Lung Cancer Key Findings

While we have seen advances in personalized treatment thanks to biomarker testing, targeted therapy and immunotherapy, and saved more lives through the introduction of lung cancer screening, the burden of lung cancer is not the same everywhere. Treatment, exposure to risk factors and use and coverage of screening varies from state to state. To save more lives, it is critical to prevent lung cancer when possible and diagnose the disease as early as possible. 

Additionally, everyone should have access to therapies that may extend or improve their lives.

By better understanding the impact of lung cancer at the state level, we can encourage interventions and advocate for policies on the state level to reduce the burden of the disease.

There is a role for all stakeholders to play in reducing lung cancer risk factors and improving access to lung cancer screening and treatment for all.

More than 229,000 people will be diagnosed with lung cancer this year, an 11% improvement over five years. However, the rate of new cases varies by state. The report finds that Utah has the nation’s lowest lung cancer incidence rate at 24.6 per 100,000 people while Kentucky has the highest rate at 83.9 per 100,000 people.

When examining incidence data, it is important to note that the COVID-19 pandemic disrupted access to medical care. This resulted in a drop in cancer diagnoses for the year 2020, particularly for cancers (including lung cancer) diagnosed before symptoms develop. This drop reflects changes in medical care for 2020 and should not necessarily be interpreted as a reduction in the underlying cancer burden.

What causes lung cancer? There are a variety of risk factors associated with lung cancer, including smoking and exposure to other hazardous chemicals such as radon gas, air pollution and secondhand smoke. Radon testing and mitigation, healthy air protections, and reducing the smoking rate through tobacco tax increases, smoke-free air laws and access to comprehensive tobacco cessation services are all ways to help prevent new lung cancer cases.

Lung cancer has one of the lowest five-year survival rates because cases are often diagnosed at later stages, when the disease is less likely to be curable. The national average of people living five years after a lung cancer diagnosis is 31.0%, which is a 24% increase in the past five years. Massachusetts ranked best at 40.9%, while Alabama ranked worst at 23.8%.

The percentage of people diagnosed with lung cancer before their cancer has spread, or the early diagnosis rate, is 29.3% nationally, increasing 18.0% of the past five years nationally. Only about one in four cases are diagnosed at an early stage when the five-year survival rate is much higher (65.0%). Unfortunately, 42.6% of cases are not caught until a late stage when the survival rate is only 12.0%. Early diagnosis rates were best in Rhode Island (38.0%) and worst in Hawaii (21.9%).

Lung cancer can often be treated with surgery if it is diagnosed at an earlier stage and has not spread to other organs in the body. Nationally, 21.4% of cases underwent surgery. State-specific rates range from highest at 32.7% in Massachusetts to lowest at 12.7% in New Mexico.

Not all people diagnosed with lung cancer are candidates for surgery. Other treatments may be the most appropriate option instead of or in addition to surgery, such as chemotherapy, radiation, targeted therapy or immunotherapy. This report focuses on surgical treatment rates because surgery is often performed with the intent of being curative, whereas the goals of other treatment options are more likely to be cancer control and/or symptom management.

There are multiple reasons why people with lung cancer may not receive treatment after diagnosis. Some of these reasons may be unavoidable, but no one should go untreated because of lack of provider or patient knowledge, lung cancer stigma, fatalism after diagnosis or cost of treatment. Nationally, 20.9% of cases did not receive any treatment. Lack of treatment rates were lowest in Rhode Island (13.4%) and highest in Nevada (36.7%).

Lung cancer screening for those at high risk gives us hope in the effort to defeat lung cancer and represents an opportunity to save more lives. Screening with annual low-dose CT scans can reduce the lung cancer death rate by up to 20% and works by detecting tumors at early stages when the cancer is more likely to be curable.

High risk is defined per the United States Preventive Task Force (USPSTF) as:

For screening to have the most impact on national and state-wide lung cancer mortality rates, more of the high-risk population should be screened annually. Currently, screening rates remain low among those who are eligible to participate in annual lung cancer screening. Nationally, only 24.4% of those at high risk were screened. Massachusetts had the highest screening rate at 38.7%, while South Dakota had the lowest at 13.5%.

Biomarkers are clues that physicians look for in tumor tissue and blood that help healthcare providers understand what is driving a person’s lung cancer and which treatment options might be most appropriate for an individual’s specific tumor makeup. Lung cancer biomarkers can be errors in a cell's DNA or high levels of proteins that live on cells. Comprehensive biomarker testing and its results are important in helping determine if targeted treatment options, as well as immunotherapy, are appropriate for individuals with lung cancer.

Insurance coverage of such testing is important for removing a cost barrier to people with lung cancer, but coverage for biomarker testing is only required in some states. American Lung Association analysis found:

• 19 states required coverage of comprehensive biomarker testing;
• 7 states required some coverage of biomarker testing, but coverage is not comprehensive or is not required by all types of plans;
• 25 states and Washington, D.C. do not require any coverage of biomarker testing

The lung cancer burden is not distributed equally among racial and ethnic groups.

