Lung cancer is the nation’s leading cause of cancer deaths, and every 2 minutes, 14 seconds, someone in the U.S. is told that he or she has lung cancer.
As a resident of Delaware, a practicing pulmonologist and the chief medical officer of the American Lung Association, I see the impacts of lung cancer every day. In our state alone, it is estimated that 910 Delawareans will be diagnosed with this disease in 2021.
The 2021 “State of Lung Cancer” report from the American Lung Association finds that, while more Americans are surviving the disease, people of color are facing poorer health outcomes than White residents, and that Delaware can and must do more to lower new incidences of lung cancer and increase early diagnosis, treatment and screening.
The fourth annual report, released this month, examines the toll of lung cancer throughout the nation and outlines steps every state can take to better protect its residents from lung cancer. This year’s report reveals that the lung cancer five-year survival rate has increased 14.5% nationally to 23.7%, yet it remains significantly lower among communities of color at 20% and Black Americans at 18%.
Delaware’s new-case incidence rate is higher than the national average (65.2 per 100,000 people compared to 57.7 in the U.S.), ranking 39 out of 50 states and Washington, D.C., and this is a 15% improvement over the past five years.
Anyone can get lung cancer. While smoking is the No. 1 risk factor and responsible for about 90% of lung cancer cases, an estimated two-thirds of lung cancer diagnoses are in never and former smokers. Current lung cancer incidence rates may result from elevated smoking rates from decades ago, exposure to secondhand smoke and increased exposure to other causes of lung cancer, such as radon and air pollution, or other factors, including family history.
The stage at which someone is diagnosed with lung cancer varies significantly by state. Nationally, only 24.5% of cases are caught early when the five-year survival rate is much higher (59%). In Delaware, the survival rate is 24%, which marks a 28% improvement over the past five years, and early diagnosis is among the best in the nation at 26% (ranking seventh out of 49 states measured). Cases that are diagnosed at an earlier stage before the tumor has spread are also more likely to be eligible for surgery, though Delaware’s surgery rates as first course of treatment are below the national average, at 18.9%.
The good news is that more Americans than ever are surviving lung cancer, but there remains much more work to be done.
More treatment options are available for lung cancer than ever before, yet not everyone is receiving treatment following diagnosis. In Delaware, 19.4% of those diagnosed did not receive any form of treatment. While not everyone may choose to pursue treatment after diagnosis, no one who wants treatment should be forced to go untreated due to cost or lack of accessibility.
Lung cancer screening can help detect the disease early when it’s more curable. In March, the U.S. Preventive Services Task Force updated the lung cancer-screening eligibility guidelines, lowering the age for eligibility from 55 to 50 and the pack-years smoked to a 20-pack history of smoking (from 30), as well as smoking history to the last 15 years.
These updated guidelines will nearly double the number of people eligible for screening to 14.2 million, including dramatic increases in the number of women and Black Americans who are now eligible for screening. If everyone eligible were screened, close to 48,000 lives in the U.S. would be saved.
While Delaware ranks above average compared to other states, only 9% of eligible residents were screened in 2020, indicating that there is need for education and awareness. Lung cancer screening is a powerful tool to save lives. It’s a relatively new test, and we’re only seeing a fraction of those who qualify actually getting screened. The Lung Association is continuing to push for greater awareness of this test to save more lives here in Delaware and encourage former and current smokers to learn about screening and take the screening eligibility quiz at savedbythescan.org.
Our state officials must do more to protect and expand quality and affordable health care coverage and improve access to lung cancer screening and treatment. The American Lung Association wants to ensure that all Delawareans have access to treatment options and quality and affordable health care.
Dr. Albert Rizzo is chief medical officer of the American Lung Association.
