Despite Improvements in Lung Cancer Screening, Increased Efforts Still Needed to Address Disparities

Lung cancer remains the leading cause of deaths out of all types of cancer, even while the rate of survival has gone up from 21% to 25% nationally in the past 5 years, according to the American Lung Association’s 2022 State of Lung Cancer report. The annual report aimed to describe lung cancer burden at the national and state levels—including a spotlight on disparities—and propose opportunities to prevent the disease and save lives.

Nationally, 21% of cases still receive no treatment, even though there was a 15% rate of improvement in treatment over the past 5 years. With rates varying from state to state, 237,000 individuals will receive a diagnosis of lung cancer this year, representing an 11% decrease in new national cases of lung cancer over the previous 5 years.

Because lung cancer is usually detected in the later stages, the 5-year rate of survival is among the lowest. By 5 years after a lung cancer diagnosis, 25% of patients are alive, which is an improvement of 21% since 5 years ago. Over the past 5 years, early diagnosis rates have increased by 17%.

Access to treatment and early diagnosis screening tools can extend and improve quality of life, according to the report, which highlighted opportunities for improvement. The high mortality rate of lung cancer can be improved by using low-dose CT scans as a yearly screening tool to identify early-stage tumors that have a higher likelihood of curability and can reduce death rates up to 20% of the time.

Most health care payers are required to cover lung cancer screening, but state Medicaid programs are programs are one of the only few not required to do so for the traditional Medicaid population. And if screening is covered, plans may require patients to meet eligibility criteria such as prior authorization or require them to pay for their scans.

An appraisal of screening coverage status for the Medicaid population by the American Lung Association found that 46 state Medicaid fee-for-service programs provide coverage for lung cancer screenings, while 3 programs provided no coverage, and 1 has no obtainable information regarding their policy for coverage.

According to the US Preventive Services Task Force (USPSTF), lung cancer screening guidelines for 2021 target those in the age range of 50 to 80 years who have 20 or more pack-years (eg, 1 pack per day for 20 years, 2 packs over 10 years) and are current smokers or quit smoking within the last 15 years.

Racial and ethnic disparities were a major focus of report, which revealed a lower rate of 5-year survival for communities of color at 20% compared with 25% nationally.

Compared with White Americans, people of color currently have worse outcomes after a lung cancer diagnosis, according to the report. The likelihood of an early diagnosis and of obtaining surgical treatment is less, and these populations are more likely not to receive any treatment at all.

For instance, compared with their White counterparts, Black Americans are 19% less likely to receive surgical treatment, and Latino Americans are 28% more likely to receive no treatment at all.

The report also noted how screening guidelines have evolved to address the persistent racial disparities in lung cancer outcomes.

As of March 2021, the USPSTF used emerging research to include a broader age range and larger number of current and former smokers in its screening recommendation, significantly increasing the number of women and Black Americans in the high-risk population.

However, in 2021, out of those considered at high risk, just 5.8% were screened, indicating that more high-risk individuals need to be screened to increase screening efficacy and save more lives.

The report authors noted that the incidence and treatment data are from 2015 through 2019, so they do not reflect the potential impact of COVID-19 on cancer diagnosis, treatment, or survival. Still, they expressed hope that the information in the report would be useful for researchers and policy makers seeking to lessen the burden of lung cancer in the United States.

In a news release, the American Lung Association said that the report “highlights that states must do more to reduce the burden of lung cancer and encourages everyone to join the effort to end lung cancer.”

Reference

State of lung cancer: 2022 report. American Lung Association. November 15, 2022. Accessed November 16, 2022. https://www.lung.org/getmedia/647c433b-4cbc-4be6-9312-2fa9a449d489/solc-2022-print-report