Black individuals with lung cancer were 13% less likely to be diagnosed early, 17% less likely to receive surgical treatment, 11% more likely to not receive any treatment, and 15% less likely to survive five years.

Latino individuals with lung cancer were 18% less likely to be diagnosed early and 23% more likely to not receive any treatments. However, they were 2% more likely to receive surgical treatment and equally likely to survive five years after diagnosis.

Asian or Pacific Islander individuals with lung cancer were 18% less likely to be diagnosed early compared to white individuals. However, they were 20% more likely to receive surgical treatment, 6% less likely to not receive any treatment and 15% more likely to survive five years compared to white individuals.

Indigenous Peoples (American Indians/Alaska Natives)with lung cancer were 14% less likely to be diagnosed early, 27% less likely to receive surgical treatment, 21% more likely to not receive any treatment and 41% less likely to survive five years compared to white individuals.

Keys to lung cancer prevention include eliminating tobacco use and reducing exposures to radon, air pollution and secondhand smoke, all of which are known to cause lung cancer. Despite the known causes of lung cancer, it is not always possible to identify the cause of an individual person’s lung cancer. If you have concerns about your risk, because of your exposures or family history, it is important to discuss this with your doctor.

This report and its assets contain information and data on exposures to these risk factors on the state level:

• Tobacco use is the leading cause of lung cancer, accounting for 80 to 90% of cases. While we have seen historic decreases in the national smoking rate, not all people in the United States or regions of the country have benefited equally.
• Secondhand smoke has also been shown to cause lung cancer. There is no known safe level of exposure to secondhand smoke. The “State of Lung Cancer” report highlights that making homes, workplaces and public spaces smokefree air zones, with no smoking allowed, can reduce exposure to secondhand smoke and, in turn, lower the risk of lung cancer. The American Lung Association’s “State of Tobacco Control,” grades states on laws to protect the public from secondhand smoke.
• Radon, a naturally occurring radioactive gas, is the second-leading cause of lung cancer in the United States and the leading cause among people who have never smoked. Radon is a colorless and odorless gas that can seep into homes and buildings. Some geographical areas have naturally higher average rates of elevated radon than others, but because any building can be at risk for elevated levels, the only way to know one’s radon level is to do a test. If testing confirms indoor radon levels at or above the U.S. EPA action level of 4 pCi/L (picoCuries per liter of air), corrective measures should be taken to reduce exposure. The American Lung Association recommends that mitigation be performed by trained professionals following recognized standards. Such measures should also be considered at levels at or above 2 pCi/L. The report highlights the estimated percentage of indoor radon tests at or above the EPA action level by state. Hawaii has the lowest percentage of indoor radon tests at or above the action level (0.4%) and South Dakota has the highest (59.8%).
• Exposure to year-round particle pollution in the air has been shown to cause lung cancer. Each year the American Lung Association releases the “State of the Air” report. The 2026 “State of the Air” report found more than 152.3 million people are living in places with failing grades for unhealthy levels of air pollution.

• Nationally, the lung cancer survival rate increased in the past five years from 25% to 31%.
• Lung cancer screening with low-dose CT scans has been recommended for those at high risk since 2013, but only 24.4% of those eligible were screened according to 2024 data.
• Nationally, only 29.3% of cases are diagnosed at an early stage when the five-year survival rate is much higher (65%).
• Racial disparities exist in the lung cancer landscape. People of color are less likely to be diagnosed early as compared to white individuals. Black individuals and Indigenous Peoples are less likely to receive surgical treatment as compared to white populations. Black and Latino individuals as well as Indigenous Peoples are more likely not to receive any treatment as compared to white individuals. Additionally, survival rates are significantly lower among Black individuals and Indigenous Peoples as compared to white individuals.
• The analysis in the “State of Lung Cancer” serves as a baseline against which future data can be compared, which may be especially beneficial as progress is made in increasing lung cancer screening rates for those at high risk, expanding comprehensive coverage of biomarker testing and decreasing lung cancer mortality rates overall.

As the American Lung Association works toward defeating lung cancer, the goal of the “State of Lung Cancer” report is to empower the public to learn more about lung cancer in their state. All new lung cancer discoveries approved and recommended today have been studied in clinical trials, including lung cancer screening and treatment advances. Individuals can join the Lung Association’s efforts to address lung cancer by urging Congress to support the bipartisan Clinical Trial Modernization Act (H.R. 3521/S. 4440) to make clinical trials more accessible, including for people with lung cancer. You can learn more at Lung.org/solc.

The report looks at key lung cancer measures to highlight the burden and examine opportunities to better address lung cancer at the state level. Report findings show that lung cancer rates for every measure vary significantly by state, and that each state can do more to defeat lung cancer, such as increasing the rate of screening among those at high risk, addressing racial disparities that impact lung cancer outcomes, decreasing exposure to radon and secondhand smoke and eliminating tobacco use.

This report provides unique information for federal and state officials, public health practitioners, researchers and those affected by lung cancer and emphasizes the need for resources and action to decrease the toll of lung cancer across the nation.