Alabama

The rate of new lung cancer cases in Alabama is 65.2 and significantly higher than the national rate of 58.7. It ranks 37th among all states, placing it in the average tier. Over the last five years, the rate of new cases in Alabama improved by 8.9%.

Racial and Ethnic Disparities in New Cases

• The rate of new lung cancer cases is 57.6 among Black Americans in Alabama, significantly lower than the rate of 61.1 among Black Americans nationally, and significantly lower than the rate of 68.4 among whites in Alabama.
• The rate of new lung cancer cases is 21.5 among Latinos in Alabama, significantly lower than the rate of 29.9 among Latinos nationally, and significantly lower than the rate of 68.4 among whites in Alabama.
• The rate of new lung cancer cases is 38.1 among Asian Americans or Pacific Islanders in Alabama, not significantly different than the rate of 34.6 among Asian Americans or Pacific Islanders nationally, and significantly lower than the rate of 68.4 among whites in Alabama.
• The rate of new lung cancer cases is 16.4 among Indigenous Peoples (American Indians/Alaska Natives) in Alabama, significantly lower than the rate of 42.0 among Indigenous Peoples nationally, and significantly lower than the rate of 68.4 among whites in Alabama.



Note: Value of 0 indicates data is not available

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5-Year Survival Rate

The percent of people still alive five years after being diagnosed with lung cancer (the survival rate) in Alabama is 17.1%, which is significantly lower than the national rate of 22.6%. It ranks 47th among the 47 states with survival data, placing it in the bottom tier. Over the last five years, the survival rate in Alabama did not change significantly.

Stage at Diagnosis

Most lung cancer cases are diagnosed at later stages when the cancer has spread to other organs, treatment options are less likely to be curative, and survival is lower. 

Nationally, only 22.9% of cases are caught early when the five-year survival rate is much higher (59%). Unfortunately, most cases (47%) are not caught until a late stage when the survival rate is only 6%. 

In Alabama, 21.4% of cases are caught at an early stage, which is significantly lower than the national rate of 22.9%. It ranks 38th among the 49 states with data on diagnosis at an early stage, placing it in the below average tier. Over the last five years, the early diagnosis rate in Alabama improved by 33.4%.



Note: Value of 0 indicates data is not available

Racial and Ethnic Disparities in Early Diagnosis

• The early diagnosis rate is 16.8% among Black Americans in Alabama, significantly lower than the rate of 19.7% among Black Americans nationally, and significantly lower than the rate of 22.4% among whites in Alabama.
• The early diagnosis rate is 28.8% among Latinos in Alabama, not significantly different than the rate of 20.4% among Latinos nationally, and not significantly different than the rate of 22.4% among whites in Alabama.
• The early diagnosis rate is 21.5% among Asian Americans or Pacific Islanders in Alabama, not significantly different than the rate of 19.9% among Asian Americans or Pacific Islanders nationally, and not significantly different than the rate of 22.4% among whites in Alabama.
• The early diagnosis rate is not available for other racial and ethnic groups in Alabama due to too few cases among these groups over the time period to allow for accurate analysis.

Lung Cancer Treatment

Surgical Treatment

Lung cancer can often be treated with surgery as part of the first course of treatment if it is diagnosed 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.

Alabama ranked 37th (out of the 49 states with available data) with 17.8% of cases undergoing surgery as part of the first course of treatment. This is significantly lower than the national rate of 20.6% and puts Alabama in the below average tier. Over the last five years, the percent of cases undergoing surgery in Alabama did not change significantly.

Racial and Ethnic Disparities in Surgical Treatment

• The percent of cases undergoing surgery is 14.3% among Black Americans in Alabama, significantly lower than the rate of 17.1% among Black Americans nationally, and significantly lower than the rate of 18.6% among whites in Alabama.
• The percent of cases undergoing surgery is 26.3% among Latinos in Alabama, not significantly different than the rate of 20.6% among Latinos nationally, and not significantly different than the rate of 18.6% among whites in Alabama.
• The percent of cases undergoing surgical treatment is not available for other racial and ethnic groups in Alabama due to too few cases among these groups over the time period to allow for accurate analysis.



Note: Value of 0 indicates data is not available

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Lack of Treatment

Not every patient receives treatment after being diagnosed with lung cancer. This can happen for multiple reasons, such as the tumor having spread too far, poor health, or refusal of treatment. Some of these reasons may be unavoidable, but no one should go untreated because of lack of provider or patient knowledge, stigma associated with lung cancer, fatalism after diagnosis, or cost of treatment. Dismantling these and other barriers is important to reducing the percent of untreated patients.

