North Dakota

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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 how lung cancer is affecting your state and contact your governor to ask or thank them for helping to end lung cancer by supporting insurance coverage of comprehensive biomarker testing.

Rate of New Cases Survival Rate Early Diagnosis Surgical Treatment Lack of Treatment Screening
Rate of New Cases
Survival Rate
Early Diagnosis
Surgical Treatment
Lack of Treatment
Screening

Requires Coverage of Comprehensive Biomarker Testing

No

Highlighted Disparity

Indigenous peoples in North Dakota are most likely to be diagnosed with lung cancer

Lung Cancer Rates

New Cases

New Cases:

  • The rate of new lung cancer cases in North Dakota is 54.3 and not significantly different than the national rate of 52.8.
  • It ranks 26th among all states, placing it in the average tier.
  • Over the last five years, the rate of new cases in North Dakota improved by 24%.
  • In 2022, the most recent year of data available for this report, the COVID-19 pandemic continued to disrupt access to medical care, including delays and reductions in cancer diagnoses and screening. This led to a decline in incidence rates for most cancers, including lung cancer, and should not be interpreted as a reduction in the underlying cancer burden.
5-Year Survival Rate

5-Year Survival Rate:

  • The percent of people alive five years after being diagnosed with lung cancer (the survival rate) in North Dakota is 31.0%, which is not significantly different than the national rate of 29.7%.
  • It ranks 15th among the 39 states with survival data, placing it in the average tier.
  • Over the last five years, the survival rate in North Dakota improved by 30%.
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. The earlier lung cancer is diagnosed, the more likely that treatments will be effective and improve chances of survival.

Nationally, only 28.1% of cases are caught early when the five-year survival rate is much higher (65%). Unfortunately, most cases (43.1%) are not caught until a late stage when the survival rate is only 10%.

 

Early Diagnosis:

  • In North Dakota, 32.1% of cases are caught at an early stage, which is significantly higher than the national rate of 28.1%.
  • It ranks 6th among the 50 states with data on diagnosis at an early stage, placing it in the above average tier.
  • Over the last five years, the early diagnosis rate in North Dakota improved by 36%.

Lung Cancer Treatment

Biomarker Coverage

Lung tumors may have changes in DNA that can be targeted by treatments, but the tumor has to be tested for these changes. Insurance coverage of such testing is important for removing a cost barrier to lung cancer patients, but is only required in some states.

Biomarker Coverage:

  • North Dakota has yet to require any insurance coverage of comprehensive biomarker testing, including for lung cancer, as of August 2025.
Surgical

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.

Surgical Treatment:

  • North Dakota ranked 33rd (out of the 49 states with available data) with 17.7% of cases undergoing surgery as part of the first course of treatment.
  • This is significantly lower than the national rate of 20.7% and puts North Dakota in the below average tier.
  • Over the last five years, the percent of cases undergoing surgery in North Dakota did not change significantly.
Lack of Treatment

Not every person receives treatment after being diagnosed with lung cancer. This can happen for multiple reasons, such as 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, lung cancer stigma, fatalism after diagnosis, or cost of treatment. Dismantling these barriers is important to reducing the percent of people who do not receive any treatment.

 

No Treatment:

  • North Dakota ranked 3rd (out of the 49 states with available data) with 14.8% of cases not receiving any treatment.
  • This is significantly lower than the national rate of 21.0% and puts North Dakota in the top tier.
  • Over the last five years, the percent of cases receiving no treatment in North Dakota did not change significantly.

Screening

High Risk

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% by detecting the disease at early stages when it is more likely to be curable.

Based on new research, in March 2021, the United States Preventive Services Task Force (USPSTF) expanded its recommendation for screening to include a wider age range and more who currently or have formerly smoked. This dramatically increased the number of women and Black individuals considered at high risk for lung cancer.

High Risk is defined as:

  2020 Guidelines 2021 Guidelines
Age 55-80 years 50-80 years
Smoking History 30 or more pack years
(this means 1 pack a day for 30 years, 2 packs a day for 15 years, etc.)		 20 or more pack years
(this means 1 pack a day for 20 years, 2 packs a day for 10 years, etc.)
Smoking Status Currently smoke or quit within the last 15 years

Screening for High Risk:

  • In North Dakota, 21.1% of those at high risk were screened, which was not significantly different than the national rate of 18.2%.
  • It ranks 15th among all states, placing it in the above average tier.
  • Screening rates in this year’s report have been updated to correct an error in the data source and should not be compared to previous reports.

