Missouri
Fee-For-Service Medicaid Coverage of Screening
Covered and Using Updated Guidelines
Highlighted Disparity
Latino Americans in Missouri are least likely to be diagnosed early.
Lung Cancer Rates
New Cases:
- The rate of new lung cancer cases is 70 and significantly higher than the national rate of 57.
- Missouri ranks 45th among all states, placing it in the below average tier.
- Over the last five years, the rate of new cases improved by 8%.
5-Year Survival Rate:
- The percent of people alive five years after being diagnosed with lung cancer (the survival rate) in Missouri is 23%, which is significantly lower than the national rate of 25%.
- It ranks 31st among the 46 states with survival data, placing it in the below average tier.
- Over the last five years, the survival rate in Missouri improved by 22%.
Early Diagnosis:
- 26% of cases are caught at an early stage, which is not significantly different than the national rate of 26%.
- It ranks 21st 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 Missouri improved by 15%.
Lung Cancer Treatment
Surgical Treatment:
- Missouri ranked 34th (out of the 49 states with available data) with 18% of cases undergoing surgery as part of the first course of treatment.
- This is significantly lower than the national rate of 21% and puts Missouri in the below average tier.
- Over the last five years, the percent of cases undergoing surgery in Missouri did not change significantly.
Lack of Treatment:
- Missouri ranked 4th (out of the 49 states with available data) with 15% of cases not receiving any treatment.
- This is significantly lower than the national rate of 21% and puts Missouri in the top tier.
- Over the last five years, the percent of cases receiving no treatment in Missouri improved by 11%.
Screening
Screening for High Risk:
- In Missouri, 8% of those at high risk were screened, which was significantly higher than the national rate of 6%.
- It ranks 14th among all states, placing it in the above average tier.
- Screening rates may be higher in states with large, regional managed care providers that did not share screening data.
Medicaid Coverage:
- Missouri was one of the 46 states whose Medicaid fee-for-service programs covered lung cancer screening as of July 2022.
- While their program used recommended guidelines for determining eligibility, it did require prior authorization and copays.
Prevention
Tobacco Use:
- The smoking rate in Missouri is 18% and significantly higher than the national rate of 14%.
- It ranks 36th among all states, placing it in the below average tier.
Radon:
- In Missouri, 31% of radon tests results were at or above the action level recommended by EPA.
- It ranks 32nd among all states, placing it in the below average tier.
Racial & Ethnic Disparities
Black Americans:
- The rate of new lung cancer cases is 76 per 100,000 population among Black Americans in Missouri, significantly higher than the rate of 59 among Black Americans nationally, and significantly higher than the rate of 71 among whites in Missouri.
- The five-year survival rate is 22% among Black Americans in Missouri, not significantly different than the rate of 22% among Black Americans nationally, and not significantly different than the rate of 23% among whites in Missouri.
- 25% of lung cancer cases are diagnosed at an early stage among Black Americans in Missouri, significantly higher than the rate of 23% among Black Americans nationally, and not significantly different than the rate of 27% among whites in Missouri.
- 14% of Black Americans with lung cancer in Missouri underwent surgery, significantly lower than the rate of 17% among Black Americans nationally, and significantly lower than the rate of 18% among whites in Missouri.
- 17% of Black Americans with lung cancer in Missouri did not receive any treatment, significantly lower than the rate of 22% among Black Americans nationally, and significantly higher than the rate of 15% among whites in Missouri.
Latino Americans:
- The rate of new lung cancer cases is 31 per 100,000 population among Latinos in Missouri, not significantly different than the rate of 29 among Latinos nationally, and significantly lower than the rate of 71 among whites in Missouri.
- State-level survival rates are not available for Latino Americans at this time. Nationally, the five-year survival rate among Latino Americans is 19%, 25% lower than among white Americans.
- 19% of lung cancer cases are diagnosed at an early stage among Latinos in Missouri, not significantly different than the rate of 23% among Latinos nationally, and significantly lower than the rate of 27% among whites in Missouri.
- 21% of Latinos with lung cancer in Missouri underwent surgery, not significantly different than the rate of 22% among Latinos nationally, and not significantly different than the rate of 18% among whites in Missouri.
- Other lung cancer rates are not available for Latino Americans in Missouri due to too few cases over the time period to allow for accurate analysis.
Asian Americans or Pacific Islanders:
- The rate of new lung cancer cases is 37 per 100,000 population among Asian Americans or Pacific Islanders in Missouri, not significantly different than the rate of 34 among Asian Americans or Pacific Islanders nationally, and significantly lower than the rate of 71 among whites in Missouri.
- State-level survival rates are not available for Asian Americans or Pacific Islanders at this time. Nationally, the five-year survival rate among Asian Americans or Pacific Islanders is 23% and not significantly different than among white Americans.
- 20% of lung cancer cases are diagnosed at an early stage among Asian Americans or Pacific Islanders in Missouri, not significantly different than the rate of 22% among Asian Americans or Pacific Islanders nationally, and not significantly different than the rate of 27% among whites in Missouri.
- 25% of Asian Americans or Pacific Islanders with lung cancer in Missouri underwent surgery, not significantly different than the rate of 25% among Asian Americans or Pacific Islanders nationally, and significantly higher than the rate of 18% among whites in Missouri.
- 12% of Asian Americans or Pacific Islanders with lung cancer in Missouri did not receive any treatment, significantly lower than the rate of 21% among Asian Americans or Pacific Islanders nationally, and not significantly different than the rate of 15% among whites in Missouri.
Indigenous Peoples:
- The rate of new lung cancer cases is 31 per 100,000 population among Indigenous Peoples (American Indians/Alaska Natives) in Missouri, significantly lower than the rate of 41 among Indigenous Peoples nationally, and significantly lower than the rate of 71 among whites in Missouri.
- State-level survival rates are not available for Indigenous Peoples at this time. Nationally, the five-year survival rate among Indigenous Peoples is 19% and not significantly different than among white Americans.
- Other lung cancer rates are not available for Indigenous Peoples (American Indians/Alaska Natives) in Missouri due to too few cases over the time period to allow for accurate analysis.
Summary
Despite the early diagnosis rate in Missouri 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.
Missouri 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.
Missouri falls into the top 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.