Inclusion Criteria:  women who are 50 to 80 years old 20+ pack-years of smoking history live within 45 miles of UF Health Shands Hospital or in Duval County, specifically the 12,000+ HealthStreet cohort  Exclusion Criteria:  women outside the acceptable age range insufficient smoking history women who live outside the 45 miles of UF Health Shands Hosptial or not in Duval County not in the HealthStreet system