Screening Mammography Visits Useful for Smoking Cessation, Lung Cancer Screening Referrals

By Marilynn Larkin

February 06, 2020

NEW YORK (Reuters Health) - Screening mammography visits offer opportunities to engage smokers with tobacco cessation services and, if appropriate, lung cancer screening, a single-center study suggests.

"Smoking cessation is a difficult process for many people and it requires support within the healthcare system and outside the system. Concerted efforts among different healthcare providers that are part of the patient's medical team can assist patients in this process and let them know that whenever they feel ready, we will be there to assist them in any way we can," Dr. Efren Flores of Massachusetts General Hospital (MGH) in Boston told Reuters Health by email.

"Multidisciplinary collaborations among all healthcare members are necessary to provide equitable care that is both sensible to our patient's needs and to the barriers they face in accessing these services," he noted. "Collaborative care integration is necessary to assist patients in overcoming barriers to care, the stigma of smoking, and in the process of quitting."

"Radiologists can contribute to and advance public health initiatives that improve health outcomes for all patients, particularly for underserved populations, by finding novel ways of integrating different touch points of the health care system," he added.

With this in mind, in 2018, two sets of questions were added to the MGH screening mammography intake questionnaire to assess patients' smoking history and interest in referral to the health center-based tobacco cessation program.

As reported in the Journal of the American College of Radiology, Dr. Flores and colleagues analyzed data from the women who responded (89.3%; 1,907 of 2,136), of whom 10.5% were current smokers (mean age, 57.3; 80.6% non-Hispanic white) and 29.1%, former smokers (mean age, 63.9; 84.9% non-Hispanic white).

Among current smokers, 26.4% requested referrals: 23.9% by mail, 8% by in-person counseling, and 7.5% via telephone-based consultation. No sociodemographic characteristics predicted referral requests.

Also among current smokers, 13.4% met the Centers for Medicare and Medicaid Services' age and tobacco use criteria for lung cancer screening, of whom 40.7% were up to date for screening at the time of the mammography visit.

Among former smokers, 7.8% met the criteria, of whom 25.6% were up to date for screening.

Overall, 9.3% of ever smokers met the eligibility criteria, of whom less than a third (31.4%) were up to date for screening.

The authors conclude that screening mammography "presents opportunities for radiology practices to advance public health goals," including tobacco cessation and lung cancer screening.

Dr. Timothy Brennan, Director of the Addiction Institute at Mount Sinai West and Mount Sinai St. Luke's in New York City, commented by email, "The burden of tobacco use disorder in America is profound, and any opportunity to screen for (it) and refer for cessation counselling should be implemented."

"One never knows when someone is ready to change, so screening them during a visit like a mammography is a good idea," he told Reuters Health. "Mammograms are understandably anxiety-provoking as they are screening for cancer, so perhaps this is a uniquely motivating time for tobacco screening."

Nonetheless, he noted, "Questionnaire fatigue is real, and barraging patients with incessant questions about their health history at every visit is bound to lead to false negative and false positive screens, so I think any implementation should be well-designed to engage patients and not add to their stress of the visit."

"One doesn't have to practice addiction medicine to screen for addiction pathology," he added. "Indeed, most patients with addiction disorders never reveal their illness to their primary care doctors, so it is up to us to keep a low index of suspicion and screen people wherever they interact with the health system. The approach in this article is laudable."

SOURCE: Journal of the American College of Radiology, online January 10, 2020.