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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 lawmakers urging them to save lives by protecting and expanding access to quality and affordable healthcare.

Rate of New Cases Survival Rate Early Diagnosis Surgical Treatment Lack of Treatment Screening
Rate of New Cases
Survival Rate
Early Diagnosis
Surgical Treatment
Lack of Treatment
Screening

Fee-For-Service Medicaid Coverage of Screening

Covered

Highlighted Disparity

Latino individuals in Hawaii are most likely to be diagnosed with lung cancer.

Lung Cancer Rates

New Cases

New Cases:

  • The rate of new lung cancer cases is 41.9 and significantly lower than the national rate of 54.6.
  • Hawaii ranks 6th among all states, placing it in the above average tier.
  • Over the last five years, the rate of new cases in Hawaii improved by 24%.
5-Year Survival Rate

5-Year Survival Rate:

  • The percent of people alive five years after being diagnosed with lung cancer (the survival rate) in Hawaii is 22.8%, which is significantly lower than the national rate of 26.6%.
  • It ranks 35th among the 42 states with survival data, placing it in the bottom tier.
  • Over the last five years, the survival rate in Hawaii improved by 22%.
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. In general, the earlier that lung cancer is diagnosed, the more likely that treatments will be effective and improve chances of survival.

Nationally, only 26.6% of cases are caught early when the five-year survival rate is much higher (63%). Unfortunately, most cases (44%) are not caught until a late stage when the survival rate is only 8%.

 

Early Diagnosis:

  • 20.3% of cases are caught at an early stage, which is significantly lower than the national rate of 26.6%.
  • It ranks 47th among the 47 states with data on diagnosis at an early stage, placing it in the bottom tier.
  • Over the last five years, the early diagnosis rate in Hawaii improved by 33%.

Lung Cancer Treatment

Surgical

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.

Surgical Treatment:

  • Hawaii ranked 35th (out of the 47 states with available data) with 17.7% of cases undergoing surgery as part of the first course of treatment.
  • This is significantly lower than the national rate of 20.8% and puts Hawaii in the below average tier.
  • Over the last five years, the percent of cases undergoing surgery in Hawaii did not change significantly.
Lack of Treatment

Not every patient receives treatment after being diagnosed with lung cancer. This can happen for multiple reasons, such as 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 patients who do not receive any treatment.

Lack of Treatment:

  • Hawaii ranked 41st (out of the 47 states with available data) with 24.3% of cases not receiving any treatment.
  • This is significantly higher than the national rate of 20.6% and puts Hawaii in the below average tier.
  • Over the last five years, the percent of cases receiving no treatment in Hawaii did not change significantly.

Screening

High Risk

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% by detecting tumors at early stages when they are more likely to be curable.

Based on new research, in March of 2021, the United States Preventive Services Task Force expanded its recommendation for screening to include a larger age range and more current and former smokers. This will dramatically increase the number of women and Black Americans considered at high risk for lung cancer.

High Risk is defined as:

  2020 Guidelines 2021 Guidelines
Age 55-80 years 50-80 years
Smoking History 30 or more pack years
(this means 1 pack a day for 30 years, 2 packs a day for 15 years, etc.)		 20 or more pack years
(this means 1 pack a day for 20 years, 2 packs a day for 10 years, etc.)
Smoking Status Current smoker or quit within the last 15 years
 

Screening for High Risk:

  • In Hawaii, 2.6% of those at high risk were screened, which was significantly lower than the national rate of 4.5%.
  • It ranks 40th among all states, placing it in the below average tier.
  • Actual screening rates may be higher in states with large, regional managed care providers that did not share screening data.

For screening to be most effective in reducing the overall lung cancer mortality rate, 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. Rates vary tremendously between states and more can be done to increase screening rates.

Medicaid Coverage

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.

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.

 

Medicaid Coverage:

  • Hawaii was one of the 49 states whose Medicaid fee-for-service programs covered lung cancer screening as of October 2023. 
  • While their program used recommended guidelines for determining eligibility, it did require prior authorization and copays.

Prevention

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

State of Tobacco Control

Each year the Lung Association publishes the "State of Tobacco Control" report. The 2023 report grades the federal government and all 50 states on key tobacco control policies. States are graded in five policy areas: tobacco control and prevention spending, smokefree air, tobacco taxes, access to cessation services and flavor tobacco prohibitions.
View Report Card

Tobacco Use:

  • The smoking rate in Hawaii is 10.1% and significantly lower than the national rate of 13.5%.
  • It ranks 4th among all states, placing it in the above average tier.
Radon
​
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 naturally have higher average radon levels than others, but since any home can be at risk for elevated levels, the only way to know is to do a test. If testing shows interior radon levels at or above the U.S. EPA action level of 4 pCi/L (picoCuries per liter of air) or higher, it is recommended to take corrective measures to reduce your exposure to radon gas. Such measures should also be considered at levels at or above 2 pCi/L.
 

