Logo of American Lung Association. Text reading, "State of Lung Cancer" with icon of lungs

North Carolina

Understand lung cancer burden in North Carolina by looking at the measures of incidence, survival rates, stage at diagnosis, surgical treatment and availability of screening centers.

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. 

Lung Cancer Rates

New Cases

The rate of new lung cancer cases in North Carolina is 68.0 and significantly higher than the national rate of 58.7. It ranks 41st among all states, placing it in the below average tier. Over the last five years, the rate of new cases in North Carolina improved by 11.6%.

Racial and Ethnic Disparities in New Cases
  • The rate of new lung cancer cases is 64.3 among Black Americans in North Carolina, significantly higher than the rate of 61.1 among Black Americans nationally, and significantly lower than the rate of 70.7 among whites in North Carolina.
  • The rate of new lung cancer cases is 24.1 among Latinos in North Carolina, significantly lower than the rate of 29.9 among Latinos nationally, and significantly lower than the rate of 70.7 among whites in North Carolina.
  • The rate of new lung cancer cases is 31.5 among Asian Americans or Pacific Islanders in North Carolina, not significantly different than the rate of 34.6 among Asian Americans or Pacific Islanders nationally, and significantly lower than the rate of 70.7 among whites in North Carolina.
  • The rate of new lung cancer cases is 58.7 among Indigenous Peoples (American Indians/Alaska Natives) in North Carolina, significantly higher than the rate of 42.0 among Indigenous Peoples nationally, and significantly lower than the rate of 70.7 among whites in North Carolina.


Note: Value of 0 indicates data is not available


5-Year Survival Rate

The percent of people still alive five years after being diagnosed with lung cancer (the survival rate) in North Carolina is 22.0%, which is not significantly different than the national rate of 22.6%. It ranks 24th among the 47 states with survival data, placing it in the average tier. Over the last five years, the survival rate in North Carolina improved by 12.8%.

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 North Carolina, 22.6% of cases are caught at an early stage, which is not significantly different than the national rate of 22.9%. It ranks 30th among the 49 states with data on diagnosis at an early stage, placing it in the average tier. Over the last five years, the early diagnosis rate in North Carolina improved by 35.1%.



Note: Value of 0 indicates data is not available

Racial and Ethnic Disparities in Early Diagnosis
  • The early diagnosis rate is 19.2% among Black Americans in North Carolina, not significantly different than the rate of 19.7% among Black Americans nationally, and significantly lower than the rate of 23.5% among whites in North Carolina.
  • The early diagnosis rate is 20.3% among Latinos in North Carolina, not significantly different than the rate of 20.4% among Latinos nationally, and not significantly different than the rate of 23.5% among whites in North Carolina.
  • The early diagnosis rate is 17.4% among Asian Americans or Pacific Islanders in North Carolina, not significantly different than the rate of 19.9% among Asian Americans or Pacific Islanders nationally, and significantly lower than the rate of 23.5% among whites in North Carolina.
  • The early diagnosis rate is 19.0% among Indigenous Peoples (American Indians/Alaska Natives) in North Carolina, not significantly different than the rate of 20.2% among Indigenous Peoples (American Indians/Alaska Natives) nationally, and not significantly different than the rate of 23.5% among whites in North Carolina.

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.

North Carolina ranked 29th (out of the 49 states with available data) with 19.0% 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 North Carolina in the below average tier. Over the last five years, the percent of cases undergoing surgery in North Carolina did not change significantly.

Racial and Ethnic Disparities in Surgical Treatment
  • The percent of cases undergoing surgery is 16.4% among Black Americans in North Carolina, significantly lower than the rate of 17.1% among Black Americans nationally, and significantly lower than the rate of 19.5% among whites in North Carolina.North Carolina ranked 15th (out of the 48 states with available data) with 13.4% of cases receiving no treatment. This is significantly lower than the national rate of 15.2% and puts North Carolina in the above average tier. Over the last five years, the percent of cases receiving no treatment in North Carolina improved by 17.7%.
  • The percent of cases undergoing surgery is 22.5% among Latinos in North Carolina, not significantly different than the rate of 20.6% among Latinos nationally, and significantly higher than the rate of 19.5% among whites in North Carolina.
  • The percent of cases undergoing surgery is 23.1% among Asian Americans or Pacific Islanders in North Carolina, not significantly different than the rate of 23.3% among Asian Americans or Pacific Islanders nationally, and not significantly different than the rate of 19.5% among whites in North Carolina.
  • The percent of cases undergoing surgery is 16.7% among Indigenous Peoples (American Indians/Alaska Natives) in North Carolina, not significantly different than the rate of 17.0% among Indigenous Peoples (American Indians/Alaska Natives) nationally, and not significantly different than the rate of 19.5% among whites in North Carolina.


Note: Value of 0 indicates data is not available


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.

North Carolina ranked 15th (out of the 48 states with available data) with 13.4% of cases receiving no treatment. This is significantly lower than the national rate of 15.2% and puts North Carolina in the above average tier. Over the last five years, the percent of cases receiving no treatment in North Carolina improved by 17.7%.


Racial and Ethnic Disparities in Lack of Treatment
  • The percent of cases receiving no treatment is 13.0% among Black Americans in North Carolina, significantly lower than the rate of 15.8% among Black Americans nationally, and not significantly different than the rate of 13.4% among whites in North Carolina.
  • The percent of cases receiving no treatment is 13.2% among Latinos in North Carolina, significantly lower than the rate of 20.6% among Latinos nationally, and not significantly different than the rate of 13.4% among whites in North Carolina.
  • The percent of cases receiving no treatment is 11.4% among Asian Americans or Pacific Islanders in North Carolina, significantly lower than the rate of 16.3% among Asian Americans or Pacific Islanders nationally, and not significantly different than the rate of 13.4% among whites in North Carolina.
  • The percent of cases receiving no treatment is 13.6% among Indigenous Peoples (American Indians/Alaska Natives) in North Carolina, not significantly different than the rate of 17.1% among Indigenous Peoples (American Indians/Alaska Natives) nationally, and not significantly different than the rate of 13.4% among whites in North Carolina.


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 North Carolina, 7.8% of those at high risk were screened, which was significantly higher than the national rate of 5.7%. It ranks 16th 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.

North Carolina was one of the 38 states whose Medicaid fee-for-service programs covered lung cancer screening as of February 2020. While their program used recommended guidelines for determining eligibility and did not require cost sharing, it did require prior authorization. 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.  


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 North Carolina is 17.4% and significantly higher than the national rate of 15.5%. It ranks 32nd among all states, placing it in the average tier.


Each year the Lung Association publishes the "State of Tobacco Control" report. The 2020 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 North Carolina 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.

  • 8 counties in North Carolina are considered Zone 1 which means they have predicted average indoor radon screening levels greater than 4 pCi/L.
  • 31 counties in North Carolina 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. 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 North Carolina report card. 

Summary

  • Rate of New Cases: Below Average Tier
  • Five-Year Survival Rate: Average Tier
  • Early Diagnosis Rate: Average Tier
  • Surgical Treatment Rate: Below Average Tier
  • Lack of Treatment Rate: Above Average Tier
  • Fee-For-Service Medicaid Coverage of Screening: Yes
  • Highlighted Disparity: Asian Americans or Pacific Islanders in North Carolina are least likely to be diagnosed early.

Despite the early diagnosis rate in North Carolina falling into the average 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. 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.

North Carolina has improved access to screening by covering it through its fee-for-service Medicaid program. 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.

North Carolina falls into the above 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.

North Carolina 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. 

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