THE SCOPEOF LUNG CANCERIN MINNESOTA

November 2014

Key Findings

• More people die each year from lung cancer than

prostate, breast and colorectal cancer combined,

making it the leading cancer killer in America.

• In Minnesota, American Indians are

disproportionately affected by lung cancer. There

are proportionally more cases and deaths among

American Indians than any other group.

• Not only smokers develop lung cancer. Among

respondents to the American Lung Association’s

Lung Health Survey that had been diagnosed with

lung cancer but reported never smoking, more than

half (56%) reported secondhand smoke exposure

and about 1 in 8 (13%) reported radon exposure. See

more about the Lung Health Survey on page 6.

• Lung cancer is hard to detect in its early stages. The

majority of lung cancers in Minnesota are diagnosed

after the cancer has metastasized (spread). New

recommendations from the American Lung

Association could help find lung cancer earlier and

improve survival.

1

Lung cancer is……cancer that starts in the lung,

usually in the cells lining air

passages. It can often metastasize

(spread) to other areas of the body, like the brain, liver, other areas

of the lung, and elsewhere.

…the leading cause of cancer deaths in Minnesota. Lung cancer

kills more than twice as many men as prostate cancer and nearly

twice as many women as breast cancer in Minnesota.

…usually caused by one or more of these risk factors: smoking

(accounts for 80-90% of lung cancer), radon and secondhand

smoke. A family history of lung cancer also increases risk.

Most Common Types of Cancer Deaths

FEMALES

LUNG & BRONCHUS 24%

BREAST 15%

COLON & RECTUM 10%

PANCREAS 6%

OVARY 6%

MALES

LUNG & BRONCHUS 27%

PROSTATE 11%

COLON & RECTUM 9%

PANCREAS 6%

LEUKEMIA 5%

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Minnesota cancer deaths for 2001-2010 combined

2

Lung cancer patterns are different for men vs womenThe rate of new cases of lung and bronchus cancer in females increased

by 40% between 1988 and 2004, with a similar increase in deaths, but both

rates have been stable since then. In contrast, the rate of new cases in males

decreased by 18% since 1988, with a small decrease in the rate of deaths, as

well. This difference in trends likely reflects national smoking patterns over the

past 50 years.

Incidence (new cases) and Mortality (deaths)

0102030405060708090

1988 1993 1998 2003 2008

Age-

adju

sted

rate

per

100

,000

peo

ple

Year of diagnosis or death

Male cases Female cases

Male deaths Female deaths

Source: Minnesota Department of Health. Incidence data (new cases) are for 1988-2011. Mortality data (deaths) are for 1988-2010.

0102030405060708090

1988 1993 1998 2003 2008

Age

-adj

uste

d ra

te p

er 1

00,0

00 p

eopl

e

Year of diagnosis or death

Male cases Female cases

Male deaths Female deaths

Source: Minnesota Department of Health. Incidence data (new cases) are for 1988-2011. Mortality data (deaths) are for 1988-2010.

There are racial/ethnic disparities for lung cancer Proportionally more American Indians in Minnesota are diagnosed with and

die from lung cancer than any other race/ethnicity category. White Hispanic

people have the lowest rate of lung cancer deaths, followed by Asian/Pacific

Islanders.

020406080

100120140

AmericanIndian

Black White (non-Hispanic)

White(Hispanic)

Asian/PacificIslander

Rate

* pe

r 100

,000

peo

ple

Race/ethnicity

Rate of new cases Rate of deaths

* Average annual age-adjusted rate per 100,000 people.Source: Minnesota Department of Health. Incidence data (new cases) are for 2002-2011 combined. Mortality data (deaths) are for 2001-2010 combined.

3

Lung Cancer Deaths Increase With Age

050

100150200250300350400450500

45-49years

50-54years

55-59years

60-64years

65-69years

70-74years

75-79years

80-84years

85+yearsM

orta

lity

rate

* pe

r 100

,000

peo

ple

Age group

Male Female

* Average annuall rate per 100,000 people.Source: Minnesota Department of Health. Data are for 2001-2010 combined.

Lung cancer, like most types of cancer, mainly occurs in older adults. Fewer

than 2% of all lung cancer cases nationwide are found in people younger than

45. The mortality rate is highest among adults 70 years and older. Lung cancer

deaths are more common among males, reflecting the historically higher

prevalence of smoking among males.

“I wish they would have tested

me for (biological) markers.“Lung Health Survey Respondent

4

Lung cancer is most often diagnosed after it has spreadLung cancer cases are most frequently diagnosed in the distant stage, which means

the cancer has spread to distant organs. Few lung cancer cases are diagnosed in the

early stages when survival is better. The graph below shows:

• In Minnesota, 52% of lung cancer deaths were diagnosed in the distant stage (after

it had spread), emphasizing the importance of early detection and screening.

• People whose cancer is detected in the early stages (localized, even regional) have

better five-year survival rates.

With better screening tools, it would be possible to find and diagnose a lung cancer

earlier, which could lead to better survival. (See Lung Cancer Screening section on

page 3.)

