A digital outreach program for lung cancer screening reached 11% of eligible individuals in a North Carolina study, but disparities in engagement persist, according to research published in the Journal of General Internal Medicine.
The study, led by researchers at Wake Forest University and the University of North Carolina at Chapel Hill, evaluated a fully automated digital health intervention called mPATH-Lung. Of 26,909 individuals invited to complete eligibility questions via their electronic patient portal, only 3,049—about 11%—did so within 16 weeks.
The study, titled Using Digital Outreach to Identify Individuals Eligible for Lung Cancer Screening: A Secondary Analysis of a Randomized Trial, was conducted by Bundy, R., and published in the Journal of General Internal Medicine. It builds on findings from a parent trial (NCT04083859) that demonstrated digital health interventions increased lung cancer screening rates. The new analysis focused on how many people such outreach strategies actually reach and who is excluded.
Disparities in Digital Outreach
Older adults, rural residents, and individuals with lower socioeconomic status were less likely to engage with the digital program. For example, 12.8% of white participants completed the eligibility questions, compared to 8.6% of Black participants and 8.0% of Hispanic individuals. Urban residents and those with commercial insurance also showed higher engagement than their rural or low-income counterparts.
These gaps underscore a paradox: while digital tools offer scalable solutions, they risk exacerbating existing health inequities. Technology alone will not deliver equitable access,
the study authors wrote, advocating for hybrid approaches that combine automated systems with human support, community partnerships, and offline channels.
The findings align with broader trends highlighted in the 2026 Annual Report to the Nation on the Status of Cancer, a collaborative effort among the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), the American Cancer Society, and the North American Association of Central Cancer Registries (NAACCR). The report noted that cancer death rates fell for both men and women from 2019 to 2023, driven largely by progress against lung cancer, which remains the leading cause of cancer death in the U.S.
According to the report, lung cancer is the second most common cancer in both men and women and the leading cause of cancer death globally, with 1.9 million deaths in 2024. The International Agency for Research on Cancer (IARC) emphasized that primary prevention, particularly tobacco control, is the most effective way to reduce lung cancer risk. Screening with low-dose computed tomography (LDCT) has also been shown to reduce mortality by detecting the disease at an earlier stage.
Broader Context and Expert Insights
James Fan Wu, a hematology oncology fellow at the Medical College of Wisconsin, highlighted similar challenges at the ASCO Quality Care Symposium. He noted that in North Carolina, 12% to 17% of eligible adults undergo screening, depending on data sources. A safety-net program serving predominantly Black and Hispanic patients with incomes under $15,000 achieved 85% annual adherence, suggesting that tailored programs can improve outcomes.
Wu emphasized that the bottleneck lies in identifying eligible patients rather than their willingness to screen. We don’t reliably know who is eligible,
he said, citing electronic records that missed a third of self-reported eligible individuals. He called for better smoking and risk data to refine eligibility criteria and expand screening to non-smokers.
These insights reflect findings from a 2026 IARC review, which concluded that LDCT screening reduces lung cancer mortality and late-stage incidence. The review, part of the IARC Handbooks of Cancer Prevention, was published in The New England Journal of Medicine on 24 September 2026. The study, led by Neamtiu L, Callister MEJ, Crosbie P, and others, analyzed global data to assess the benefits and harms of screening strategies.
Other research presented at the ASCO symposium revealed systemic barriers to screening. For example, 87% of missed screenings among breast cancer survivors were never ordered or completed, with few refusals. A separate study found that 15% of participants in the PATHFINDER 2 trial were up to date with low-dose CT screening at enrollment, with 20% achieving this a year later.
What’s Next for Screening Programs
The North Carolina study demonstrates that digital outreach can engage large groups quickly but also reveals the need for multi-channel strategies. Future efforts may prioritize text messaging as a primary tool, given its universal reach, alongside community-based support systems and offline support. Researchers stress that closing equity gaps requires not just technological innovation but systemic changes to ensure no high-risk individual is left behind.
The CDC’s 2026 Annual Report to the Nation also emphasized the importance of early detection and treatment. It noted that while cancer death rates have declined for over 20 years, lung cancer remains a critical focus. The report examined trends in new U.S. cancer cases from 2003 to 2022 and deaths from 2004 to 2023, highlighting the need for continued investment in screening and prevention initiatives.
Experts agree that refining eligibility criteria is essential. Current guidelines rely on smoking history, but emerging research suggests expanding screening to non-smokers and those with other risk factors. The IARC’s upcoming Volume 21 of the Handbooks of Cancer Prevention will include detailed assessments of these approaches, providing a framework for policymakers and clinicians.
For individuals, the takeaway is clear: while digital tools can expand access, they are not a panacea. Readers should consult qualified healthcare professionals to determine their eligibility for lung cancer screening and explore strategies tailored to their needs. As the CDC and IARC emphasize, addressing disparities requires a multifaceted approach that combines technology, policy, and community engagement.