Lung Cancer Key Findings

While we have seen advances in personalized treatment thanks to biomarker testing, targeted therapy and immunotherapy, and saved more lives through the introduction of lung cancer screening, the burden of lung cancer is not the same everywhere. Treatment, exposure to risk factors, and use and coverage of screening vary from state to state. To save more lives, it’s critical to prevent lung cancer when possible and diagnose the disease as early as possible. Additionally, everyone should have access to therapies that may extend or improve the quality of their life. 

By better understanding the impact of lung cancer at the state level, we can encourage interventions to save and extend lives. This report considers the following measures of lung cancer burden by state: new cases, survival, early diagnosis, surgical treatment, lack of treatment, screening and prevention, racial disparities and coverage of comprehensive biomarker testing and identifies where each state ranks on each of these measures. 

Policymakers must do more to protect and expand quality and affordable healthcare coverage and improve access for all to lung cancer screening and treatment. 

Close to 235,000 people will be diagnosed with lung cancer this year, with the rate of new cases varying by state. The report finds that Utah has the nation’s best lung cancer rate while Kentucky has the worst at almost 2.4 times the incidence rate of Utah. Over the last five years, the rate of new cases decreased 15% nationally. 

In 2021, the most recent year of data available for this report, the COVID-19 pandemic disrupted access to medical care, including delays and reductions in cancer diagnoses and screening. This led to a decline in 2021 incidence rates for most cancers, including lung cancer, and should not be interpreted as a reduction in the underlying cancer burden. 

There are a variety of risk factors associated with lung cancer, including smoking, exposure to radon gas, air pollution and secondhand smoke. Radon testing and mitigation, healthy air protections, and reducing the smoking rate through tobacco tax increases, smokefree air laws and access to comprehensive quit smoking services are all ways to help prevent new lung cancer cases. 

Lung cancer has one of the lowest five-year survival rates because cases are often diagnosed at later stages, when the disease is less likely to be curable. The national average of people alive five years after a lung cancer diagnosis is 28.4%, which is a 26% improvement over the last five years. Massachusetts ranked best at 37.9%, while Oklahoma ranked worst at 22.2%.

Nationally, only 27.4% of cases are diagnosed at an early stage when the five-year survival rate is much higher (64%). Unfortunately, 43% of cases are not caught until a late stage when the survival rate is only 9%. Early diagnosis rates increased 11% over the last five years nationally and were best in Massachusetts (34.7%) and worst in Hawaii (21.1%).

Lung cancer can often be treated with surgery if it is diagnosed at an early stage and has not spread. Nationally, 20.7% of cases underwent surgery, ranging from best at 31.8% in Massachusetts to worst at 13.0% in New Mexico. 

Surgical treatment rates decreased by 2% in 2021, likely due to the impact of the COVID-19 pandemic on access to medical care. 

Patients who are not healthy enough to undergo the procedure or whose cancer has spread may not be candidates for surgery. Other treatments may be recommended instead of or in addition to surgery, such as chemotherapy, radiation, targeted therapy or immunotherapy. This report focuses on surgical treatment because it is more likely to be curative. 

There are multiple reasons why patients may not receive treatment after diagnosis. Some of these reasons may be unavoidable, but no one should go untreated because of lack of provider or patient knowledge, stigma associated with lung cancer, fatalism after diagnosis, or cost of treatment. Nationally, 20.9% of cases did not receive any treatment. Lack of treatment rates were best in Massachusetts (13.2%) and worst in Nevada (36.7%).

Biomarker testing and its results are an important way to find certain biomarkers that can help determine what treatment options would be best for individuals with lung cancer and other diseases.  

Biomarkers are clues that physicians look for in tumor tissue and blood to help understand why lung cancer is growing and the best way to treat it. Lung cancer biomarkers can be errors in a cell's DNA or high levels of proteins that live on cells. Target treatments exist to address many biomarkers, which is why it is important for patients and their providers to know the results from biomarker testing before beginning treatment.  

Insurance coverage of such testing is important for removing a cost barrier to people with lung cancer, but coverage for biomarker testing is only required in some states. As of August 2024, 15 states required insurance coverage of comprehensive biomarker testing, 5 states required some coverage, and 30 states and Washington, D.C. had no coverage requirements. 

