Texas
Fee-For-Service Medicaid Coverage of Screening
Covered and Using Updated Guidelines
Highlighted Disparity
Black individuals in Texas are least likely to receive surgical treatment.
Lung Cancer Rates
New Cases:
- The rate of new lung cancer cases is 46.8 and significantly lower than the national rate of 54.6.
- Texas ranks 10th among all states, placing it in the above average tier.
- Over the last five years, the rate of new cases improved by 20%.
5-Year Survival Rate:
- The percent of people alive five years after being diagnosed with lung cancer (the survival rate) in Texas is 24.8%, which is significantly lower than the national rate of 26.6%.
- It ranks 25th among the 42 states with survival data, placing it in the below average tier.
- Over the last five years, the survival rate in Texas improved by 19%.
Early Diagnosis:
- 23.4% of cases are caught at an early stage, which is significantly lower than the national rate of 26.6%.
- It ranks 44th among the 47 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 Texas improved by 8%.
Lung Cancer Treatment
Surgical Treatment:
- Texas ranked 42nd (out of the 47 states with available data) with 16.1% 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 Texas in the bottom tier.
- Over the last five years, the percent of cases undergoing surgery in Texas in Texas improved by -8%.
Lack of Treatment:
- Texas ranked 45th (out of the 47 states with available data) with 29.2% of cases not receiving any treatment.
- This is significantly higher than the national rate of 20.6% and puts Texas in the bottom tier.
- Over the last five years, the percent of cases receiving no treatment in Texas did not change significantly.
Screening
Screening for High Risk:
- In Texas, 1.2% of those at high risk were screened, which was significantly lower than the national rate of 4.5%.
- It ranks 48th among all states, placing it in the bottom tier.
- Actual screening rates may be higher in states with large, regional managed care providers that did not share screening data.
Medicaid Coverage:
- Texas was one of the 49 states whose Medicaid fee-for-service programs covered lung cancer screening as of October 2023.
Prevention
Tobacco Use:
- The smoking rate in Texas is 13.1% and not significantly different than the national rate of 13.5%.
- It ranks 18th among all states, placing it in the average tier.
Radon:
- In Texas, 7.7% of radon tests results were at or above the action level recommended by EPA.
- It ranks 4th among all states, placing it in the top tier.
Racial & Ethnic Disparities
Black individuals:
- The rate of new lung cancer cases is 57.0 per 100,000 population among Black individuals in Texas, not significantly different than the rate of 56.3 among Black individuals nationally, and significantly higher than the rate of 55.4 among white individuals in Texas.
- The five-year survival rate is 22.4% among Black individuals in Texas, not significantly different than the rate of 23.8% among Black individuals nationally, and significantly lower than the rate of 24.6% among white individuals in Texas.
- 21.4% of lung cancer cases are diagnosed at an early stage among Black individuals in Texas, significantly lower than the rate of 23.2% among Black individuals nationally, and significantly lower than the rate of 24.4% among white individuals in Texas.
- 12.7% of Black individuals with lung cancer in Texas underwent surgery, significantly lower than the rate of 17.0% among Black individuals nationally, and significantly lower than the rate of 17.0% among white individuals in Texas.
- 30.2% of Black individuals with lung cancer in Texas did not receive any treatment, significantly higher than the rate of 22.4% among Black individuals nationally, and significantly higher than the rate of 28.5% among white individuals in Texas.
Latino individuals:
- The rate of new lung cancer cases is 25.1 per 100,000 population among Latino individuals in Texas, significantly lower than the rate of 28.2 among Latino individuals nationally, and significantly lower than the rate of 55.4 among white individuals in Texas.
- 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.
- 20.4% of lung cancer cases are diagnosed at an early stage among Latino individuals in Texas, significantly lower than the rate of 23.1% among Latino individuals nationally, and significantly lower than the rate of 24.4% among white individuals in Texas.
- 13.7% of Latino individuals with lung cancer in Texas underwent surgery, significantly lower than the rate of 21.6% among Latino individuals nationally, and significantly lower than the rate of 17.0% among white individuals in Texas.
- 32.4% of Latino individuals with lung cancer in Texas did not receive any treatment, significantly higher than the rate of 26.1% among Latino individuals nationally, and significantly higher than the rate of 28.5% among white individuals in Texas.
Asian Americans or Pacific Islanders:
- The rate of new lung cancer cases is 28.5 per 100,000 population among Asian or Pacific Islanders individuals in Texas, significantly lower than the rate of 32.9 among Asian or Pacific Islanders individuals nationally, and significantly lower than the rate of 55.4 among white individuals in Texas.
- 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.
- 19.6% of lung cancer cases are diagnosed at an early stage among Asian or Pacific Islander individuals in Texas, significantly lower than the rate of 22.8% among Asian or Pacific Islander individuals nationally, and significantly lower than the rate of 24.4% among white individuals in Texas.
- 18.1% of Asian or Pacific Islander individuals with lung cancer in Texas underwent surgery, significantly lower than the rate of 24.7% among Asian or Pacific Islander individuals nationally, and not significantly different than the rate of 17.0% among white individuals in Texas.
- 26.9% of Asian or Pacific Islander individuals with lung cancer in Texas 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 28.5% among white individuals in Texas.
Indigenous Peoples:
- The rate of new lung cancer cases is 21.3 per 100,000 population among Indigenous Peoples (American Indians/Alaska Natives) in Texas, significantly lower than the rate of 39.4 among Indigenous Peoples nationally, and significantly lower than the rate of 55.4 among white individuals in Texas.
- 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.
- 27.5% of lung cancer cases are diagnosed at an early stage among Indigenous Peoples (American Indians/Alaska Natives) in Texas, not significantly different than the rate of 23.5% among Indigenous Peoples (American Indians/Alaska Natives) nationally, and not significantly different than the rate of 24.4% among white individuals in Texas.
- 18.2% of Indigenous Peoples (American Indians/Alaska Natives) with lung cancer in Texas underwent surgery, not significantly different than the rate of 16.3% among Indigenous Peoples (American Indians/Alaska Natives) nationally, and not significantly different than the rate of 17.0% among white individuals in Texas.
- 29.5% of Indigenous Peoples (American Indians/Alaska Natives) with lung cancer in Texas did not receive any treatment, significantly higher than the rate of 23.2% among Indigenous Peoples (American Indians/Alaska Natives) nationally, and not significantly different than the rate of 28.5% among white individuals in Texas.
Summary
The early diagnosis rate in Texas falls into the below 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.
Texas has improved access to expanded screening by covering it through its fee-for-service Medicaid program. 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 Texas falls into the bottom 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.