Early detection counts

On Nov. 4, the American Lung Association released its eighth annual “state of Lung Cancer” report, which looks at both national and state trends in areas such as detection, treatment and outcome of the disease for Lung Cancer Awareness Month.

The number one leading cause of cancer deaths in the U.S., an estimated 277,000 Americans will be diagnosed with lung cancer this year. The report uses the most recent data available, from 2022, to look at both the United States as a whole, as well as individual states and Washington, D.C. to look at the trends in lung cancer.

New cases

The estimation of 227,000 new diagnoses shows a five-year decrease of 13%. The report notes that ongoing disruptions due to the COVID-19 pandemic have hindered some people’s access to medical care that includes delays and reductions in both cancer diagnosis and screenings. Therefore, the decline in new cases for lung cancer, and other cancers, shouldn’t be interpreted as a reduction in the disease’s underlying burdens of early diagnosis, screening and treatment.

The report finds that Utah has the nation’s lowest new cancer case rate while Kentucky has the highest. Iowa falls in the below average tier, ranked 39th of all states with new lung cancer cases at 60.3%. Iowa has seen a 7% improvement in new cancer cases.

In Clarke County, data from 2018 to 2022 through the Iowa Health and Human Services shows an average of nine cases of lung and bronchus cancer, with an age adjusted rate per 100,000 of 67.02.

Survival rate

Because of its tendency to be diagnosed at later stages, lung cancer has one of the lowest five-year survival rates. The national average after five years is 29.7%, with Rhode Island having the best rate at 35.5% and Alabama the worst at 22.7%. The national average is a 26% improvement over the last five years. Iowa ranks 27 of 39 states with survival data, placing it in the below average tier.

Over the past five years, Iowa has had a five-year survival rate of 27.1%, a 28% improvement.

Early diagnosis

When diagnosed early, the five-year survival rate jumps to 65% for those cancers still localized and confirmed to primary site. However, only 28.1% of cases are diagnosed at an early stage, whereas 43% are not caught until later stages when the cancer has metastasized - these cases have a survival rate of 10%. Early diagnosis rates did increase by 10% over the last five years, with Rhode Island having the best rate at 35.5% and Hawaii the worst at 21.8%.

In early diagnosis, Iowa falls in the average tier, ranked 24 of 50 states. The state has 28.5% of cases caught at early stages, an improvement of 25% over the last five years.

Lung cancer screening

Screening for lung cancer is done using low-dose CT scans for high risk individuals. Using 2021 guidelines, high risk individuals are defined as those aged 50 to 80, have 20 or more pack years (1 pack a day for 20 years, 2 packs a day for 10 years, etc.) and those who currently smoke or quit within the last 15 years.

Screenings can reduce death by lung cancer by as much as 20%; nationally, only 18.2% of high risk individuals were screened. Rhode Island had the best screening rate of 31% and Wyoming the worst at 9.7%. Additionally, the report stated that screenings have saved 80,000 years of life and could increase to 500,000 if everyone eligible is screened.

Here, Iowa lands in the average tier at 26 of all states, with 18.4% of high risk individuals screened.

Surgical treatment

When diagnosed early enough and when it hasn’t spread, lung cancer can be treated with surgery. Across the nation, 20.7% of lung cancer cases went to surgery. Massachusetts had the best surgery rates with 31.9% while New Mexico had the worst at 13.1%. The report notes that surgical rates did not change from the previous five years, likely due to COVID’s impact on medical care access.

With little change in the last five years, Iowa ranks 36 of 49 states with available data, with 17.2% of cases utilizing surgery as the first course of action, falling in the below average tier.

Lack of treatment

The report notes various reasons why a person with lung cancer may not receive treatment, such as stigma around lung cancer, lack of provider knowledge or cost of treatments. Twenty-one percent of cases in the U.S. did not receive treatment, with lack of treatments being the highest in Nevada at 36.9% and the lowest in Massachusetts at 13.2%.

With 21% of lung cancer cases receiving treatment, Iowa falls in the above average tier ranked 21 of 49 states with available data. However, those cases receiving no treatment increased by 19% over the last five years.

Racial disparities

The report also looked at the incidences of lung cancer in different ethnicities compared to white individuals:.

Nationwide, Black individuals were 13% less-likely to be diagnosed early, 19% less likely to receive surgical treatment, 11% more likely not to receive treatment and 13% less likely to survive five years.

Latino individuals were 18% less likely to receive an early diagnosis, 26% more likely to not receive any treatment, 2% more likely to receive surgical treatment and equally likely to survive five years.

Asian or Pacific Islander individuals were 18% less likely to be diagnosed early, 18% more likely to receive surgical treatment, 3% less likely to not receive treatment and 16% more likely to survive five years.

Indigenous peoples were 13% less likely to be diagnosed early, 26% less likely to receive surgical treatment, 23% more likely to not receive treatment and equally likely to survive five years.

In Iowa, rates did not differ significantly for Black and Latino individuals; there was not information available for Asian or Pacific Islanders or Indigenous peoples due to lack of cases in the study time frame.

Prevention

While it is not possible to completely avoid lung cancer for some individuals, eliminating tobacco use and reducing exposure to secondhand smoke, radon and air pollution and can all help reduce chances.

Tobacco use in Iowa rates 13.7%, higher than the national average of 11.4%. This ranks Iowa as 33rd of all states to be in the below average tier. Utah ranks top with 6% and West Virginia bottom with 20.4%.

Iowa ranks 49 among all states for radon exposure, with 57.9% of radon test results at or above the recommended EPA levels. Iowa is followed by North Dakota with 58% and South Dakota with 59.8%. Hawaii ranks the best with 0.4% radon testing.

Symptoms

While the early symptoms of lung cancer can be mistaken for other or less serious conditions, it’s important to know the signs.

Early symptoms include a persistent cough, shortness of breath, hoarseness, chest pain and unexplained weight loss. Recognizing symptoms and knowing your individual risk for lung cancer are important when speaking to your doctor about symptoms and screening options.

Forward momentum

As funding and staffing cuts have taken place at the National Institutes of Health and U.S. Centers for Disease Control and Prevention, along with cuts to Medicaid and the Affordable Health Care Act, members of the American Lung Association promote vigilance in advocating for cancer research and funding.

“I have worked at the American Lung Association for more than 40 years, and it is incredible to see how advancements in research and early detection have completely changed what it means to be diagnosed with lung cancer,” President and CEO of the American Lung Association Harold Wimmer said in a Nov. 4 press release. “... CDC is critical in helping to prevent lung cancer by funding programs to prevent tobacco use and help people quit, and the research done at NIH has led to 73 new treatments for lung cancer in the last decade alone. The cuts to programs and research are devastating. Lives hang in the balance — we must keep up the momentum.”

The American Lung Association calls for all states to implement policies that require insurance coverage of comprehensive biomarker testing, allowing critical access for their residents.

Biomarkers help doctors know what to look for in tumor tissue and blood to help them understand why the cancer is growing and determine the best course of treatment. However, not all states have insurance coverage for biomarker testing.

As of August of 2025, there are 17 states with comprehensive biomarker testing coverage, five with some coverage, and 28 states and Washington, D.C. with no coverage requirements. Iowa has required insurance coverage for the testing.

To read the full report and to compare state date, visit lung.org/research/state-of-lung-cancer.