Smoking-related stigma as a barrier to participation in lung cancer screening

To synthesise evidence on how smoking-related stigma influences participation in lung cancer screening, including its impact on screening uptake, intention to participate, and healthcare-seeking behaviour among people who currently smoke or formerly smoked. A rapid review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses–informed methodology. Searches were performed in PubMed, Web of Science, and Embase without date restrictions. Eligible studies included qualitative and quantitative research involving adults eligible for, invited to, or targeted for lung cancer screening. Smoking-related stigma was conceptualised as perceived, internalised, anticipated, and structural stigma. Data were extracted and synthesised using a structured narrative approach. Forty-four studies were included. Smoking-related stigma was frequently described as a potential barrier to lung cancer screening participation, particularly in qualitative studies. Quantitative findings were more heterogeneous, with some studies reporting weak or nonsignificant associations, operating through psychological (eg, shame, guilt, and self-blame), social (eg, anticipated judgement), and structural mechanisms (eg, eligibility criteria emphasising smoking history). Stigma was associated with reduced intention to participate, avoidance of screening, and delayed healthcare-seeking. Variations appeared to be influenced by study design, population characteristics, and measurement approaches. While smoking-related stigma may be a relevant and potentially modifiable barrier to lung cancer screening participation, the current evidence remains heterogeneous. Future studies using standardised stigma measures and longitudinal designs are needed to clarify the extent to which stigma independently influences screening uptake. Addressing stigma through empathetic, nonjudgemental communication, careful framing of screening programmes and system-level interventions may improve engagement with lung cancer screening.