Lung cancer survival rates have risen, but data show racial inequality

The national survival rate for lung cancer jumped more than 5 percentage points, from 21.7 to 26.6 percent, over the last five years, said report author Zach Jump, the national senior director of epidemiology, statistics and research at the American Lung Association.

Treatments that boost the immune system to attack cancer cells, known as targeted immunotherapies, have contributed to the overall improvement, experts say. Other factors include better access to lung cancer screenings, greater awareness of the disease and patients’ increased willingness to discuss lung cancer with their medical providers.

Stigma surrounding the disease has long been one of the main culprits for late-stage diagnoses, along with historically poor treatment options.

“People assumed this was a death sentence, so they were kind of in denial,” Jump said.

However, the nationwide numbers obscure disparities in diagnosis and outcomes at the state and community level. Utah has the lowest rate of new lung cancer cases in the nation, the report shows, whereas Kentucky has the highest. Experts think one of the biggest factors is smoking rates.

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And when comparing communities of color with White individuals, the data show that Black people had a 16 percent lower survival rate, and Latinos were 9 percent less likely to survive. Asian people were 14 percent more likely to survive compared with White people, while American Indians and Alaska Natives had about the same survival rate as their White peers.

Part of the challenge is that screening rates for lung cancer remain low. Unlike in many other organs, lung tissue does not have many pain receptors, so a patient might not feel anything until the disease has spread to the lung lining or beyond. But annual low-dose CT scans can detect the disease while it’s still in early stages.

In 2021, the United States Preventive Services Task Force — an independent panel of experts that assesses the effectiveness of preventive health care — lowered the recommended age to start screening from 55 to 50. The revision also increased the number of people who would fall in the high-risk category for lung cancer. But only 4.5 percent of high-risk individuals were screened, the report found.

Health insurance coverage could be one of the causes of the low screening rates. Medicaid is not required to cover lung cancer screenings, so hurdles including prior authorization from insurance providers and out-of-pocket fees may have deterred people trying to access testing, the cancer society report said.

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Cigarette smoking is still the number one risk factor for lung cancer, but rates among nonsmokers are increasing. Other contributing factors include radon, air pollution and secondhand smoke.

“This is not only becoming a disease of people of color, it’s becoming a disease of nonsmoking young women,” said Janani Reisenauer, an interventional pulmonologist at the Mayo Clinic Comprehensive Cancer Center.

Reisenauer adds that unlike other cancers, such as breast cancer, the public health awareness and messaging about lung cancer is not as prevalent.

“Some of the reticence to do that with lung cancer is that there’s always been this affiliation that it’s a smoker’s disease, so I think some of that public messaging needs to change,” Reisenauer said.