Alabama ranked 35th (out of the 48 states with available data) with 17.8% of cases receiving no treatment. This is significantly higher than the national rate of 15.2% and puts Alabama in the average tier. Over the last five years, the percent of cases receiving no treatment in Alabama did not change significantly.

Racial and Ethnic Disparities in Lack of Treatment

• The percent of cases receiving no treatment is 19.2% among Black Americans in Alabama, significantly higher than the rate of 15.8% among Black Americans nationally, and significantly higher than the rate of 17.6% among whites in Alabama.
• The percent of cases receiving no treatment is not available for other racial and ethnic groups in Alabama due to too few cases among these groups over the time period to allow for accurate analysis.



Note: Value of 0 indicates data is not available

Screening

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, more of the high-risk population should be screened - currently screening rates are very low among those at high risk. This may be because of a lack of access or low awareness and knowledge among patients and providers. As rates vary tremendously between states, it is clear that more can be done to increase screening rates.

In Alabama, 5.9% of those at high risk were screened, which was not significantly different than the national rate of 5.7%. It ranks 29th among all states, placing it in the average tier.

Medicaid Coverage of Screening

Medicaid beneficiaries are disproportionately affected by lung cancer, yet standard Medicaid programs are one of the only healthcare payers not required to cover lung cancer screening. If screening is covered, Medicaid programs may use different eligibility criteria, require prior authorization or charge individuals for their scans. The American Lung Association analyzed lung cancer screening coverage policies in state Medicaid fee-for-service programs to assess the current status of lung cancer screening coverage for the Medicaid population and found that 6.4% of those at high risk had been screened in states where fee-for-service Medicaid plans covered screening, compared to 3.3% in states that did not cover screening. 

Alabama was one of the 9 states whose Medicaid fee-for-service programs did not cover lung cancer screening as of February 2020. Coverage may also vary between fee-for-service and managed care plans within a state’s Medicaid program. 

The Lung Association urges all state Medicaid programs to cover lung cancer screening based on evidence-based guidelines across all fee-for-service and managed care plans and to remove any financial or administrative barriers that limit access to this lifesaving service.  

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Prevention

Tobacco use is the leading risk factor for lung cancer. Smoking and secondhand smoke both have been shown to cause lung cancer.

The smoking rate in Alabama is 19.2% and significantly higher than the national rate of 15.5%. It ranks 41st among all states, placing it in the below average tier.

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Each year the Lung Association publishes the "State of Tobacco Control" report. The 202019 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. View the Alabama report card.

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.

• 13 counties in Alabama are considered Zone 1 which means they have predicted average indoor radon screening levels greater than 4 pCi/L.
• 33 counties in Alabama are considered Zone 2 which means they have predicted average indoor radon screening levels from 2 to 4 pCi/L.

Air Pollution is a known risk factor of lung cancer.

• Year-round outdoor particle pollution is known to cause lung cancer. One outdoor air pollutant found to cause lung cancer is year-round particle pollution. Each year the Lung Association publishes the "State of the Air" report. The 2020 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 Alabama report card. 

Summary

• Rate of New Cases: Average Tier
• Five-Year Survival Rate: Bottom Tier
• Early Diagnosis Rate: Below Average Tier
• Surgical Treatment Rate: Below Average Tier
• Lack of Treatment Rate: Average Tier
• Screening Rate: Average Tier
• Fee-For-Service Medicaid Coverage of Screening: No
• Highlighted Disparity: Black Americans in Alabama are least likely to be diagnosed early.

The early diagnosis rate in Alabama falls into the below average tier. The the state still has a lot of work to do to make sure that more of those at high risk for lung cancer are screened. When this rate increases, we can anticipate that the surgery rate would increase, as surgery is often the recommended treatment for those diagnosed at an earlier stage. In addition, when cases are found earlier, we would expect the five-year survival rate to increase.  

The Lung Association encourages all states to cover lung cancer screening based on recommended guidelines across all fee-for-service and managed care plans without any financial or administrative barriers in their Medicaid programs. 

Alabama falls into the average tier for percent of patients receiving no treatment. Some patients do refuse treatment, but fatalism, stigma and access issues can prevent eligible patients from receiving treatment that may save or extend their lives. All patients should work with their doctors to establish a treatment plan and goals. 

Alabama 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 Lung Association is here to help. Our Freedom From Smoking program has helped over a million people quit smoking for good. 
• Support comprehensive and strong tobacco control policies, including: 
  •  Higher tobacco taxes, which both encourage people to quit and prevent children and others from starting to smoke. 
  • Adequate funding of tobacco control programs, which 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, which leads to more successful quit attempts. 
• Make your house and car clean 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.