This research study will test whether support from a Community Health Worker (CHW) to address barriers to annual LDCT screening will result in an increased number of patients who receive the annual screening as per the recommended standard of care compared to passive outreach using a reminder letter.

This research study is a randomized controlled trial comparing phone outreach by a trained Community Health Worker (CHW) following a reminder letter to the reminder letter alone for patients who are at least a month overdue to have a routine annual low dose CT scan (LDCT) screening for lung cancer. CHWs will be able to identify and address barriers to accessing screening for those patients randomized to that arm of the study. Outcomes that will be measured include scheduling and completing the LDCT as well as agreeing to a referral for tobacco treatment.

Inclusion Criteria:

• 30 or more pack years of tobacco use
• If no longer using tobacco, no more than 15 years since last use
• At least 13 months since last low dose CT scan screening

Exclusion Criteria:

• Development of serious medical condition that would preclude treatment of lung cancer if found
• Death since baseline screen

Outcomes assessor will be blind to which intervention the subjects have received.