BACKGROUND-AIM:
The CCM-ITALUNG2 pilot was implemented in 2022-2024 to evaluate the feasibility of an organized two-round low-dose CT (LDCT) lung cancer screening program offered in combination with smoking cessation (SC) in five Italian centres (Florence, Pisa, Massa, Milan, and Turin).

METHODS:
Within the screening pathway, recruitment included delivering SC brief advice, and possible referral to local Smoking Cessation Services (SCSs). Actual participation to SCSs programs was recorded, and a survey on smoking status was carried out to all current smokers at recruitment, after 6 months from the second-round LDCT.

RESULTS:
1144 individuals were recruited using different strategies, including in-person invitation by general practitioners (GPs; 32%) or other healthcare personnel (O(;)HPs; 18%), self-presentation (36%), phone invitation using GPs’ patient lists (14%). Participants invited by GPs, compared to self-presented, were more likely to report lower education level (53% vs. 25%, p < 0.001), and co-morbidity (27% vs. 14%, p < 0.001). During recruitment sessions, SC brief advice was administered to almost all current smokers (N=1,004); 37% accepted referral to SCSs, and 20% actually attended SCSs quitting smoking programs. Individuals referred to SCSs were more likely to come from the Pisa, Massa, and Florence Centers (adjusted Odds Ratio [AOR]= 6.81;p<0.01; 55% vs. 24%), and to be recruited by face-to-face invitation (AOR=2.38;p<0.01; 56% vs. 34%). Self-presented and individuals invited by oHPs were more likely to attend SCSs programs (AOR=3.52; p<0.001; 65% vs.34%), and to come from Pisa, Milan, and Turin Centres (AOR=13.15; p<0.001; 74% vs. 19%). Programs at SCSs were administered through individual (72%) or group sessions (22%); 66% of participants received SC drugs (among them, 87% cytisine). Most participants received SC leaflets and were invited to visit a SC website developed for the pilot (http://www.liberodalfumo.it/). At the end of the study, 792 out of 1004 current smokers (79%) were interviewed to report their smoking status after two screening rounds. In an intention-to-treat analysis, 160 (16%) reported to be continuously abstinent to nicotine (i.e., former smokers). They were more likely to have the highest education level (AOR=1.86; p=0.011; 21% vs. 14%), and an indeterminate or a true positive baseline LDCT (respectively, AOR=1.63; p=0.028; 22% vs. 15%; AOR=2.97; p=0.051¸31% vs. 15%). Among the 160 quitters, 68 (43%) reported to have quitted through SCSs programs, and 9% for LDCT results or anxiety due to having a LDCT scan.

CONCLUSIONS:
Delivering SC brief advice during recruitment and offering SCS referral were feasible within the screening pathway. Invitation strategies influenced SCSs referral and actual participation to SCSs programs. At the end of the study, in addition to the 18 participants with lung cancer (1.6%) that were diagnosed through the baseline LDCT, 160 current smokers (16%) became continuously abstinent to nicotine.