Over 80% of lung cancer cases are associated with smoking and other risk factors, such as air pollution, workplace exposure and ionising radiation. Stopping people from being exposed to these risk factors can help to prevent lung cancer.
Helping people to stop smoking
NICE's first public health guideline, published in 2006, was on brief interventions and referrals for people who smoke. Since then we've published a suite of guidance and advice on smoking, covering interventions and strategies to prevent childen and young people from taking up smoking, how to reduce harm from tobacco and how to help people who already smoke to quit. More recently we've published guidance on outdoor air quality, recommending a number of actions to reduce pollution from road traffic.
Smoking prevalence began to decline in the 1970s and has continued to do so. Smoking rates are highest among the most disadvantaged communities. In 2018, over a quarter of people in routine and manual occupations reported that they are current smokers, while just over 10% of people in professional and managerial roles smoked.
The NICE quality standard on smoking: supporting people to stop states that healthcare practitioners should ask people if they smoke and offer advice on how to stop for those who do smoke. In 2016, 73% of people seen in secondary care were asked if they smoked by a healthcare practitioner, according to an audit report on smoking cessation from the British Thoracic Society (BTS). However only 28% of people who smoked were asked if they’d like to quit and only 6% of people who smoked received advice on how to stop.
The picture in primary care is more promising. Data from NHS Digital’s Quality and Outcomes Framework (QOF) show a steady increase in offers of support and treatment to current smokers. In 2018, almost 90% of smokers aged 15 or over who are registered with a GP had a record of an offer of support or treatment.
To support people to quit smoking the quality standard also says that people should be offered a referral to an evidence‑based smoking cessation service. These services increase the likelihood that someone will quit smoking. In 2018 just over a third of all people who set a quit date through NHS stop smoking services successfully quit, as confirmed with carbon monoxide validation. This quit rate has remained steady over the last 4 years.
Reducing air pollution
Air pollution is associated with around 8% of all lung cancers. Outdoor air pollution is a mixture of man-made pollutants, such as vehicle fumes, and natural substances like wind-blown dust. The International Agency for Research on Cancer (IARC) has linked tiny particles in the air to lung cancer, though it is not yet fully understood how these particles cause cancer.
The NHS Long Term Plan (LTP) outlines plans to reduce air pollution produced by the NHS, aiming for a 20% reduction in business mileage and fleet air pollutant emissions by 2023/24. The LTP adds that the overall reduction in air pollution is the responsibility of local government.
NICE’s guideline on outdoor air pollution and quality standard on outdoor air pollution cover road-traffic-related air pollution and its links to ill health. They make recommendations that will improve air quality through reduced emissions and initiatives such as clean air zones, with the aim of preventing a range of health conditions and deaths.
The Ottawa Model for Smoking Cessation has been implemented in 120 hospitals across Canada. It identifies the smoking status of all admitted patients, followed by brief advice, personalised bedside counselling, timely nicotine replacement therapy and/or pharmacotherapy, and follow-up after discharge.
It improves long-term quit rates by 11%. The Royal College of Physicians has modelled the impact of implementing the Ottawa Model for Smoking Cessation intervention within the NHS, and the NHS Long Term Plan has adopted this model.