Methodology and Sources | American Lung Association

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Methodology and Sources


The report includes state-specific measures of lung cancer incidence, adult smoking prevalence, radon zones, five-year survival, stage at diagnosis, five-year survival by stage at diagnosis, surgery as part of the first course of treatment, and accredited lung cancer screening centers.

States were ranked from best to worst for each cancer-specific measure. In addition, statements describing the distance from the mean (average) for each specific state measure were crafted to convey a clearer understanding of how each specific data point falls within the national data range, and how the state data differs from the national average.

Statements such as "much higher than average" and "similar to average," were determined by dividing each measure (incidence, smoking, survival, stage at diagnosis, surgery, and centers per person) into two sets of five contiguous ranges; one set ranging from the maximum observed value to the national average, and the other from the national average to the minimum observed value. Data values were described by which category they fell into:

  • the two lowest categories were classified as "much lower than average;"
  • data values that fell into the third and fourth lowest categories were classified as "lower than average;"
  • data values that fell into the two middle categories were classified as "similar to average;"
  • data values that fell into the third and fourth highest categories were classified as "higher than average;" and
  • data values that fell into the two highest categories were classified as "much higher than average"

State of Lung Cancer - Higher/Lower Figure graph

Data Sources

Lung cancer incidence, staging and surgical treatment data is for years 2009-2013 and includes malignant lung and bronchus tumors. These data are based on the North American Association of Central Cancer Registries (NAACCR) December 2015 data submission. Support for cancer registries is provided by the state, province or territory in which the registry is located. In the U.S., registries also participate in the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) Program or the Centers for Disease Control and Prevention's (CDC) National Program of Cancer Registries (NPCR) or both.

Incidence data for Kansas, Maryland, Minnesota, and Vermont are from CDC’s WONDER Online Database United States Cancer Statistics, as data from these states were not included in the NAACCR data submission.

Additional Maryland cancer data were provided by the Maryland Cancer Registry, Center for Cancer Surveillance and Control, Department of Health and Mental Hygiene 201 W. Preston Street, Room 400, Baltimore, MD 21201. We acknowledge the State of Maryland, the Maryland Cigarette Restitution Fund, and the NPCR of the CDC for the funds that helped support the availability of the cancer registry data.

Cases diagnosed at an early stage correspond with local stage from SEER summary staging and are generally equivalent to stage I. Cases diagnosed at a late stage correspond with distant stage from SEER summary staging and are generally equivalent to stage IV. Cases diagnosed after an early stage but before a late stage are not shown in this report but correspond with regional stage from SEER summary staging and are generally equivalent to stages II and III.

Survival rates are the age-standardized percent of cases still alive five years after diagnosis for cases diagnosed in years 2006-2012. These data are from Cancer in North America: 2009-2013 Volume Four: Cancer Survival in the United States and Canada 2006-2012 from NAACCR. Only 31 states have the infrastructure in place to track cancer cases after diagnosis; the other 29 states and District of Columbia are not included in our analysis as survival data is not available for them.

States with Cancer Survival Data Available


Survival rates by stage are for cases diagnosed in years 2008-2012 from U.S. National Institutes of Health, National Cancer Institute: SEER 18 Registries database, November 2015 submission, SEER*Stat version 8.3.2. These data are only available for the 13 states included in this database (Alaska, California, Connecticut, Georgia, Hawaii, Iowa, Kentucky, Louisiana, Michigan, New Jersey, New Mexico, Utah, and Washington).

Smoking rates are the percent of adults who have ever smoked 100 or more cigarettes and currently smoke on some days or all days. These data are based on the 2015 Behavioral Risk Factor Surveillance System from the CDC.

The number of counties in each state by radon zone comes from the Environmental Protection Agency’s Map of Radon Zones.

Data on the number of lung cancer screening centers accredited by the American College of Radiology (ACR) was provided by ACR and current as of May 2017.

State population data comes from the U.S. Census Bureau’s Population Estimates Branch, Annual Estimates of the Resident Population by Selected Age Groups and Sex for Counties: April 1, 2010 to July 1, 2015.

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