For screening to be most effective in reducing the overall lung cancer mortality rate, 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. Rates vary tremendously between states and more can be done to increase screening rates.

Prevention

Tobacco
​
Tobacco use is the leading risk factor for lung cancer. Smoking and secondhand smoke both have been shown to cause lung cancer.

State of Tobacco Control

Each year the Lung Association publishes the "State of Tobacco Control" report. The 2025 report grades the federal government and all 50 states on key tobacco control policies. States are graded in five policy areas: tobacco control and prevention spending, smokefree air, tobacco taxes, access to cessation services and flavor tobacco prohibitions.
View Report Card
 

Tobacco Use:

  • The 2023 smoking rate in North Dakota is 13.3% and significantly higher than the national rate of 11.4%.
  • It ranks 31st among all states, placing it in the below average tier.
Radon
​
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 naturally have higher average radon levels than others, but because any home can be at risk for elevated levels, the only way to know is to do a test. If testing shows interior radon levels at or above the U.S. EPA action level of 4 pCi/L (picoCuries per liter of air) or higher, it is recommended to take corrective measures to reduce your exposure to radon gas. Such measures should also be considered at levels at or above 2 pCi/L.
 

Radon Exposure:

  • In North Dakota, 58.0% of radon test results were at or above the action level recommended by EPA.
  • It ranks 50th among all states, placing it in the bottom tier.
Air Pollution
​
Air pollution is a known risk factor for lung cancer. Long-term exposure to outdoor particle pollution is known to cause lung cancer.

State of the Air

Each year the Lung Association publishes the "State of the Air" report. The 2025 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 also ranks the cleanest and most polluted areas in the country.
View Report Card

Racial & Ethnic Disparities

Black
 

Black individuals:

  • Lung cancer rates are not available for Black individuals in North Dakota due to too few cases over the time period to allow for accurate analysis. 
Latino
 

Latino individuals:

  • Lung cancer rates are not available for Latino individuals in North Dakota due to too few cases over the time period to allow for accurate analysis. 
Asian & Pacific Islander
 

Asian or Pacific Islander individuals:

  • Lung cancer rates are not available for Asian or Pacific Islander individuals in North Dakota due to too few cases over the time period to allow for accurate analysis. 
Indigenous Peoples
 

Indigenous Peoples:

  • The rate of new lung cancer cases is 132.8 per 100,000 population among Indigenous peoples (American Indians/Alaska Natives) in North Dakota, significantly higher than the rate of 39.8 among Indigenous Peoples nationally, and significantly higher than the rate of 52.5 among white individuals in North Dakota. 
  • 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. 
  • 27.4% of lung cancer cases are diagnosed at an early stage among Indigenous peoples (American Indians/Alaska Natives) in North Dakota, not significantly different than the rate of 25.2% among Indigenous peoples (American Indians/Alaska Natives) nationally, and not significantly different than the rate of 32.7% among white individuals in North Dakota. 
  • 14.9% of Indigenous peoples (American Indians/Alaska Natives) with lung cancer in North Dakota underwent surgery, not significantly different than the rate of 15.6% among Indigenous peoples (American Indians/Alaska Natives) nationally, and not significantly different than the rate of 17.8% among white individuals in North Dakota. 
  • 19.6% of Indigenous peoples (American Indians/Alaska Natives) with lung cancer in North Dakota did not receive any treatment, not significantly different than the rate of 25.0% among Indigenous peoples (American Indians/Alaska Natives) nationally, and not significantly different than the rate of 14.4% among white individuals in North Dakota.

Summary

Despite the early diagnosis rate in North Dakota falling into the above 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.

North Dakota has yet to require any insurance coverage of comprehensive biomarker testing, which can help determine what treatment options would be best for individuals with lung cancer and other diseases.

North Dakota 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.

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State Infographic

Compare how your state ranks on each lung cancer measure.

Download PDF
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What Can I Do?

You can lower your risk of lung cancer, as well as the risk of those around you, through these steps:

Take Action

Ask your governor to support comprehensive coverage of biomarker testing.

Please select a state

Take Action
  • 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.

Radon is a naturally occurring gas that can have a big impact on indoor air quality and your health. Take steps to reduce your risk if radon levels in your home are too high.
Learn more about radon

Page last updated: October 29, 2025