CHAPEL HILL, N.C., Oct. 20, 2025 - A new multi-site study, published in JAMA, co-led by researchers at the UNC Lineberger Comprehensive Cancer Center and Wake Forest University School of Medicine has demonstrated that a direct-to-patient digital health program can significantly increase recommended lung cancer screening for high-risk individuals.
Lung cancer is the leading cause of cancer-related death in the United States, yet only about 20% of eligible individuals undergo recommended screening even though early detection through screening can reduce the risk of lung cancer death, according to the National Cancer Institute.
Barriers to screening include challenges identifying screening-eligible patients, which requires assessing lifetime smoking exposure. Other barriers include limited awareness of screening recommendations among patients and providers as well as insufficient time for recommended counseling and shared decision-making about screening during regular primary care visits.

Daniel S. Reuland, MD, MPH
"We wanted to see if we could overcome these barriers by reaching out to potentially eligible patients with an interactive digital program outside the usual outpatient visits," said Daniel S. Reuland, MD, MPH, professor of medicine at the UNC School of Medicine and UNC site lead for the study. "The goal was to help patients find out if they were eligible for screening and make an informed decision about screening. We also wanted to give eligible patients a way to connect with the specialized lung cancer screening program within the health system."
The randomized clinical trial enrolled 1,333 screening-eligible individuals with a history of smoking. Intervention participants were assigned to the mPATH-Lung online program, which included a brief educational video, decision aid, and option to request a screening program appointment. Control participants received a recommendation to discuss screening with their primary care clinician.
Key Findings:
- At 16 weeks, 25% of participants using mPATH-Lung completed a screening CT scan, compared to 17% in the control group.
- Screening rates improved across all demographic and socioeconomic groups.
- No complications were reported from screening-related procedures.
"This study shows that this kind of digital outreach using the EHR portal or text messaging is a scalable way to make an impact on screening that can complement the care provided in regular face-to-face primary care visits," said Alison Brenner, PhD, associate professor of general medicine and clinical epidemiology at the UNC School of Medicine and co-author on the study. "We saw improvements across the board, including among populations that have historically faced disparities in access to screening."
"We're proud to be part of a team that's translating research into real-world solutions for patients across North Carolina and beyond," said Reuland.