By Dr. Albert Rizzo
Dr. Albert Rizzo is the chief medical officer for the American Lung Association.
Lung cancer is the nation’s leading cause of cancer deaths, and every 2 minutes and 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.
More Americans are surviving lung cancer than ever before. This trend is promising, yet the disease remains the leading cause of cancer deaths. The new “State of Lung Cancer” report from the American Lung Association identifies opportunities for Delaware leaders to save lives in our communities, including for those 910 people in our state who will be diagnosed with lung cancer this year alone.
One of the reasons lung cancer is so deadly is because it’s often caught too late. This year’s report reveals the importance of screening, which is critical to reduce the burden of lung cancer on families. Lung cancer screening can help detect the disease early, when it’s more likely to be curable. Screening with annual low-dose CT scans can reduce the lung cancer death rate by up to 20%; however, only 8.9% of eligible Delaware residents were screened in 2021. While this is higher than the national average of 5.8%, it is still just a fraction of those who qualify for screening, indicating there is a need for education and awareness.
In March of 2021, the U.S. Preventive Services Task Force updated the lung cancer-screening eligibility guidelines, lowering the age for eligibility from 55 to 50, the pack-years smoked to a 20-pack history of smoking (from 30) and smoking history in the last 15 years. These updated screening guidelines nearly doubled 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. The American 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.
Nationally, the “State of Lung Cancer” report shows continued progress for lung cancer survival. The lung cancer five-year survival rate is now 25%, an increase of 21% from 2014-18. The report also highlights that, nationally, people of color who are diagnosed with lung cancer face worse outcomes compared to White Americans, including lower survival rates and being less likely to be diagnosed early, less likely to receive surgical treatment and more likely to receive no treatment.
The stage at which someone is diagnosed with lung cancer varies significantly by state. Nationally, only 25.8% of cases are caught early, when the five-year survival rate is much higher. In Delaware, the survival rate is 26%, a 26% improvement over the past five years. Early diagnosis is among the best in the nation at 27.8% (ranking ninth out of 49 states measured), a 22% improvement. Cases that are diagnosed at an earlier stage before a tumor has spread are also more likely to be eligible for surgery. Delaware’s surgery rate as first course of treatment is 20%, marking a 50% improvement over the last five years. The good news is that more Americans than ever are surviving lung cancer, but there remains much more work to be done.
Delaware’s new-case incidence rate is consistent with the national average (62.2 per 100,000 people, compared to 56.7, respectively), ranking 35 out of 50 states and the District of Columbia, and this is a 28% improvement over the past five years for Delaware. 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. Anyone can get lung cancer. 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.
More treatment options are available for lung cancer than ever before, yet not everyone is receiving treatment following diagnosis. In Delaware, 19.2% 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.
Our state officials must do more to reduce the burden of lung cancer by protecting and expanding quality and affordable health care coverage and improving access to lung cancer screening and treatment. The American Lung Association encourages everyone to join the effort to end lung cancer.
Learn more about the report, and email President Joe Biden to thank him for his leadership on the Cancer Moonshot initiative and urge him to work to increase lung cancer screening for individuals at lung.org/solc.