Lung Cancer Progress: Survival Increasing in US

Pam Harrison

November 15, 2019

Five-year survival rates among patients with lung cancer are clearly improving across the United States, although there are wide differences in the incidence of and the risk of dying from lung cancer between the states.

These conclusions come from the American Lung Association's 2019 annual report on the "State of Lung Cancer."

"Every state can do more to defeat lung cancer such as increasing the rate of screening among those at high risk, addressing disparities in receipt of treatment, decreasing exposure to radon and secondhand smoke and eliminating tobacco use," the authors write.

Increase in Survival Over Last Decade

Over the past 10 years, the 5-year survival rate has increased from 17.2% in 2009 to 21.7% in 2019 — a 26% improvement over the decade.

However, the burden of lung cancer is not the same across the whole country, the report's authors point out.

For example, while the incidence of lung cancer was 59.6 per 100,000 individuals nationally, it ranged from a low of 27.1 per 100,000 individuals in Utah to a high of 92.6 per 100,000 individuals in Kentucky.

Similarly, chances of being alive at 5 years following the diagnosis of lung cancer went from a high of 26.4% in Connecticut to a low of 16.8% in Alabama, the report indicates.

Early diagnosis also makes a dramatic difference in 5-year survival rates, the authors observe.

If caught at a stage when the cancer is confined to the primary site, 57.7% of patients will still be alive at 5 years.

In contrast, if the cancer has already metastasized to other organs on diagnosis, only 6% of patients will still be alive at the same time point.

Countrywide, only 21.5% of patients are diagnosed at an early stage, the report indicates.

Annual CT Scans

Annual, low-dose CT scans can reduce lung cancer mortality by detecting tumors at a stage when the cancer is more likely to be curable. Indeed, "if everyone currently eligible were screened, close to 48,000 lives could be saved," the authors observe.

At the moment, annual screening rates are low at 4.2% across the whole country, with the highest screening rates in Massachusetts at 12.3% and the lowest in Nevada at 0.5%.

Importantly, Medicaid programs are one of the only healthcare payers who are not required to cover the cost of lung cancer screening, although in 2019, 31 state Medicaid programs did actually cover its cost.

This coverage makes a difference to the likelihood of patients getting screened, as in states where Medicaid plans do cover screening, 4.8% of high-risk individuals were screened in 2019 compared with 2.6% of high-risk individuals in states that do not pay for the cost of screening.

Treatment rates vary significantly across the country as well.

Nationally, 20.6% of cases underwent surgery as part of the first course of treatment, but this ranged from a high of 30.5% in Massachusetts to a low of 13.5% in New Mexico, as the authors point out.

"Not every patient received treatment after being diagnosed with lung cancer," the authors also note.

Across the country, the national average of those who receive no treatment for lung cancer was 15.4%, but again this varied from one state to another, with a low of 8% in North Dakota to a high of 30.4% in Arizona.

The authors have disclosed no relevant financial relationships.

American Lung Association: State of Lung Cancer 2019. Published November 2019.

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