In recent years, the survival rate for patients with lung cancer has increased to the point where now, almost one quarter of patients with lung cancer are alive 5 years after being diagnosed.
This new statistic is highlighted in the State of Lung Cancer report from the American Lung Association (ALA), published online on November 16.
“If you look back, the 5-year survival rate has been very slowly eeking up at about 1% over the years,” commented Andrea McKee, MD, volunteer spokesperson at the ALA, told Medscape Medical News. The report shows that the 5-year survival rate increased by 14.5% over the past 5 years. “To see this big jump is truly remarkable, so that is something we are all celebrating,” she added.
“But we have to change the fatalistic thinking that both patients and primary care physicians still have about lung cancer. Most people say, ‘Everybody I know who had lung cancer died,’ and that was the way it used to be,” she commented, “but that has now changed. Lung cancer is highly curable in its early stages, and even if not early-stage, there are treatments that are making an impact now.
“So we’ve got to change that perception, as it does exist, even on the part of primary care providers, too,” McKee emphasized.
Lung Cancer Decreasing but Still Being Diagnosed Late
The report notes that the risk of being diagnosed with lung cancer varies considerably across the United States. For example, rates of lung cancer diagnoses are almost 2.5 times higher in Kentucky than in Utah.
Overall, the incidence is decreasing. “Over the last 5 years, the rate of new cases decreased 10% nationally,” the authors point out.
However, in almost half of the cases, the disease is diagnosed in late stages.
When diagnosed at a late stage, the 5-year survival rate for lung cancer drops to only 6%, whereas when the disease is diagnosed early, the 5-year survival rate is 60%.
At present, around 24% of cases of lung cancer are diagnosed at early stages, the report notes, but again, this varies across the United States. The highest rate (30%) is in Massachusetts, and the lowest rate (19%) is in Hawaii.
The percentage of lung cancer cases diagnosed early has been steadily increasing, presumably in part because of the introduction of low-dose CT screening for individuals at highest risk (such as smokers).
However, across the nation, only 5.7% of individuals at high risk for lung cancer underwent annual low-dose CT screening, the report notes.
“CT screening is so powerful at saving lives that even with only 5.7% of people that we’ve been able to screen, I believe it’s making a difference,” McKee commented. That small national percentage still represents a considerable number of patients, she noted, “so even with what we’ve done so far, I believe that screening is making a difference, at least within my own practice, where I’m definitely seeing it,” McKee emphasized.
Recent changes to the recommendations as to who should undergo lung cancer screening “have almost doubled the size of the screening population in the US,” McKee commented. “So there are now about 15 million people who need to get screened, and it again helps that primary care physicians know that screening is very powerful at detecting early-stage lung cancer,” she said.
In her hospital’s own screening program, among the individuals who regularly undergo screening, the majority (88%) of lung cancer cases are detected at stage I or II, for which the cure rate is approximately 90%, she noted.
Another misconception of primary care physicians is that lung cancer screening has an unacceptably high false positive rate. Previous reports in the medical literature suggested the rate could be as high as 96%. “This is absolutely, positively wrong. That is not the false positive rate; the false positive rate for lung cancer screening is less than 10%,” McKee emphasized.
“So we have to change that in the minds of primary care providers as well,” she underscored.
Report Highlights Racial Disparities
The report also highlights the racial disparities that persist in all aspects of lung cancer management ― early diagnosis, surgical treatment, lack of treatment, and survival.
For example, Black Americans are 18% less likely to be diagnosed with early-stage disease and are 23% less likely to receive surgical treatment than their White counterparts. They are also 9% more likely to receive no treatment at all, and mortality from lung cancer among Black patients is 21% worse than it is for White patients.
The same trend is seen among Latinx persons, although they are just as likely as White patients to undergo surgical treatment.
First and foremost, “we have to make sure that the Blacks and Latinos are screened in an equal fashion,” McKee said. Providing screening for communities of color is one strategy that might improve screening rates, she suggested.
So, too, can outreach programs in which lung cancer experts work with leaders within these communities, because people are more likely to listen to their leaders regarding the imporance of screening for early detection of lung cancer.
Physicians also need to emphasize that even for people who quit smoking decades ago, once those persons are in their 70s, “there is a spike again in lung cancer diagnoses, and that is true for both Black and White patients,” McKee stressed.
“Again, this is something that many doctors are not aware of,” she emphasized.
McKee has disclosed no relevant financial relationships.
American Lung Association. State of Lung Cancer. Published online November 16, 2021. Full text
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