5

“I had no idea what type

of cancer I had and wish

the doctors explained

more about it.“Lung Health Survey Respondent

•

•

•

6

Lung Health SurveyThe American Lung Association created

a Lung Health Survey to identify patient

wants, needs, and experiences regarding

his or her diagnosis. Patients that had

a recent lung cancer diagnosis in the

Mayo, Allina, and North Memorial health

systems received a survey confidentially.

No personal identifiers were released. Data

shown here are for the 748 patients that

responded to the survey between August

2013 and May 2014.

RISK FACTORS: Smoking, Radon and Secondhand Smoke

Smoking is not the only

risk factor for lung

cancer

• About 80-90% of lung cancers

in the U.S. are caused by

smoking, and it increases the

risk of developing many other

types of cancer.

However, not only smokers

develop lung cancer: 17% of respondents to the Lung Health Survey conducted

by the American Lung Association had lung cancer but never smoked. Radon and

secondhand smoke are among the top three risk factors for lung cancer.

About 8% of all respondents reported ever being exposed to radon.

Among the respondents who never smoked but had developed lung cancer, more

than half (56%) reported exposure to secondhand smoke.

More Minnesotans should test their homes for radon

Radon is a serious public health

issue in Minnesota, where 2 in 5

homes have radon levels that pose

a significant health risk. Because

of Minnesota’s natural geology,

nearly 80% of counties are rated

high radon zones.

• Despite this, only a quarter (25.8%)

of respondents had ever tested

their home for radon.

• About 1 out of 8 (13%) respondents who had tested their home found levels of radon

above 4 pCi, the Minnesota Department of Health’s recommended mitigation level

(action level). In Minnesota, 40% of homes have elevated radon levels.

• The Minnesota Radon Awareness Act, passed in 2013, requires sellers of residential

real estate property to provide buyers with information on any radon testing done

on the home, what the results were (if tested), and a radon brochure created by

MDH on the health effects relating to radon exposure.

“•

I wish I would haveconnected with a support group immediately.“

Lung Health Survey Respondent

Earlier diagnosis means better survivalIn a quarter (25%) of the respondents, the lung cancer was not identified in the first

two months after symptoms began. About 9% of respondents said it took 12 months

or longer to reach a lung cancer diagnosis. An earlier diagnosis means better survival.

New recommendations from the American Lung Association could help find lung

cancer earlier in some people. (See Lung Cancer Screening section.)

About 30% of Lung Health Survey respondents that answered the question said they

were diagnosed with other conditions before their health care provider identified lung

cancer. These included lung diseases (14%), other cancers (11%), and blood or heart

diseases (4%).

1%

3%

4%

5%

7%

8%

10%

10%

14%

19%

24%

38%

0% 10% 20% 30% 40% 50%

Swelling in face or neck

General pain

Hoarseness

Coughing up Blood

Loss of appetite and weight loss

Wheezing

Repeated pneumonia or bronchitis

Pain in chest, shoulder, back, arm

Fatigue

Shortness of breath

Frequent coughing

No symptoms before diagnosis

Percent of respondents

Source: ALA Lung Health Survey, 2013-2014.

Symptoms experienced

before lung cancer

diagnosisThe three most common symptoms

that patients experienced, before

reaching a lung cancer diagnosis,

included:

• Frequent coughing (24%)

• Shortness of breath (19%)

• Fatigue (14%)

7

“I wish they would

have taken my steadily

progressive symptoms

more seriously.“Lung Health Survey Respondent

Lung cancer screeningLung cancer screening aims to detect lung cancer at an earlier stage, where it can be

more successfully treated. Results from the National Lung Screening Trial sponsored

by the National Cancer Institute show that annually screening people at high risk of

lung cancer with a low dose computed tomography (CT) scan reduced mortality by

20%. Screening high-risk patients will save lives, but it must only be used for people at

high risk and used carefully.

New recommendations for high-risk peopleBased on results from the National Lung Screening Trial, the American Lung

Association now recommends that high-risk people should be annually screened for

lung cancer with a low dose CT scan. High-risk people are those that meet all of the

following criteria:

• Current or former smokers aged 55-74 years

• A smoking history of at least 30 pack-years (for example, a pack a day for 30 years)

• No history of lung cancer

What are the risks of lung cancer screening?Lung cancer screening is not recommended for everyone. There are some risks to

lung cancer screening:

• A lung cancer

screening test

can have a false-

positive result,

which suggests

that a person has

lung cancer when

no cancer is

present, and can

lead to further

testing and

unnecessary invasive procedures that may cause harm if the person does not hav ecancer.

• There is some radiation risk. A low-dose CT scan uses about 15 times more radiation

than a chest x-ray. However, a low dose CT scan uses five times less radiation than a

conventional CT.

Patients should review the possible benefits and risks of being screened for lung

cancer and should be referred to a facility that uses “best practices” for CT screening.

Lung cancer screening is not a substitute for quitting smoking, but early diagnosis is

key for better survival and screening can be lifesaving in some patients.