Radon:

  • In Hawaii, 0.4% of radon tests results were at or above the action level recommended by EPA.
  • It ranks 1st among all states, placing it in the top tier.
Air Pollution
​
Air pollution is a known risk factor for lung cancer. Long-term exposure to outdoor particle pollution is known to cause lung cancer.

State of the Air

Each year the Lung Association publishes the "State of the Air" report. The 2023 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 also ranks the cleanest and most polluted areas in the country.
View Report Card

Racial & Ethnic Disparities

Black
 

Black individuals:

  • The rate of new lung cancer cases is 35.9 per 100,000 population among Black individuals in Hawaii, significantly lower than the rate of 56.3 among Black individuals nationally, and not significantly different than the rate of 39.2 among white individuals in Hawaii. 
  • The five-year survival rate is 22.7% among Black individuals in Hawaii, not significantly different than the rate of 23.8% among Black individuals nationally, and not significantly different than the rate of 24.4% among white individuals in Hawaii. 
  • Other lung cancer rates are not available for Black individuals in Hawaii due to too few cases over the time period to allow for accurate analysis. 
Latino
 

Latino individuals:

  • The rate of new lung cancer cases is 76.6 per 100,000 population among Latino individuals in Hawaii, significantly higher than the rate of 28.2 among Latino individuals nationally, and significantly higher than the rate of 39.2 among white individuals in Hawaii. 
  • State-level survival rates are not available for Latino individuals at this time. Nationally, the five-year survival rate among Latino individuals is 22.7%, not significantly different than the rate of 25.0% among white individuals. 
  • 19.3% of lung cancer cases are diagnosed at an early stage among Latino individuals in Hawaii, not significantly different than the rate of 23.1% among Latino individuals nationally, and not significantly different than the rate of 22.6% among white individuals in Hawaii. 
  • 15.5% of Latino individuals with lung cancer in Hawaii underwent surgery, significantly lower than the rate of 21.6% among Latino individuals nationally, and significantly lower than the rate of 23.4% among white individuals in Hawaii. 
  • 25.3% of Latino individuals with lung cancer in Hawaii did not receive any treatment, not significantly different than the rate of 26.1% among Latino individuals nationally, and not significantly different than the rate of 23.9% among white individuals in Hawaii. 
Asian & Pacific Islander
 

Asian Americans or Pacific Islanders:

  • The rate of new lung cancer cases is 43.0 per 100,000 population among Asian or Pacific Islanders individuals in Hawaii, significantly higher than the rate of 32.9 among Asian or Pacific Islanders individuals nationally, and significantly higher than the rate of 39.2 among white individuals in Hawaii. 
  • State-level survival rates are not available for Asian or Pacific Islander individuals at this time. Nationally, the five-year survival rate among Asian or Pacific Islander individuals is 28.6% and significantly higher than the rate of 25.0% among white individuals. 
  • 19.5% of lung cancer cases are diagnosed at an early stage among Asian or Pacific Islander individuals in Hawaii, significantly lower than the rate of 22.8% among Asian or Pacific Islander individuals nationally, and not significantly different than the rate of 22.6% among white individuals in Hawaii. 
  • 15.8% of Asian or Pacific Islander individuals with lung cancer in Hawaii underwent surgery, significantly lower than the rate of 24.7% among Asian or Pacific Islander individuals nationally, and significantly lower than the rate of 23.4% among white individuals in Hawaii. 
  • 24.4% of Asian or Pacific Islander individuals with lung cancer in Hawaii did not receive any treatment, significantly higher than the rate of 20.2% among Asian or Pacific Islander individuals nationally, and not significantly different than the rate of 23.9% among white individuals in Hawaii. 
Indigenous Peoples
 

Indigenous Peoples:

  • The rate of new lung cancer cases is 77.9 per 100,000 population among Indigenous Peoples (American Indians/Alaska Natives) in Hawaii, not significantly different than the rate of 39.4 among Indigenous Peoples nationally, and not significantly different than the rate of 39.2 among white individuals in Hawaii. 
  • State-level survival rates are not available for Indigenous Peoples at this time. Nationally, the five-year survival rate among Indigenous Peoples is 22.3% and not significantly different than the rate of 25.0% among white individuals. 
  • Other lung cancer rates are not available for Indigenous Peoples (American Indians/Alaska Natives) in Hawaii due to too few cases over the time period to allow for accurate analysis. 

Summary

The early diagnosis rate in Hawaii falls into the bottom tier. 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.

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

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

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State Infographic

Compare out how your state ranks on each lung cancer measure.

Download PDF
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What Can I Do?

You can lower their risk of lung cancer, as well as the risk of those around you, through these steps:

Email President Biden

Email President Biden to thank him for his leadership on the Cancer Moonshot Initiative and urge him to work to increase lung cancer screening for individuals at high risk.

Take Action
  • 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.

Radon is a naturally occurring gas that can have a big impact on indoor air quality and your health. Take steps to reduce your risk if radon levels in your home are too high.
Learn more about radon