While roughly 14.2 million Americans are eligible for lifesaving lung cancer screening, less than 6% of high-risk individuals have been screened, according to the American Lung Association's (ALA) 2022 "State of Lung Cancer" report.

Report details and key findings

In the report, ALA highlights the need for increased lung cancer screening. Currently, around 14.2 million people are eligible for lung cancer screening, which means an individual must:

• Be between 50 to 80 years old
• Have a 20 pack-year history, with one pack per day for 20 years or two packs per day for 10 years
• Currently smoke or have quit within the last 15 years 

According to the report, just 5.8% of eligible individuals have been screened for lung cancer, and lung cancer screening rates are as low as 1% in some states.

While lung cancer rates vary widely by state, the number of new cases diagnosed each year in the United States has declined by 11% overall. According to the report, Kentucky, West Virginia, and Arkansas have the highest rates of lung cancer, with incidence rates averaging between 80 to 87 cases per 100,000 people. Utah and New Mexico have the lowest rates, with incidence rates between 26 and 37 cases per 100,000 people. 

Notably, lung cancer has low survival rates compared to other types of cancer, with an overall five-year survival rate of just 25%—partially because it is often diagnosed during the later stages of the disease when it is more difficult to cure.

While the survival rate is still low, there have been some signs of improvement in recent years.

"While lung cancer screening remains underutilized, our new report revealed continued progress for lung cancer survival," said Harold Wimmer, ALA's national president and CEO. "The lung cancer five-year survival rate is now 25% and increased 21% from 2014 to 2018."  

At the state level, Rhode Island has the highest five-year survival rate, at almost 31%, and Oklahoma has the lowest, at 19.7%.

Among the report's key findings are the differences between survival rates, diagnoses, and treatment across different racial groups.

In particular, the report found that people of color have a lower survival rate from lung cancer than white people and are less likely to receive an early diagnosis.

For example, Black people with lung cancer are 15% less likely to receive an early diagnosis than white people with lung cancer. The report found that Black people are less likely to receive treatment and are 12% less likely to survive five years past their diagnosis when compared to white people.

Similarly, those who identify as Latinx, Asian or Pacific Islander, or Native American are also less likely to receive an early diagnosis for lung cancer. When compared to white people, Latinx and Native American people are 25% and 23% less likely to survive five years after their diagnosis, respectively.

Why are lung cancer screening levels so low?

According to Zach Jump, ALA's national senior research director for epidemiology and statistics, who helped lead the new study, roughly 60% of lung cancer cases are detected after the tumor has spread and can no longer be cured.

Lung cancer screening, which involves a short CT scan and is free of charge, has only been recommended by the federal government since 2014. In March 2021, the number of eligible individuals doubled when the eligibility criteria were modified.

Still, lung cancer screening rates remain low. "There's a lot of folks out there who we're not reaching," said Debra Ritzwoller, a senior investigator in economics and cancer research with the Kaiser Permanente Colorado Institute for Health Research. "There's a knowledge gap for both the patients and for the providers," she added.

Jacob Sands, a lung cancer specialist at the Dana-Farber Cancer Institute, noted that low lung cancer screening rates reflect health systems' shortcomings—not patients' failures to show up for testing.

"Amongst the medical community, I think there's a history of blaming patients for bad stuff, as opposed to recognizing the flaws within our own system," Sands said. 

However, low awareness among patients also limits lung cancer screening, said Chi-Fu Jeffrey Yang, a thoracic surgeon at Massachusetts General Hospital.

"When we go out in the community and we teach people about lung cancer screening, nobody's heard of it," Yang said. 

In addition, many people avoid the screening for various reasons. Andrea Borondy Kitts, who has been a lung cancer advocate since her husband died from the disease, initially believed that high-risk individuals would "run to their doctors" to be screened—but she frequently has to convince people to get screened. "I've had people tell me 'lung cancer is a death sentence, why would I want to know?'" Kitts said.

According to Kitts, advances in treatments have made significant progress against the disease, making early detection the best predictor of long-term survival.

"Increased lung cancer survival is attributable to advancements in research, better treatments and other factors, however, lung cancer screening is the most immediate opportunity we have to save lives," said Wimmer.

"If you are eligible for lung cancer screening, we encourage you to speak with your doctor about it. If a loved one is eligible, please encourage them to get screened," Wimmer added. (Weintraub, USA Today, 11/15; Hou, "Changing America," The Hill, 11/15)