Lung cancer screening gives us hope in the effort to defeat lung cancer and represents an opportunity to save more lives. Screening with annual low-dose CT scans can reduce the lung cancer death rate by up to 20% by detecting tumors at early stages when the cancer is more likely to be curable. Lung cancer screening has saved 80,000 additional years of life leading to $40 million in savings, which would increase to 500,000 additional years of life and $500 million if all those eligible had been screened (Phillipson et al, 2023). 

In March of 2021, the United States Preventive Services Task Force (USPSTF) expanded its recommendation for screening to include a larger age range and more current and former smokers. This dramatically increased the number of women and Black Americans who are considered at high risk for lung cancer. At the same time, the requirement for screening facilities to participate in the lung cancer screening registry in order to receive reimbursement from Medicare for screening scans was removed, which may have led to a decrease in reported scans, especially in some states.

High risk is defined as:

For screening to be most effective, more of the high-risk population should be screened annually—currently screening rates remain low among those at high risk. Nationally, only 16.0% of those at high risk were screened. Rhode Island has the best screening rate at 28.6%, while Wyoming has the worst at 8.6%. This year’s report uses a new source for screening rates and should not be compared to previous reports.

Keys to prevention include limiting tobacco use, radon, air pollution and secondhand smoke, all of which are known to cause lung cancer. However, it is not always possible to identify the cause of an individual patient’s lung cancer. If you have concerns about your risk, because of your exposures or your family history, it is important to share this with your doctor. 

This report contains information and data on exposures to these risk factors on the state level: 

• Tobacco use is the leading risk factor for lung cancer, accounting for 80 to 90% of cases. While we have seen historic decreases in the national smoking rate, not all Americans or regions of the country have benefited equally. 
• Secondhand smoke has also been shown to cause lung cancer. There is no safe level of exposure to secondhand smoke. The “State of Lung Cancer” report highlights that making homes, workplaces and public spaces smokefree air zones, with no smoking allowed, can reduce the risk of exposure. This report’s sister, “State of Tobacco Control,” grades states for efforts to protect public spaces from secondhand smoke. 
• Radon, a naturally occurring radioactive gas, is the second leading cause of lung cancer and the leading cause among nonsmokers. Radon is a colorless and odorless gas that can seep into homes and buildings.

Some geographical areas have naturally higher average radon rates than others, but since any home can be at risk for elevated levels, the only way to know is to do a test. If testing shows interior radon levels at or above the U.S. EPA action level of 4 pCi/L (picoCuries per liter of air) or higher, it is recommended you take corrective measures to reduce your exposure to radon gas. Such measures should also be considered at levels at or above 2 pCi/L. The report highlights the percent of indoor radon tests at or above the EPA action level by state. 

• Exposure to year-round particle pollution in the air has been shown to cause lung cancer. Each year the American Lung Association releases the “State of the Air” report. The 2024 “State of the Air” report found that more than 131 million people are living in places with failing grades for unhealthy levels of air pollution.

• The lung cancer survival rate increased 26% over the last five years nationally to 28.4%. 
• Lung cancer screening with low-dose CT scans has been recommended for those at high risk since 2013, but only 16.0% of those eligible were screened in 2022. 
• People of color who are diagnosed with lung cancer face worse outcomes compared to white Americans, including: less likely to be diagnosed early, less likely to receive surgical treatment, more likely to receive no treatment, and less likely to survive five years.
• Nationally, only 27.4% of cases are diagnosed at an early stage when the five-year survival rate is much higher (64%).  
• The analysis in the “State of Lung Cancer” serves as a baseline against which future data can be compared, which may be especially beneficial as progress is made on the implementation of lung cancer screening and insurance coverage of comprehensive biomarker testing. 

As the American Lung Association works toward defeating lung cancer, the goal of the “State of Lung Cancer” report is to empower the public to learn more about lung cancer in their state. Individuals can join the Lung Association’s efforts to end lung cancer by asking their governor to support insurance coverage of comprehensive biomarker testing.

The report looks at key lung cancer measures to highlight the burden and examine opportunities to better address lung cancer at the state level. The report found that lung cancer rates for every measure vary significantly by state, and that every state can do more to defeat lung cancer, such as increasing the rate of screening among those at high risk, addressing racial disparities that impact lung cancer outcomes, decreasing exposure to radon and secondhand smoke, and eliminating tobacco use.  

This report provides unique information for federal and state officials, policymakers, researchers and those affected by lung cancer and emphasizes the need for resources and action to decrease the toll of lung cancer across the country.