”
Overall, participants’ perception of their risk of developing lung cancer was low. Only 35% considered themselves at risk, while 40% disagreed with being classified as a high-risk population. In fact, 62% reported being little or not at all concerned about the possibility of developing the disease. This perception was more pronounced among men than women and was stronger among participants with lower educational attainment.
According to the researchers, this disconnect between objective risk and personal risk perception among people at high risk of lung cancer represents an opportunity to improve risk communication through clear and tailored messages, which are key to strengthening motivation to quit smoking.
One of the study’s main conclusions, highlighted by Dr Xavier Castells, Professor of Public Health at Pompeu Fabra University and researcher at Hospital del Mar, HMRIB and RICAPPS, is the need to strengthen smoking cessation programmes in order to ensure the success of lung cancer screening initiatives. “Lung cancer screening without the systematic integration of strategies to help smokers quit cannot achieve its maximum impact in reducing mortality from this disease,” he states.
In this regard, Dr Roberto Chalela, consultant pulmonologist at Hospital del Mar, points out that “lung cancer screening is not just about performing a CT scan; it is a unique opportunity to coordinate primary care, hospital services and public health efforts to reduce smoking, detect cancer early and appropriately manage the multiple incidental findings commonly observed in heavy smokers. Without this comprehensive and multidisciplinary approach, its real impact on population health remains limited.”
Dr José María Maiques, Head of the Diagnostic Imaging Department at Hospital del Mar, which is part of dibi, the biomedical and imaging diagnostics network, explains that “for radiology professionals, the experience of participating in the lung cancer screening programme has been highly rewarding because of participants’ friendliness and willingness to ensure that the low-dose chest CT scan is successfully completed, even though, paradoxically, many of them do not recognise themselves as belonging to a high-risk population.”
This study was funded by grants from the Catalan Department of Health’s PERIS programme through the project “Evaluation of the capacity of Primary Care to identify and promote participation of at-risk populations in lung cancer screening” (SLT021/21/000044), awarded to the Jordi Gol Primary Care Research Institute (IDIAP Jordi Gol), and by funding from the European Union’s Horizon 2020 programme (4-IN-THE-LUNG-RUN).
Article reference
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.
