American Lung Association’s new report examines toll of lung cancer in Vermont identifies opportunities to save lives through more access to and options for treatment
Vermont Business Magazine Lung cancer is the nation’s leading cause of cancer deaths, and it’s estimated that 570 Vermont residents will be diagnosed with this disease in 2020 alone. The 2020 “State of Lung Cancer” report examines the toll of lung cancer throughout the nation and outlines steps every state can take to better protect its residents from lung cancer.
While the report found that more Americans are surviving the disease, it also found that in Vermont, an astounding 19.7% of lung cancer cases receive no treatment, and only 18.7% of cases receive surgery as a first course of treatment.
For the first time, the annual “State of Lung Cancer” report also explores the lung cancer burden among racial and ethnic groups at the national and state levels. Although this report did not indicate that Vermont had substantial lung cancer health disparities, it did find that nationally people of color are facing poorer health outcomes than white residents.
This year’s “State of Lung Cancer” highlights the positive trend of increased lung cancer survival, as the nationwide five-year lung cancer survival rate of 22.6% reflects a 13% improvement over the past five years. In Vermont the survival rate is 24.1% with an early diagnosis rate of 24%.
“While we celebrate that more Americans are surviving lung cancer, too many people are being left behind, and the disease still remains the leading cause of cancer deaths,” said Alex Crimmin, Specialist for Health Promotions for the American Lung Association in Vermont. “Much more can and must be done in Vermont to prevent the disease and support those facing the disease.”
Dr. Anne Dixon, Pulmonologist and Medical Director for Pulmonary Disease and Critical Care Medicine at the University of Vermont Medical Center said, “This report is good news for Vermont in 3 categories: survival rate, early stage diagnosis, and the rate of high-risk patients receiving screening – and they are all connected. To continue this progress we must ensure that everyone who is diagnosed with lung cancer receives some sort of treatment. 19.7% of our local lung cancer diagnoses are not being treated at all, and that’s an important area we must focus on.”
Part of the reason that lung cancer is so deadly is because most cases are diagnosed at a later stage, after the disease has spread. Lung cancer screening is the key to catching lung cancer early when the disease is most curable, but only 22.9% of lung cancer cases nationally are diagnosed at an early stage. While this simple screening test has been available since 2015, only 13.8% of those eligible in Vermont have been screened.
“Lung cancer screening is a powerful tool to save lives,” said Dixon. “It’s a relatively new test, and we’re only seeing a fraction of those who qualify actually getting screened. We’re pushing for greater awareness of this test to save more lives here in Vermont.”
More treatment options are available for lung cancer than ever before, yet not everyone is receiving treatment following diagnosis. In Vermont 19.7% of those diagnosed did not receive any form of treatment, earning it a ranking of 41 out of the 48 states measured.
“We want to ensure that everyone has access to treatment options and quality and affordable healthcare. No one who wants care should have to forgo treatment due to lack of access or cost,” Crimmin said.
Learn more about "State of Lung Cancer" at Lung.org/solc.
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 more about how lung cancer is affecting your state and contact lawmakers urging them to save lives by protecting and expanding access to quality and affordable healthcare.
Lung Cancer Rates
The rate of new lung cancer cases in Vermont is 61.3 and not significantly different than the national rate of 58.7. It ranks 28th among all states, placing it in the average tier. Over the last five years, the rate of new cases in Vermont did not change significantly.
Yellow = US. Orange = Vermont
Racial and Ethnic Disparities in New Cases
The rate of new lung cancer cases is not available for other racial and ethnic groups in Vermont due to too few cases over the time period to allow for accurate analysis.
5-Year Survival Rate
The percent of people still alive five years after being diagnosed with lung cancer (the survival rate) in Vermont is 24.1%, which is not significantly different than the national rate of 22.6%. It ranks 12th among the 47 states with survival data, placing it in the above average tier. The change in the survival rate over the last five years is not available for Vermont.
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.
Nationally, only 22.9% of cases are caught early when the five-year survival rate is much higher (59%). Unfortunately, most cases (47%) are not caught until a late stage when the survival rate is only 6%.
In Vermont, 24.0% of cases are caught at an early stage, which is not significantly different than the national rate of 22.9%. It ranks 13th 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 Vermont did not change significantly.
Racial and Ethnic Disparities in Early Diagnosis
The early diagnosis rate is not available for racial and ethnic groups in Vermont due to too few cases among these groups over the time period to allow for accurate analysis.
Lung Cancer Treatment
Lung cancer can often be treated with surgery as part of the first course of treatment if it is diagnosed at an early stage and has not spread outside of the lung and lymph nodes close to the lung. 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.
Vermont ranked 32nd (out of the 49 states with available data) with 18.7% of cases undergoing surgery as part of the first course of treatment. This is significantly lower than the national rate of 20.6% and puts Vermont in the below average tier. Over the last five years, the percent of cases undergoing surgery in Vermont did not change significantly.
Racial and Ethnic Disparities in Surgical Treatment
The percent of cases undergoing surgical treatment is not available for racial and ethnic groups in Vermont due to too few cases among these groups over the time period to allow for accurate analysis.
Lack of Treatment
Not every patient receives treatment after being diagnosed with lung cancer. This can happen for multiple reasons, such as the tumor having spread too far, 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, stigma associated with lung cancer, fatalism after diagnosis, or cost of treatment. Dismantling these and other barriers is important to reducing the percent of untreated patients.
