Smoking habits, smoking cessation, and stigma in a population-based lung cancer screening pilot study in Belgium: a focus group study

Lung cancer screening with low-dose computed tomography (LDCT) can reduce lung cancer mortality, but implementation depends on understanding how individuals at increased risk experience screening, smoking cessation and stigma. This study explored smoking habits, cessation experiences and smoking-related stigma within a population-based lung cancer screening pilot in Flanders, Belgium. A qualitative focus group study was embedded in the ZORALCS study, a population-based lung cancer screening pilot in the South-East Region of Antwerp. Adults aged 55–74 years with different smoking histories and screening experiences were purposively recruited. Seven focus groups were conducted between November 2025 and January 2026. Discussions were audio-recorded, transcribed verbatim and analysed using the Qualitative Analysis Guide of Leuven, combining deductive and inductive coding. Thirty-eight participants took part; 71% were men, the median age was 66 years, and 45% had a low educational level. A small number of participants linked screening or a pulmonary finding to renewed reflection on stopping smoking. Most accounts concerned broader experiences of dependence, routines, stress and social context that were not specific to screening. Participants described smoking cessation as fragile and strongly influenced by routines, stress, alcohol use, social environments and relapse risk. They distinguished between stopping and not starting again, with long-term abstinence perceived as the greater challenge. Participants also described smoking-related stigma, both as a lived experience among participants with a current or past smoking history and as explicit judgement expressed by others. The findings indicate that flexible, repeated and non-judgemental cessation support may be relevant within lung cancer screening programmes. Further research should determine how such support can best be tailored and implemented.