Key Findings | American Lung Association

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Key Findings

Every three and a half minutes someone in the United States will die from lung cancer, accounting for about one in four cancer deaths. The five-year survival rate for lung cancer is less than one in five (18.1 percent) - much lower than those for many other common cancers, making it the leading cause of cancer deaths in the United States. Why is lung cancer so deadly? Partly because most lung cancer cases are diagnosed at a later stage, when the disease is less curable. Much more must be done to address this horrible disease.

A strategic imperative of the American Lung Association is to defeat lung cancer, and to do so, we need a multipronged approach that engages a variety of tactics and stakeholders to address the disease, its risk factors, public policy efforts and public health protections, access to lung cancer screening and more.

The LUNG FORCE "State of Lung Cancer" report identifies potential interventions and also provides a state-specific understanding of the burden of and opportunities to address lung cancer.

The report also serves as both a guidepost and rallying call, providing policymakers, researchers, healthcare practitioners, as well as patients, caregivers and others committed to ending lung cancer with a one-stop resource for identifying where their state can best focus its resources to decrease the toll of lung cancer. See the rates in your state and then sign our petition asking your governor to act.

The State-by-State Toll of Lung Cancer

While we have seen some advancements in personalized treatment thanks to biomarker testing, targeted therapies, as well as a method of early detection, the burden of lung cancer is not the same everywhere. Treatment, exposure to risk factors, and access to screening facilities vary from state to state. To save lives, it's critical to both prevent lung cancer when possible and diagnose the disease at an earlier stage.

By better understanding the impact of lung cancer at the state level, we can encourage interventions to save lives. This report considers the following measures of lung cancer burden by state: incidence, survival rates, stage at diagnosis, surgical treatment and availability of screening centers and identifies where each state ranks on each of these measures.


More than 234,000 people will be diagnosed with lung cancer this year, and the rate of new cases varies greatly by state. The report finds that Utah has the nation’s lowest lung cancer rates while Kentucky has the highest. There are a variety of risk factors associated with lung cancer, including smoking, exposure to radon gas, air pollution and secondhand smoke. Radon testing and mitigation, healthy air protections, and reducing the smoking rate through tobacco tax increases, smokefree air laws and access to comprehensive quit smoking services are all ways to help prevent new lung cancer cases.

Survival Rates

The survival rate of lung cancer varies by state. Lung cancer has one of the lowest five-year survival rates among leading cancers because it is often not caught at an early stage when it is more likely to be curable. The five-year lung cancer survival rate was 20.0 percent nationally, ranging from 24.0 percent in New York to 15.9 in Louisiana. Only 31 states track this important metric, which should be implemented by all states to enhance monitoring of lung cancer, as well as all other cancers.

Screening Centers

Research has shown that lung cancer screening can catch more cases earlier and save lives. The availability of more lung cancer screening sites will increase screening access for patients at high risk, and have a positive impact on early detection and survival of lung cancer. Delaware had the most screening centers per million people at 21.1, while Utah had the fewest centers per million people at 0.7.

If half of those currently eligible were screened, an estimated 15,000 lives could be saved. For those ages 55-80 with a 30 pack year history who still smoke or have quit within the last 15 years, screening with annual low-dose CT scans can reduce the lung cancer death rate by up to 20 percent by detecting tumors at early stages when it is more likely to be curable. 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.

When looking at survival rates, the analysis in this report showed that states with more accredited screening centers per capita generally have higher survival rates, with each additional center per million people being associated with a 0.3 point increase in the lung cancer survival rate.

Early Diagnosis

The stage at which someone is diagnosed with lung cancer varies significantly by state. People diagnosed in early stages are five times more likely to survive. Unfortunately, only 18.9 percent of cases nationally are diagnosed at an early stage. The percent of cases diagnosed at an early stage was highest for Wyoming at 23.3 percent and lowest for Hawaii at 15.0 percent.

Surgical Treatment

Lung cancer is more likely to be curable if the tumor can be removed through surgery, and surgery is more likely to be an option if the diagnosis is made at an early stage before the cancer has spread. Nationally, 21.0 percent of cases underwent surgery as part of the first course of treatment, ranging from 30.1 percent in Massachusetts to 14.3 percent in Oklahoma.

