District of ColumbiaUnderstand lung cancer burden in District of Columbia by looking at the measures of incidence, survival rates, stage at diagnosis, surgical treatment and availability of screening centers.
The rate of new lung cancer cases in the District of Columbia is 53.4 and significantly lower than the national rate of 59.6. It ranks 10th among all states, placing it in the average tier.
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.
Nationally, 15.4 percent of cases recieve no treatment. Data on lack of treatment is not available for the District of Columbia.
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.
In the District of Columbia, 2.3 percent of those at high risk were screened, which was lower than the national rate of 4.2 percent. It ranks 43rd among all states, placing it in the below average tier.
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 4.8 percent of those at high risk had been screened in states where fee-for-service Medicaid plans covered screening, compared to 2.6 percent in states that did not cover screening.
The District of Columbia was one of the 31 states whose Medicaid fee-for-service programs covered lung cancer screening as of January 2019. While their program used recommended guidelines for determining eligibility, it did require prior authorization.
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 the District of Columbia is 14.3% and significantly lower than the national rate of 16.4%. It ranks 10th among all states, placing it in the above average tier.
Each year the American Lung Association puts out the "State of Tobacco Control" report. The 2019 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. District of Columbia's 2019 "State of Tobacco Control" report grades are:
- "F" for Tobacco Prevention Program Funding;
- "A" for Smokefree Air;
- "A" for Tobacco Taxes;
- "D" for Access to Tobacco Cessation Treatments; and
- "A" 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.
- No counties in District of Columbia are considered Zone 1 which means they have predicted average indoor radon screening levels greater than 4 pCi/L.
- No counties in District of Columbia 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" report. The 2019 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 District of Columbia report card.
For more information about air pollution, visit Lung.org/healthy-air.
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 21.5 percent of cases are caught early when the five-year survival rate is much higher (57.7 percent). Unfortunately, most cases (48.5 percent) are not caught until a late stage when the survival rate is only 6.0 percent.
The early diagnosis rate is not available for the District of Columbia.
The American Lung Association's "State of Lung Cancer" report explores how lung cancer varies by state. It does this by analyzing key lung cancer indicators including incidence, survival, stage at diagnosis, surgical treatment, lack of treatment and screening rates. Learn more about how lung cancer is affecting your state and contact your local officials to urge them to help save more lives by encouraging lung cancer screening.
- Incidence Rate: Average
- Five-Year Survival Rate: N/A
- Early Diagnosis Rate: N/A
- Surgical Treatment Rate: N/A
- Lack of Treatment Rate: N/A
- Screening Rate: Below Average Tier
- Fee-For-Service Medicaid Coverage of Screening: Yes, used recommended guidelines for determining eligibility, but required prior authorization
Early diagnosis data is not available for the District of Columbia. 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 District of Columbia has improved access to screening by covering it through its fee-for-service Medicaid program. The Lung Association encourages all states and the District of Columbia 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.
District of Columbia 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.
- 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 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.
Increasing lung cancer screening rates among those at high risk will help ensure that more patients undergo surgery during their initial round of treatment and survive the disease.
The percent of people still alive five years after being diagnosed with lung cancer (the survival rate) is 21.7 percent nationally. District of Columbia is one of the 6 states for which survival data is not available as they do not track cases after diagnosis.
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.
Nationally, 20.6 percent of cases undergo surgery as part of the first course of treatment. Data on surgery as part of the first course of treatment is not available for the District of Columbia.