Abstract for: From Eligibility to Uptake: Endogenizing Participation Behavior in Lung Cancer Screening Models

Lung cancer remains the leading cause of cancer mortality in the United States, with over 130,000 deaths each year. While risk-based screening guidelines have advanced significantly, real-world participation remain dismally low. This work addresses the gap in current modeling by exploring the dynamic behavioral processes that shape individuals’ screening decisions and undermine existing strategies. Through collaboration with the American Lung Cancer Screening Initiative (ALCSI), we have analyzed survey data from at-risk populations to identify key concerns and decision drivers underlying low screening participation. These insights inform the development of a dynamic behavioral model that captures the mechanisms limiting participation. The goal is to surface insights that can be integrated into population-level models to inform more effective screening policies. Initial findings suggest that beyond limited awareness of lung cancer and screening options, many at-risk individuals harbor bleak perceptions and stigma around the disease—perceptions that undermine the considerable value of early detection. We have developed a preliminary dynamic model that captures how factors such as false positives, false negatives, and survival rates—both for screened and unscreened individuals—shape participation behavior. These elements help illuminate why life-saving interventions may still be underutilized. We plan to conduct a Group Model Building session to refine the structure of our behavioral model of lung cancer screening participation. Leveraging real-world data on screening rates and outcomes, we aim to test and validate the model. Once validated, it can be integrated with existing frameworks to support more realistic assessments of policy interventions aimed at improving screening uptake and reducing lung cancer mortality. Proof reading