Integrating Smoking Cessation With Lung Cancer Screening in Aotearoa New Zealand: Equity Considerations and Implications for Policy Development

International evidence increasingly supports integrating smoking cessation services within lung cancer screening programs, yet limited guidance exists for Aotearoa New Zealand, where smoking-related harm and lung cancer disproportionately affect Māori. In this commentary, we summarise literature on smoking cessation interventions delivered alongside lung screening, focusing on intervention modality, intensity, timing and equity implications relevant to a future national program. Evidence from 25 studies and four systematic reviews showed wide variation in reported outcomes, including complete cessation of nicotine use (quitting) and switching from tobacco to less harmful products (switching), reflecting heterogeneity in intervention design and outcome measurement. Overall, intensive, multi-session behavioural support combined with pharmacotherapy achieved higher quit rates than brief advice or single-session interventions, particularly when cessation support was delivered immediately or co-located with screening. Equity considerations were central to the interpretation of the international findings in our review. Māori face structural, systemic and access barriers that limit the effectiveness of standard cessation approaches, highlighting the need for culturally safe, whānau (family)-centred and Māori-led interventions. Integrating intensive smoking cessation support into the lung screening pathway represents a critical opportunity to reduce inequities and improve outcomes for Māori within a future national lung screening program.