Lung Cancer Rates
Incidence is the number of new lung cancer cases diagnosed each year. The rate of new lung cancer cases in North Carolina is 70.9, higher than the national rate of 63.0, and ranks 38th among all states.
5-Year Survival Rate
The percent of people still alive five years after being diagnosed with lung cancer (the survival rate) in North Carolina is 19.5 percent, about the same as the national rate of 20.0 percent, and 17th among the 31 states with survival data. It is important to track survival rates in order to identify progress against lung cancer and where more efforts are needed to save lives.
Stage at Diagnosis
Most lung cancer cases are diagnosed at later stages when the cancer has spread to other organs, treatment options are more limited, and survival is lower.
In North Carolina only 19.0 percent of cases are caught early when survival is much higher (55.3 percent nationally). Unfortunately, most cases (50.0 percent) are not caught until a late stage when survival is only 4.5 percent (nationally). Stage-specific survival data is not available for North Carolina. Stage at diagnosis does not add up to 100 percent because middle stages are not shown.
|Percent of Cases Diagnosed at Stage||5-Year Survival|
|Percent of Cases Diagnosed at Stage||50||18.9|
Lung cancer can often be treated with surgery as part of the first course of treatment if it is at an early stage and has not spread outside of the lung and lymph nodes close to the lung. While surgery may not be an option for every patient, those who receive it as part of their initial treatment have higher survival rates than those who do not. Patients who are not healthy enough to undergo the procedure or whose cancer has spread too far may not be candidates for surgery. Other treatments may be recommended instead of or in addition to surgery, such as chemotherapy, radiation, targeted therapy or immunotherapy.
North Carolina ranked 21st (out of the 48 states with available data) with 20.5 percent of cases undergoing surgery as part of the first course of treatment, about the same rate as nationally (21.0 percent).
Screening for lung cancer with annual low-dose CT scans among those at high risk can reduce the lung cancer death rate by up to 20 percent by detecting tumors at early stages when they are more likely to be curable.
High-risk is defined as:
- 55-80 years of age;
- Have a 30 pack-year history of smoking (this means 1 pack a day for 30 years, 2 packs a day for 15 years, etc.);
- AND, are a current smoker, or have quit within the last 15 years.
For screening to be most effective, patients must be able to access high-quality centers offering the service, such as those accredited by the American College of Radiology. Patients may benefit from a greater number of accredited centers in their state as can improve the chances of a center being nearby and their ability to get screened.
North Carolina ranked 14th among all states with 6.0 accredited lung cancer screening centers per million people, about the same as the national rate of 4.8 centers per million people. Although better than many states, this is still far below the 21.1 centers per million people in Rhode Island. This may indicate that lack of access could be a barrier to lung cancer screening for some in North Carolina.
Tobacco use is the leading risk factor for lung cancer. Smoking and second-hand smoke have both been shown to cause lung cancer.
The smoking rate in North Carolina is 19.0 percent, higher than the national average of 16.8 percent.
The line in the chart shows that, on average, each one point increase in the smoking rate for a state equals an increase of 2.4 points in the lung cancer incidence (the number of new lung cancer cases) rate. For North Carolina the smoking rate is higher than the national average, while the lung cancer incidence rate is higher than what would be expected for this smoking rate, as shown by the North Carolina data point being above the green line in the chart. This suggests that people living in North Carolina might have higher exposures to other risk factors besides smoking.
Each year the American Lung Association puts out the "State of Tobacco Control" report. The 2018 report grades all 50 states and the federal government on four key tobacco control policies: tobacco control and prevention spending, smokefree air, tobacco taxes, and cessation coverage. North Carolina's 2018 "State of Tobacco Control" report grades are:
- "F" for Tobacco Prevention Program Funding;
- "F" for Smokefree Air;
- "F" for Tobacco Taxes;
- "F" for Access to Tobacco Cessation Treatments; and
- "F" for Tobacco 21 Laws.
For more information about smoking, visit Lung.org/stop-smoking.
Radon is the second leading cause of lung cancer. Radon is a colorless and odorless gas that can seep into homes and buildings. Some geographical areas have naturally higher prevalence of high radon levels than others, but any home can have elevated levels. The US EPA has set an action level of 4 pCi/L. At or above this level of radon, the EPA recommends you take corrective measures to reduce your exposure to radon gas.
- 8 counties in North Carolina are considered Zone 1 which means they have predicted average indoor radon screening levels greater than 4 pCi/L.
- 31 counties in North Carolina are considered Zone 2 which means they have predicted average indoor radon screening levels from 2 to 4 pCi/L.
For more information on radon testing and removal, visit Lung.org/radon.
Air Pollution is a known risk factor of lung cancer.
- One outdoor air pollutant found to cause lung cancer is year-round particle pollution. Each year the American Lung Association puts out the "State of the Air 2017" report. The 2017 report grades U.S. counties on harmful particle pollution and ozone pollution recorded over a three-year period, and details trends for metropolitan areas over the past two decades. The report ranks also both the cleanest and most polluted areas in the country. View the North Carolina report card.
For more information about air pollution, visit Lung.org/healthy-air.
Both the smoking rate and lung cancer incidence rate in North Carolina are higher than average. The state has an average number of screening centers per person, which could contribute to both its average rate of surgery during the initial round of treatment and average survival rate.
North Carolina residents can lower their risk of lung cancer, as well as the risk of those around them, through these steps:
- Talk to your healthcare provider if you meet the high-risk criteria, and encourage others who meet the criteria to do the same:
- If you or someone you know is ready to quit smoking, the American Lung Association is here to help. Our Freedom From Smoking program has helped over a million people quit smoking for good.
- Higher tobacco taxes both encourage people to quit and prevent children and others from starting to smoke.
- Well-funded tobacco control programs are an important part of helping people quit and keeping potential new smokers from starting.
- Comprehensive coverage of all FDA-approved smoking cessation medication and the three forms of counseling, with no barriers to accessing them, leads to more successful quit attempts.
- Make your house and car smokefree air zones, with no smoking allowed. Avoid places that are not smokefree, and advocate for smokefree air policies in restaurants, bars, casinos or anywhere they are not in place.
- Test your house for radon, and take steps to reduce your risk if levels are too high.
- Reduce your exposure to unhealthy outdoor air.
- Stay indoors on unhealthy air days.
- Support clean air policies, including emissions limits and no vehicle idling zones.
Maintaining a high number of quality, accredited screening centers will help ensure that both as many patients undergo surgery during their initial round of treatment and as high a survival rate as possible.