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 [email protected]
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 [email protected]
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.
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