Vermont ranked 41st (out of the 48 states with available data) with 19.7% of cases receiving no treatment. This is significantly higher than the national rate of 15.2% and puts Vermont in the below average tier. Over the last five years, the percent of cases receiving no treatment in Vermont did not change significantly.
Racial and Ethnic Disparities in Lack of Treatment
The percent of cases receiving no treatment is not available for racial and ethnic groups in Vermont due to too few cases among these groups over the time period to allow for accurate analysis.
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 percent by detecting tumors at early stages when they are more likely to be curable.
High-risk is defined as:
- 55-80 years of age;
- Have a 30 pack-year history of smoking (this means 1 pack a day for 30 years, 2 packs a day for 15 years, etc.);
- AND, are a current smoker, or have quit within the last 15 years.
For screening to be most effective, 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. As rates vary tremendously between states, it is clear that more can be done to increase screening rates.
In Vermont, 13.8% of those at high risk were screened, which was significantly higher than the national rate of 5.7%. It ranks 2nd among all states, placing it in the top tier.
Medicaid Coverage of Screening
Medicaid beneficiaries are disproportionately affected by lung cancer, yet standard Medicaid programs are one of the only healthcare payers not required to cover lung cancer screening. If screening is covered, Medicaid programs may use different eligibility criteria, require prior authorization or charge individuals for their scans. The American Lung Association analyzed lung cancer screening coverage policies in state Medicaid fee-for-service programs to assess the current status of lung cancer screening coverage for the Medicaid population and found that 6.4% of those at high risk had been screened in states where fee-for-service Medicaid plans covered screening, compared to 3.3% in states that did not cover screening.
Vermont was one of the 38 states whose Medicaid fee-for-service programs covered lung cancer screening as of February 2020. While their program used recommended guidelines for determining eligibility, it did require prior authorization and cost sharing. Coverage may also vary between fee-for-service and managed care plans within a state’s Medicaid program.
The Lung Association urges all state Medicaid programs to cover lung cancer screening based on evidence-based guidelines across all fee-for-service and managed care plans and to remove any financial or administrative barriers that limit access to this lifesaving service.
Tobacco use is the leading risk factor for lung cancer. Smoking and secondhand smoke both have been shown to cause lung cancer.
The smoking rate in Vermont is 13.7% and significantly lower than the national rate of 15.5%. It ranks 10th among all states, placing it in the above average tier.
Each year the Lung Association publishes the "State of Tobacco Control" report. The 2020 report grades all 50 states and the federal government on four key tobacco control policies: tobacco control and prevention spending, smokefree air, tobacco taxes, and cessation coverage. View the Vermont report card.
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 have naturally higher prevalence of high radon levels than others, but any home can have elevated levels. The US EPA has set an action level of 4 pCi/L. At or above this level of radon, the EPA recommends you take corrective measures to reduce your exposure to radon gas.
- No counties in Vermont are considered Zone 1 which means they have predicted average indoor radon screening levels greater than 4 pCi/L.
- 12 counties in Vermont are considered Zone 2 which means they have predicted average indoor radon screening levels from 2 to 4 pCi/L.
Air Pollution is a known risk factor of lung cancer.
- Year-round outdoor particle pollution is known to cause lung. Each year the Lung Association publishes the "State of the Air" report. The 2020 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 ranks also both the cleanest and most polluted areas in the country. View the Vermont report card.
- Rate of New Cases: Average Tier
- Five-Year Survival Rate: Above Average Tier
- Early Diagnosis Rate: Average Tier
- Surgical Treatment Rate: Below Average Tier
- Lack of Treatment Rate: Below Average Tier
- Screening Rate: Top Tier
- Fee-For-Service Medicaid Coverage of Screening: Yes
- Highlighted Disparity: No racial disparities were found in Vermont for these lung cancer metrics .
Despite the early diagnosis rate in Vermont 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. When this rate increases, we can anticipate that the surgery rate would increase, as surgery is often the recommended treatment for those diagnosed at an earlier stage. In addition, when cases are found earlier, we would expect the five-year survival rate to increase.
Vermont has improved access to screening by covering it through its fee-for-service Medicaid program. The Lung Association encourages all states to cover lung cancer screening based on recommended guidelines across all fee-for-service and managed care plans without any financial or administrative barriers in their Medicaid programs.
It is alarming that Vermont falls into the below average 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.
Vermont residents can lower their risk of lung cancer, as well as the risk of those around them, through these steps:
- Talk to your healthcare provider if you meet the high-risk criteria and 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.
- Test your house for radon and take steps to reduce your risk if levels are too high.
- Reduce your exposure to unhealthy outdoor air:
- Stay indoors on unhealthy air days.
- Support clean air policies, including emissions limits and no vehicle idling zones.
About the American Lung Association
The American Lung Association is the leading organization working to save lives by improving lung health and preventing lung disease through education, advocacy and research. The work of the American Lung Association is focused on four strategic imperatives: to defeat lung cancer; to champion clean air for all; to improve the quality of life for those with lung disease and their families; and to create a tobacco-free future. For more information about the American Lung Association, a holder of the coveted 4-star rating from Charity Navigator and a Gold-Level GuideStar Member, or to support the work it does, call 1-800-LUNGUSA (1-800-586-4872) or visit: Lung.org.
Source: Williston, VT (November 17, 2020) – American Lung Association