Digital health is often presented as a way to close healthcare gaps. But in this Romanian cancer-prevention study, the people using digital tools reported screening at much higher rates—raising the possibility that technology can also widen disparities. Digital health services and technology are rapidly developing following the COVID-19 pandemic.

Against that rapid development, the study aimed to reveal differences between users of digital health technology, or DHT, and the general population with regard to cancer prevention. The rapid pace of development and adoption generates skepticism from government, policymakers, and health system managers about the impact of digital self-care information and services on quality, safety, cost, and inequalities.

These services may address some inequalities regarding access to health services. At the same time, they may create other inequalities, including disparities in the resources or skills needed to take advantage of new technologies.

This was an observational descriptive study on a conventional sample of users of the Alprevia application in Romania, collected over one month, September twenty twenty-one, and defined as the DHT sample. The application estimates risk, collects previous screening data, and recommends examinations, tests, consultations, and lifestyle changes for cardiovascular diseases, cancer, diabetes, and depression.

The application collects no personal identification data. For September, the application recorded data from two hundred seventy men and women who had assessed their cancer risk. Access was free, with no username, password, or registration required, and the general population was invited through web and Facebook advertisements.

No specific groups were invited, and the analysis included two hundred sixty-one applications with complete data; percentages were calculated for people using each screening method within the target group. Table one compares age distributions in the general population, totaling thirteen million six hundred forty-one thousand seventy-two people, with the DHT sample of two hundred sixty-one participants.

It reports counts, percentages, and p-values across ages twenty to seventy-four. The authors identify statistically significant differences in the twenty-five to twenty-nine and sixty-five to seventy-four age groups, with p-values of zero point zero four four zero, zero point zero two nine five, and zero point zero two two five, highlighting age-related differences in the DHT conventional sample.

Figure one shows the general population’s age and sex distribution, with green bars representing males and red bars representing females across age groups from twenty to twenty-four through seventy to seventy-four years. This provides the demographic context for the digital health sample, or DHT, and helps viewers interpret how representative the study population may be within Romania’s highly connected setting.

Figure two shows the age and sex distribution of the digital health technology sample, with green bars representing males and red bars representing females across age groups from twenty to twenty-four through seventy to seventy-four years. The chart reports percentages rather than raw participant counts, allowing readers to see how the sample is distributed across demographic groups.

This matters because the authors’ findings on digital health and cancer screening depend on who is represented in the sample. Table two reports women’s participation in recommended cervical, breast, and colorectal cancer screening, alongside Romania and Europe twenty-seven reference figures.

Within the target groups, reported proportions include forty-eight point thirteen percent for Pap screening, twenty-nine point thirty-one percent for mammography, and thirteen point fifty-six percent for colonoscopy; the table also separates some Romanian cervical and breast figures by education level.

It matters because the results document screening uptake across different tests and age groups, while also marking unavailable comparisons as not available. The cervical cancer tests involved Pap smears every three years and HPV-DNA testing every five years.

Among women aged twenty to sixty-nine, forty-eight percent of DHT users reported having had a Pap test, compared with twenty-seven percent in Romania and a seventy-one point eight percent European Union average. In the most recent Romanian EHIS from twenty nineteen, thirty-seven point five percent of women reported Pap smear screening in the preceding two years, compared with seventy point eight percent in the European Union.

Table three reports preventive-test prevalence among men in the target age groups. For prostate screening at ages fifty-five to sixty-nine, prostate-specific antigen screening is listed at fifty percent, while clinical examination is sixteen point sixty-seven percent; Romania and Europe twenty-seven averages are marked not available.

For colorectal screening at ages fifty to seventy-four, colonoscopy is twenty-one point seventy-four percent, fecal occult blood testing is four point thirty-five percent, and fecal immunochemical testing is zero percent. The authors frame these findings within broader educational barriers to using digital health for cancer prevention.

Among women in the DHT group, thirteen point fifty-six percent reported undergoing colorectal cancer tests, including sigmoidoscopy or colonoscopy. Only one point sixty-nine percent had undergone FOBTs, and one point sixty-nine percent had undergone FITs.

This was far below the European Union twenty-seven average of thirty point six percent, but it was four times higher than the percentage reported for the general Romanian population. The DHT group was times higher than the general Romanian population but closely mirrored the European average.

The age distribution also reveals a large proportion of users younger than forty, indicating that DHT can help detect cancers early in these age groups in the future, which can be considered a strength of DHT in oncology. Challenges and barriers exist in balancing digital self-care utilization and general accessibility.

Primary care centers are usually the first point of contact in prevention, and whether digital health will change this arrangement is questionable. Digital health users reported cancer screening more often than the general Romanian population, but the tool reached a selected, internet-literate group.

Digital prevention may reduce disparities only when it is integrated into primary care and made broadly accessible.