The leading cause of cancer worldwide could be better detected and treated with special algorithms built into the electronic health record (EHR), according to new research out in NEJM Catalyst today.
Lung cancer screening is relatively new, as it was first recommended in 2013. Doctors use low-dose computerized tomography (LDCT) to test patients who have no symptoms but are long-term smokers. But only about 16 percent of those who are eligible in the U.S. currently get screened. This new study details how the University of Rochester Medicine primary care network reached a nearly 72 percent lung cancer screening rate.
“Our biggest success was not only screening a high percentage of eligible patients, but also enrolling those patients in the comprehensive program to ensure they receive the necessary annual follow-up screenings,” said Robert Fortuna, MD, MPH, professor of Primary Care and Pediatrics at the University of Rochester Medical Center (URMC) and lead author of the study.
Fortuna and a team of primary care physicians, radiologists, pulmonologists, thoracic surgeons, and advanced practitioners launched a coordinated program in January 2022, designed to better identify and reach patients who meet the complicated criteria for lung cancer screening. The program more than doubled the network’s lung cancer screening rate from 33 percent in March 2022 to 72 percent in June 2025.
That increase may have also helped the team catch cancer cases earlier. In 2023 and 2024, the program diagnosed 63 cases of lung cancer, nearly 78 percent of which were diagnosed at an early stage, when treatments are more likely to have positive outcomes.
Lung cancer screening implementation has been challenging due to knowledge gaps, difficulties in identifying eligible individuals, and limited access.
Currently, guidelines recommend annual low-dose CT scans for people 50-80 years old who currently smoke or who have quit within 15 years and have smoked a lifetime equivalent of 20 pack-years (i.e., one pack of cigarettes per day for 20 years or two packs a day for 10 years, etc.).
“There are a lot of barriers in identifying the individuals that meet this criteria,” said M. Patricia Rivera, MD, chief of Pulmonary and Critical Care Medicine at URMC and an author of the study. “For breast cancer screening, you just need to be a woman over 40. Anyone 45 or older should get a colonoscopy. For lung cancer screening, we have to quantify the smoking history, which is very complicated as smoking habits change over time and are often poorly recorded in the medical record.”
To better identify patients who are eligible for lung cancer screening, the team developed a custom algorithm in the electronic health record to more accurately calculate pack-year smoking history and flag eligible patients.
Each morning, primary care teams at the 42 practices across the network can see who on their daily schedule is due for breast, colon, and lung cancer screening. Teams also get alerts during visits as a backup reminder to discuss lung cancer screening and smoking cessation with patients.
While technology is important, people are the true key to the program’s success, according to Fortuna. Collaboration among primary care, radiology/imaging, and pulmonary teams enabled a seamless flow of information and streamlined patients’ journeys. Leveraging an existing infrastructure of population health experts helped refine screening processes, track patients between visits, and ensure they returned for annual screenings and follow-ups.
“Aligning our lung cancer screening program with our broader population health initiatives allowed us to leverage familiar workflows and broadened our reach. Throughout the country, health systems are pursuing similar goals and most have some sort of population health structure in place,” said Fortuna. “My hope is that by sharing our success, others will be able to adopt and build upon what we’re doing to screen more patients and save more lives nationwide.”
