The Last Mile in Cancer Screening
Why Delivering Results to PCPs Is Essential but Not Sufficient for Faster Treatment and Better Outcomes
By Peter S. Tippett, MD, PhD, Founder & CEO, careMESH
In cancer screening and early detection, industry conversations often center on test performance, patient adherence, and market adoption. Those are important measures. But, since the actual goal of screening is to improve outcomes, one question deserves much more attention: what happens after the result is generated?
More specifically, how quickly and reliably does that result reach the primary care physician or another appropriate care team member -- who then succeeds at initiating the next step in care? Ensuring dependable result delivery is a key step to support better outcomes. In practice, result delivery is a core lever for reducing time-to-treatment and improving outcomes.
That urgency is backed by strong evidence. A major systematic review and meta-analysis published in The British Medical Journal (BMJ) found that even a four-week delay in cancer treatment is associated with increased mortality across surgery, systemic therapy, and radiotherapy. For surgery, each four-week delay was associated with a 6% to 8% increase in the risk of death, with even greater impact in some radiotherapy and systemic treatment settings. For organizations focused on earlier detection, this means the interval between an abnormal result and clinical action is not merely operational. It is clinically consequential.
That is why the primary care provider remains so central. In many screening models, PCPs remain the first clinicians to contextualize results, guide the patient conversation, order follow-up testing, and coordinate referral to specialty care. Yet the systems supporting them are often fragmented. A study in JAMA Network Open found that most primary care practitioners feel responsible for managing abnormal cancer screening test results. Still, fewer than half report being very satisfied with the process. Limited EHR functionality, insufficient staff support, and social barriers to follow-up were all cited as significant obstacles. Improving these workflows can help PCPs feel more capable and committed to timely patient care.
In other words, the physician who owns the next action often lacks the infrastructure to notice the issue in a timely manner and to execute on it efficiently. Often, getting a screening result message to a dedicated workflow built for that purpose, or to a particular office staff member or coordination team charged with efficiently handling notifications like these, is required. Healthcare organizations must prioritize improving communication infrastructure and workflows to close this gap and enable timely care.
Of course, if the PCP ordered the test in the first place, the PCP is likely to receive the results in an orderly manner. But consider numerous other scenarios including: tests performed by another provider, patient self-screening -- community, employer or charity screening programs, -- commercial screening performed at patient request, -- incidental discoveries or predictions by AI, -- incidental discoveries that are equivalent to screening like: physical findings (lumps), or xrays, or laboratory tests performed for a different reason or in places like urgent care centers, or pre-surgical settings….. The scenarios are many, and the opportunities for things to fall through the cracks, resulting in delays or worse, are myriad.
That timing gap matters enormously. A highly sensitive or accurate test can identify risk earlier, but health and patient value are created only when that result activates timely downstream care. If a positive or abnormal result is delayed, routed incorrectly, buried in a disconnected workflow, lost to follow-up, or sent through channels that lack accountability, the testing organization has generated insight without ensuring action. In cancer care, that can mean slower diagnostic resolution, slower specialist access, slower treatment initiation, and worse outcomes.
The World Health Organization has been direct on this point: improving cancer outcomes requires more than earlier detection. It also requires improving diagnostic and referral capacity and ensuring timely access to treatment. That framing is especially relevant for organizations whose mission is to expand screening, whether through at-home testing, molecular screening, multi-cancer early detection, or other means.
The greatest opportunity for improving outcomes is not just in identifying and screening more patients. It is about helping provider organizations move those patients efficiently to, and potentially through, the next stages of care.
This is where many screening organizations still struggle. careMESH has highlighted the real-world consequences of fragmented provider communication: only 46% of faxed referrals result in a scheduled visit, and up to 50% of PCPs may never know whether their patient saw the recommended specialist. Those statistics reflect a broader truth about care coordination in the United States. When the referral and results infrastructure is weak, the system creates avoidable leakage between detection and intervention. For patients with abnormal screening results, that leakage can mean delay, confusion, duplicate work, unnecessary anxiety, and significant increases in risk.
There is also growing evidence that operational interventions work. A cluster randomized clinical trial published in JAMA found that multilevel, systems-based outreach in primary care improved timely follow-up of overdue abnormal cancer screening results for breast, cervical, colorectal, and lung cancer. The combination of EHR reminders and patient outreach improved follow-up completion compared with usual care, underscoring the need for interoperable, scalable infrastructure that enables these interventions to be effective across EHR environments. This is an important signal: the barrier is not solely clinician or patient intent. It is the lack of scalable, interoperable infrastructure that turns abnormal findings into (potentially multi-step) accountable action.
If a screening organization wants to reduce time to treatment and demonstrate real-world value, it cannot stop at generating a result and notifying the patient (or even a provider). It must think more broadly about provider connectivity, workflow integration, referral visibility, and closed-loop follow-up. The most effective screening organizations and programs will be those that make it easy for PCPs and their teams to know what happened, what needs to happen next, and whether the patient actually advanced to the appropriate next step in care.
This is particularly important in categories where screening success depends on large-scale adoption or in community settings. Primary care practices are already overloaded. Many have staffing constraints, uneven digital maturity, and limited ability to manage exceptions manually. If result delivery adds friction instead of removing it, even strong screening programs can lose momentum. But if result delivery is embedded into native workflow and paired with reliable coordination across the care network, screening organizations and programs can improve both provider experience and patient progression.
For screening program management, this analysis changes how success should be measured. Screening adoption and uptake, test volume, positivity rate, and screening adherence remain important. But increasingly, so do operational measures such as time from result to PCP receipt, time from PCP receipt to follow-up order, referral completion, diagnostic resolution, and first definitive treatment. In the long term, population metrics showing increased quality and survival, or decreased disease incidence, are the benchmarks. These metrics can foster a collective sense of purpose, showing how operational excellence directly impacts patient outcomes and organizational value. They obviously show value to patients, but also help demonstrate value to health systems, risk-bearing provider organizations, and partners focused on quality, equity, and total cost of care.
At careMESH, we believe this “last mile” is where much of the future value in screening and diagnostics will be won or lost. careMESH provides tools and programs to notify PCPs, appropriate workflows, and staff members sending millions of notifications in a typical year. careMESH also provides tools for patient coordinators and navigators to coordinate, manage, track, speed, and ensure programs like these never drop the ball.
The organizations that lead the next chapter of cancer screening will not simply produce better tests utilized by more and more people. They will build better pathways from result to action. They will ensure that PCPs and other caregivers receive the right information, in the right workflow, with the visibility needed to move patients forward without delay. In cancer care, faster communication is not just better operations. It is better medicine.
Articles Referenced
Hanna TP, King WD, Thibodeau S, et al. Mortality due to cancer treatment delay: systematic review and meta-analysis. BMJ. 2020. Link.
Atlas SJ, Tosteson ANA, Wright A, et al. A Multilevel Primary Care Intervention to Improve Follow-up of Overdue Abnormal Cancer Screening Test Results: A Cluster Randomized Clinical Trial. JAMA. 2023. Link.
World Health Organization. Guide to cancer early diagnosis. Geneva: WHO; 2017. Link.
Atlas SJ, et al. Primary Care Intervention to Improve Follow-up of Overdue Abnormal Cancer Screening Test Results. JAMA. 2023. Link.