TOPLINE

Among 13,000 cigarette smokers screened for lung cancer, 511 also regularly used cigars, pipes, or cigarillos. The 5-year cumulative incidence of lung cancer in people who currently smoked both types of tobacco products was 8.85%, and adding these tobacco products to risk calculations made 8.2% of users newly eligible for screening under the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial 2012 (PLCOm2012) criteria.

METHODOLOGY

• Researchers analysed data from SUMMIT, a prospective cohort study of a low-dose CT screening service in London, involving 13,000 participants aged 55-77 years who were current or former cigarette smokers.
• Participants were eligible if either they met the US Preventive Services Task Force 2013 criteria (ie, ≥ 30 pack-year history and quit within 15 years if former smokers) or they had a PLCOm2012 risk estimate of at least 1.3%, with eligibility initially depending only on cigarette consumption.
• Investigators evaluated the impact of regular cigar, cigarillo, and pipe smoking (defined as at least once per week) on the risk for lung cancer and screening eligibility by recalculating PLCOm2012 and Liverpool Lung Project version 2 (LLPv2) risk scores to include these tobacco products.
• Overall, 2299 (17.7%) participants were ever smokers of cigars or cigarillos, 681 (5.2%) were ever smokers of pipes, and 12,489 (96.1%) were never smokers of any of these types and only smoked cigarettes. The median follow-up duration was 64 months, during which 654 participants were diagnosed with lung cancer.

TAKEAWAY

• Current cigarette smokers who also currently smoked cigars, cigarillos, or pipes had a higher risk for lung cancer than current cigarette-only smokers (adjusted hazard ratio [aHR], 1.58; 5-year incidence of lung cancer, 8.85% vs 5.74%).
• Among 511 regular users of cigars, cigarillos, or pipes, 42 (8.2%) had PLCOm2012 risk values that changed from below to above the screening eligibility threshold when these products were included (P < .001), representing 11.1% (41/368) of former cigarette smokers. Using LLPv2, 3 of 511 participants (0.6%) crossed the screening eligibility threshold after adding these products.
• The inclusion of cigars, cigarillos, and pipes in risk estimation increased the mean 6-year PLCOm2012 risk by 16% (from 4.5% to 5.2%) and the mean 5-year LLPv2 risk by 8% (from 12.0% to 13.0%) among users of these products.
• Former cigarette smokers who were current or former users of cigars, cigarillos, or pipes had a lower risk than current cigarette-only smokers (aHR, 0.51 and 0.40, respectively); however, all groups had a substantially higher incidence than expected for never smokers.

IN PRACTICE

"Our contemporary cohort study confirms older evidence that cigarette smokers who also use cigars, cigarillos or pipes have a substantial risk of lung cancer. Importantly, we demonstrate that ignoring these other tobacco products when considering a person's risk can make some ineligible for lung cancer screening. Those involved in delivering organised population screening must consider the tobacco habits of the target group and incorporate other known harmful tobacco products, not cigarettes alone, when estimating total exposure, as already intended in the UK lung cancer screening programme," the authors of the study wrote.

SOURCE

The study was led by Simran Vaja, Cancer Research UK and University College London Cancer Trials Centre, University College London, London, England. It was published online on August 07, 2026, in the British Journal of Cancer.

LIMITATIONS

The cohort included people already eligible for screening, so the effect may be different in broader primary care populations. Only 24 lung cancers occurred among regular users of cigars, cigarillos, or pipes, so some estimates were imprecise. Very few women used these products, so sex-specific conclusions were limited. Cigars and pipes were converted into cigarette equivalents, which may not have fully captured real exposure.

DISCLOSURES

University College London and University College London Hospital received funding for the SUMMIT study from GRAIL. Several authors reported receiving consulting fees or honoraria and having other ties with various sources including GRAIL. Full disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.