States with the most screening centers per capita had a higher portion of patients undergoing surgery as part of the first course of treatment, with each additional center per million people associated with a 0.4 point increase in the percent of patients undergoing surgery. This is a small increase, but might be indicative of a larger trend.

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. This report focuses on surgery because it is more likely to be curative.


The relationships between screening centers per capita and survival, and early stage at diagnosis and surgery are intriguing but at this time do not prove that more screening centers per capita lead to improvements in these outcomes. The data on stage at diagnosis and surgery used in this report is from 2009-2013. Lung cancer screening was first recommended in 2013, and not covered by insurance or Medicare without cost-sharing until 2015. These diagnoses occurred before screening was widely available, and before it was covered without cost-sharing.

Similarly, for survival rate, there is an additional five-year data lag that is required to track cases after diagnosis. Given these data limitations, the observed relationships suggest that additional factors are driving the number of screening centers per capita and survival, stage at diagnosis, and surgery. For example, states with higher quality healthcare could be expected to have better lung cancer outcome measures and be more likely to have accredited screening centers. These data can serve as a baseline to track the impact of lung cancer screening on a host of measures, including stage at detection, and ultimately, survival.

The analysis in the "State of Lung Cancer" serves as a baseline against which future data can be compared, which may be especially beneficial as progress is made on the implementation of lung cancer screening.


A key to prevention is to raise awareness about tobacco use, exposure to radon gas, air pollution, and secondhand smoke, all of which are known to cause lung cancer. Despite understanding of these risk factors, for some patients the cause of lung cancer is not clear. A family history of lung cancer may mean you are at a higher risk of getting the disease. If others in your family have or ever had lung cancer, it is important to mention this to your doctor.

This report contains information and data on exposures to these risk factors on the state level:

  • Tobacco use is the leading risk factor for lung cancer, accounting for 80 to 90 percent of cases. While we have seen historic decreases in the national smoking rate, not all Americans or regions of the country have benefited equally. This report outlines existing smoking rates at the state level, and the relationship between adult smoking and lung cancer incidence by state.
  • Secondhand smoke has also been shown to cause lung cancer. There is no safe level of exposure to secondhand smoke. The report highlights that making homes, work places and public spaces smokefree air zones, with no smoking allowed, can reduce the risk of exposure. The report also offers state grades for efforts to protect public spaces from secondhand smoke.
  • Radon, a naturally occurring radioactive gas, is the second leading cause of lung cancer and the leading cause among nonsmokers. Radon is a colorless and odorless gas that can seep into homes and buildings. Some geographical areas have naturally higher radon rates than others, but any home can have elevated levels. The U.S. Environmental Protective Agency (EPA) has set an action level of 4 pCi/L (picocuries per liter of air). At or above this level of radon, the EPA recommends you take corrective measures to reduce your exposure to radon gas. The report highlights counties and their predicted average indoor radon screening level.
  • Exposure to year-round particle pollution in the air has been shown to cause lung cancer. Each year the American Lung Association puts out the “State of the Air” report. The 2017 report grades U.S. counties on harmful particle and ozone pollution recorded over a three-year period and details trends for metropolitan areas over the past two decades. The report also ranks both the cleanest and most polluted areas in the country.

Raising awareness of screening as secondary prevention can lead to early detection and increase survival in those diagnosed. For lung cancer screening to help as many of the at-risk population as possible, patients must have access to high-quality centers accredited by the American College of Radiology. Patients may benefit from a greater number of accredited centers in their state which can increase their ability to get screened.


As the American Lung Association works toward defeating lung cancer, it is the goal of the LUNG FORCE "State of Lung Cancer" report to empower the public with the knowledge and information to appeal to state governors and raise awareness of this deadly disease. The report takes a look at key lung cancer measures to highlight the burden and examine opportunities to better address lung cancer at the state level. The report found that in addition to incidence, early diagnosis, and surgical treatment, it is imperative for states to track survival rate and to identify opportunities to enact lung cancer interventions like decreasing exposure to radon and secondhand smoke, and eliminating tobacco use. This report is both a one-stop resource and rallying cry for state officials, policymakers, researchers and those affected by lung cancer and to emphasize the need for resources and action to decrease the toll of lung cancer across the country.

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