8

“My primary care doctor was fabulous and

requested a chest xray immediately. Even though

the radiologist suggested a recheck xray in

three months since it looked like pneumonia. My

primary doctor pushed for a CT scan, then PET,

then biopsy.“Lung Health Survey Responden t

Does insurance cover lung cancer screening?Health insurance companies may not cover the cost for lung cancer screening and

patients should contact their insurance companies to see what is covered. At this point,

Medicare does not cover lung cancer screening. The U.S. Preventive Services Task

Force’s recent recommendation means that marketplace plans and many other private

plans would be required to cover the screening in accordance with the Affordable Care

Act. Some private insurance companies have already elected to cover the screening.

What can I do about my risk for lung cancer?• Don’t smoke. If you smoke, quit. This is the best way to reduce your risk of

developing or dying from lung cancer. Approximately 90% of lung cancers in males

and 80% in females are caused by smoking, which increases the risk of developing

many other cancers as well.

• Test your home for radon and follow through on the results-based

recommendations. Radon is a colorless, odorless radioactive gas that seeps up from

the earth and damages the cells that line the lung when inhaled. It’s the second

leading cause of lung cancer. To learn more and to get a radon test kit, go to the

Minnesota Department of Health’s Radon in Minnesota Homes (www.health.state.

mn.us/divs/eh/indoorair/radon/).

• Avoid secondhand smoke. Also known as environmental tobacco smoke, it is the

third leading cause of lung cancer.

• Ask your doctor about lung cancer screening if you smoke. Your healthcare

provider can help determine whether screening is right for you.

What patients from the Lung Health Survey want professionals to know: • Patients want to learn more about their diagnosis and often report a lack of clarity

on their diagnosis.

• Patients want more information on their type of lung cancer.

• Patients want more education about genetic predispositions and biomarker testing.

• Providers need to emphasize optimistic advice.

9

“There is a possibility of a long battle instead of a short one. More encouragement would have helped.“

Lung Health Survey Respondent

Resources• Lung cancer is the #1 cancer killer of women, yet only 1% of women cited it as a

“top-of-mind” cancer affecting women. The American Lung Association’s LUNG FORCE campaign will unite women to stand together against lung cancer and for

lung health. www.LUNGFORCE.org

• Use an interactive tool to find out whether

you meet lung cancer screening guidelines at

LungCancerScreeningSavesLives.org

• Learn more about lung cancer screening at:

. For patients: Is It Right for Me?

www.lung.org/lung-disease/lung-cancer/

lung-cancer-screening-guidelines/lung-cancer-

screening-for-patients.pdf

. For physicians: Should My Patient Be Screened?

www.lung.org/lung-disease/lung-cancer/lung-cancer-screening-

guidelines/lung-cancer-screening-doctor.pdf)

• Learn more about Talking with Your Patients

About Screening for Lung Cancer from the U.S.

Preventative Services Task Force.

www.uspreventiveservicestaskforce.org/

Home/GetFileByID/796

• Call the Lung HelpLine at 1-800-LUNG-USA.10

Lung health questiree, 7 days a week

ons? a.m. - midnight EST a.m. - 11 p.m. CST

sthma Lung HelpLine

l COPD 1-800-LUNG-USA (800-586-4872)ung Cancer moking Cessation www.Lung.orgtaffed by experienced

Ask an expert.egistered nurses, espiratory therapists nd certif ied cessation ounselors

front

F87

ALS

Srrac

490 Concord ia Ave l S t . Pau l , MN 55103Ph: 651-227-8014 F: 651-227-5459 Info@LungMN.org

LungMN.org

Data sources for this reportCancer incidence data are collected by the Minnesota Cancer Surveillance System,

which is Minnesota’s central cancer registry at the Minnesota Department of Health

(MDH). Cancer mortality data are collected by the Minnesota Center for Health

Statistics at MDH and analyzed by the Minnesota Cancer Surveillance System.

The American Lung Association created a Lung Health Survey to identify patient

wants, needs, and experiences regarding his or her diagnosis. Each partnering clinic

system mailed the survey for all patients in their roster with an ICD-9 diagnosis codes

of 162 (trachea, bronchus, and lung); 163 (pleura); and 165 (Other in the respiratory

system) (i.e. lung cancer) within the past 5 years and living in Minnesota. Partnering

systems were: Mayo, Allina, and North Memorial. There was a 32% response rate

(748 responses) from August 2013 – May 2014 capturing 74 out of 87 counties in

Minnesota. A little over half (51.3%) were female, 37.8% male, and about 10% did not

provide gender. Among the respondents that answered the question on age, 1.6% were

age 45 and under, 31.1% were between the ages of 46 and 65, and 67.3% were 66 years

of age and over.

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651-201-5900

The Minnesota Department of Health’s Environmental Public Health Tracking Program (MN Tracking) gathers and analyzes data about the environment, people’s exposure to environmental hazards, and health effects. These data are available at Minnesota Public Health Data Access (https://apps.health.state.mn.us/mndata).

800-205-4987 toll-freehealth.dataportal@state.mn.us

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.