WINSTON-SALEM, N.C., Oct. 20, 2025 —  A new study led by researchers at Wake Forest University School of Medicine, in collaboration with the University of North Carolina at Chapel Hill and MD Anderson Cancer Center, has found that a direct-to-patient digital health program can significantly increase lung cancer screening rates among people at high risk. 

The findings appear online today in JAMA. 

Lung cancer is the leading cause of cancer death worldwide, but early detection through screening can improve outcomes and save lives. Despite this, less than 20% of eligible Americans are screened for lung cancer each year. Barriers include lack of awareness, confusion about guidelines and limited time for shared decision-making during doctor visits.  

“Our goal was to address these barriers by testing a digital program that reaches patients directly, outside of traditional clinical encounters,” said David P. Miller, M.D., professor of implementation science in the Division of Public Health Sciences at Wake Forest University School of Medicine and corresponding author of the study. 

Researchers conducted a randomized clinical trial at two large academic health systems in North Carolina. Over 26,000 individuals with a history of smoking were invited to participate. Those eligible were randomly assigned to either the new digital health program (mPATH-Lung) or to enhanced usual care.  

The enhanced usual care group received a message letting them know they were eligible for lung cancer screening and were encouraged to talk with their primary care doctor about it. They also watched a short video about lung health. This approach provided more information and support than what patients might typically receive but did not include mPATH-Lung. 

The mPATH-Lung program included a brief educational video, a decision aid and the option to request a screening appointment, all delivered online, outside of a clinic visit. The main outcome measured was whether participants completed a chest CT scan for lung cancer screening within 16 weeks. 

Key Findings 

• 24.5% of participants using the digital program completed a screening CT scan, compared to 17% in the usual care group. 

• The program increased screening rates across all demographic and socioeconomic groups. 

• The digital approach allowed patients to learn about screening, weigh the benefits and risks, and easily request appointments. 

• There were no complications from screening-related procedures in either group 

“Our study shows that reaching patients directly with digital tools can help overcome barriers to lung cancer screening and potentially save lives,” Miller said. “By empowering individuals with information and easy access to screening, we can make a real difference in early detection of lung cancer.” 

According to Miller, the findings demonstrate that digital health interventions can modestly but meaningfully increase lung cancer screening rates, even among groups that have historically faced barriers to care. Early detection is crucial, as patients diagnosed at an early stage have much higher survival rates. The study’s approach could be adapted to other preventive health services, helping more people benefit from life-saving screenings. 

The researchers noted that further studies are needed to test digital lung cancer screening programs in a wider range of health care settings and populations. Future research will also explore the best ways to keep patients engaged with digital health tools over time. 

To extend the impact of this work, Miller and co-investigator Ajay Dharod, M.D., associate professor of internal medicine, launched mPATH Health, a startup spun out of Wake Forest University School of Medicine, to make the program widely available and improve lung cancer screening and other preventive care needs. This effort reflects Advocate Health’s academic learning health system model, which emphasizes translating research into real-world solutions that benefit as many people as possible. 

Miller, Dharod and Wake Forest University Health Sciences have ownership interest in the mPATH technology used to conduct this research. 

This research was supported by National Cancer Institute under grant R01CA237240. The project described used the Data and Design Services of the Wake Forest Clinical and Translational Science Institute, which is supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), through award UM1TR004929. Additional funding was provided by the University Cancer Research Fund of the University of North Carolina at Chapel Hill Lineberger Comprehensive Cancer Center. The project also used services from the North Carolina Translational and Clinical Sciences Institute funded by NCATS through award UM1TR004406. 

Journal

JAMA

Funder

NIH/National Cancer Institute

DOI

10.1001/jama.2025.17281

Lung cancer remains a leading cause of cancer mortality worldwide, often due to its late diagnosis and rapid progression. Conventional screening models, notably those endorsed by national health agencies, emphasize targeted screening based on heavy smoking history and an age threshold, typically focusing on individuals aged 55 to 80. These models have been rigorously tested in outpatient contexts but have not fully accounted for patient demographics frequenting Emergency Departments, where urgent health needs often overshadow preventive screening efforts.

This recent observational study embarked on examining demographic and clinical factors among ED patients that fall outside the national lung cancer screening parameters yet exhibit notable incidences of lung cancer diagnosis. Unsurprisingly, researchers found that conventional screening guidelines were insufficient to capture these at-risk individuals within the ED setting. The study emphasized three pivotal demographic factors—older age beyond traditional thresholds, female sex, and preference for non-English languages—as critical markers associated with an increased likelihood of lung cancer diagnosis in these patients.

