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18 lung cancers found. One mobile CT unit. Four cities. 🔬
The BRELT3 trial just showed what a mobile LDCT program can actually deliver in underserved communities.
According to ILCN, 2,018 people completed LDCT screening across four cities in Northeast Brazil, with 87% of participants identifying as nonwhite and 64% holding only primary-level education. These are the populations most likely to be missed by traditional fixed-site screening programs.
The results are worth studying closely.
🔹 0.84% of screened participants received a lung cancer diagnosis
🔹 33% of those diagnoses were stage III or IV disease
🔹 12% of participants had suspicious findings based on Lung-RADS categories 3 or 4
🔹 66% of participants had an estimated 6-year lung cancer risk above 2%, per the PLCOm2012-noRace model
🔹 Of 46 participants for whom biopsy was indicated, 34 completed biopsy and diagnostic procedures
The eligibility criteria for BRELT3 are worth noting for teams designing their own protocols. Participants were aged 50 to 80, currently or formerly smoked at least 20 pack-years, and had quit no more than 15 years prior. LDCT findings were classified using the 2022 Lung-RADS version. Lung-RADS 3 and 4 triggered referral for further workup.
Here is the operational model that made this work.
The BRELT3 framework has three layers.
Layer 1 is community recruitment. Media campaigns plus active outreach through community health workers in primary care settings. This is how you reach the 87% who would never walk into a hospital for elective screening.
Layer 2 is mobile LDCT delivery. The CT unit travels to the population. Fixed geography is no longer the ceiling on who gets screened. The median BMI of the cohort was 24.5, which matters for scan quality in real-world settings.
Layer 3 is standardized triage and follow-up. Lung-RADS classification upon scan completion, with immediate referral pathways for categories 3 and 4. Without this layer, detection events sit in a referral queue and never convert to treatment.
The Lung-RADS distribution from BRELT3 is a useful benchmark.
🔹 Category 1 (negative): 28% of participants
🔹 Category 2 (benign findings): 57%
🔹 Category 3 (probably benign): 5%
🔹 Category 4A, 4B, 4X combined: 7%
For any imaging program director building a mobile LDCT workflow, that distribution tells you exactly what your referral volume will look like at scale.
The prior BRELT studies built the evidence base here. BRELT1, reported in 2016, found a lung cancer prevalence of about 1.5% in a Brazilian region endemic for granulomatous disease, comparable to international studies. BRELT2 enrolled 3,819 individuals across three states and confirmed feasibility across practice settings.
BRELT3 added the mobile unit and community health worker model on top of that foundation.
If your health system is evaluating mobile lung cancer screening, save this post. The BRELT3 recruitment, triage, and follow-up structure is a replicable blueprint for reaching the populations that current fixed-site programs consistently miss.
👉 Follow Jonathan Govette, CEO of Oatmeal Health, for daily healthcare insights on LinkedIn. Deeper dives in The Oatmeal Bite on Substack: https://news.oatmealhealth.com
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Author:
CEO/Co-Founder @ Oatmeal Health | AI Lung Cancer Screening | Almost Became a Doctor | Engineer | Follow to Share What I’ve Learned Along the Way
I help patients get the care they need earlier, preventing late-stage cancer.
That’s been the throughline across three companies and almost 20 years in healthcare. At ReferralMD, we fixed broken referral networks so patients didn’t fall through the cracks. At Oatmeal Health, it’s lung cancer: building the diagnostic and screening infrastructure so the 85% of cases caught too late get caught early instead.
Today as CEO of Oatmeal Health, I lead a team embedding AI into radiology workflows to turn routine lung CT scans into reimbursable cancer risk assessments. We partner with FQHCs to reach underserved communities, and with health systems and payers to make early detection economically sustainable. Think HeartFlow or Cleerly, but for lungs.
Between companies, I advised at Techstars and Plug and Play, mentoring founders building in digital health. That experience shaped how I think about what separates companies that ship from companies that stall: distribution, reimbursement, and clinical trust, not just technology.
I’m a CancerX alumnus, a 3x healthcare founder, and someone who believes the biggest problems in cancer aren’t scientific. They’re operational.
We’re hiring mission-driven builders at Oatmeal Health. If you want to work on something that matters, reach out.
When I’m not working, I’m traveling, mentoring, and keeping up with one very energetic husky. 🐾
Substack – The Oatmeal Bite:
Millions of patients get less care because of who they are, where they live, or how they look. I’m fighting to change that. CEO @OatmealHealth, a startup built for the underserved. The Oatmeal Bite: intel for clinicians, investors, and advocates.
Jonathan Govette
CEO of Oatmeal Health
Substack:
https://oatmealhealthjonathangovette.substack.com/