Incorporating older patients beyond the conventional upper age limits into risk stratification challenges existing paradigms that often exclude individuals over 80 years. This is particularly important given the evolving demographic shifts globally, where populations are aging, and cancer prevalence rises in the elderly. Female sex also emerged as a notable risk factor. This contradicts historical gender biases that have primarily associated lung cancer risk with male smokers, underscoring the need for gender-sensitive approaches within lung cancer diagnostic strategies.

Moreover, the study highlighted language preference as a novel and impactful determinant. Non-English language preference may serve as a proxy for cultural, socioeconomic, or access-related barriers influencing health behaviors and screening uptake. This finding calls attention to the structural inequities in healthcare access and the potential of non-traditional factors in refining risk models and improving early detection among marginalized groups.

These insights call for an urgent reevaluation of lung cancer screening frameworks within ED settings. Implementing diagnostic protocols that incorporate demographic nuances could enhance early detection rates, potentially improving patient outcomes. The study advocates for a more expansive, inclusive approach rather than a rigid adherence to existing guidelines forged mostly for outpatient populations.

Clinicians working in EDs face a unique set of challenges when integrating cancer screening activities amidst acute care workflows. The fast-paced environment, compounded by resource limitations and varied patient presentations, renders systematic screening difficult. Yet, this research underscores the importance and feasibility of tailoring screening criteria to the realities of emergency medicine, thereby bridging gaps in cancer detection.

Technically, refining lung cancer screening models necessitates the use of advanced epidemiological tools that can incorporate multidimensional risk factors—demographic, behavioral, and clinical. Machine learning algorithms and predictive analytics could be deployed to develop dynamic, adaptable models targeting high-yield patient subsets within the ED. Integration of electronic health records (EHR) and decision-support systems could automate risk stratification, ensuring timely identification without burdening clinical staff.

Beyond individual risk factors, the study prompts a deeper investigation into the pathophysiological underpinnings that might differentiate lung cancer development in non-traditional patient groups. For instance, why might older females or non-English-speaking individuals present with a higher incidence of lung malignancy outside established screening brackets? Exploring genetic susceptibilities, environmental exposures, and health disparities will enrich our understanding and aid in designing targeted interventions.

Another crucial implication lies in public health policy. Current lung cancer screening policies must evolve to incorporate findings that highlight gaps in reach and effectiveness. Policymakers should consider expanding screening guidelines and instituting culturally competent outreach programs focusing on diverse populations identified at risk. Public awareness campaigns designed in multiple languages and tailored to different communities will enhance engagement and adherence.

The study conducted by Wang, Cheeti, Murray, and colleagues represents a vital step in transforming lung cancer diagnosis protocols. By systematically evaluating Emergency Department populations, their observational research identifies previously underappreciated risk factors and patient subsets that could benefit from proactive screening measures. This paves the way for a more equitable, precise, and effective lung cancer diagnostic pathway.

The incorporation of older age beyond national screening upper limits is particularly illustrative of a broader call to rethink geriatric oncology considerations. As life expectancy increases globally, excluding older individuals from cancer preventive strategies could inadvertently increase late-stage diagnoses. Therefore, this study underscores the urgency of inclusive screening that reflects demographic realities.

Further research is also necessary to validate these findings across diverse healthcare systems and to test the practicality of enhanced screening protocols in the ED. Pilot programs incorporating linguistic and gender-specific screening criteria could provide crucial data on implementation challenges and patient outcomes, ultimately informing national guidelines.

In conclusion, this study propels the medical community to reevaluate and expand lung cancer screening frameworks beyond traditional confines. The integration of age, sex, and language preference as risk markers stands to revolutionize early detection, particularly in vulnerable Emergency Department populations. As healthcare moves toward personalized and precision medicine, such innovative approaches will be indispensable in battling lung cancer morbidity and mortality at scale.

Subject of Research: People

Article Title: Identifying lung cancer in Emergency Department patients outside national lung cancer screening guidelines

News Publication Date: 25-Feb-2025

Web References: http://dx.doi.org/10.21037/jtd-24-1399

References: Wang H, Cheeti R, Murray M, Muirheid TA, McDowell J, Sambamoorthi U. Identifying lung cancer in Emergency Department patients outside national lung cancer screening guidelines. J Thorac Dis 2025;17(2):695-706. doi: 10.21037/jtd-24-1399

Keywords: Lung cancer