Cigarette brands manufactured by Reynolds Amercian are displayed at a tobacco shop on July 11, 2014 in San Francisco, California. Alabama ranks 46th for lung cancer survival, with just 22.3% living beyond five years, below the 28.4% national average. (Photo by Justin Sullivan/Getty Images)
Alabama ranks near the bottom of the nation for lung cancer survival, with just over one-fifth of diagnosed patients surviving beyond five years.
According to a November report from the American Lung Association, Alabama ranks 46th among the 47 states with survival data, with only 22.3% of diagnosed patients surviving beyond five years, below the national average of 28.4%.
“With this report, and the work that’s been done nationally, we are seeing changes in the tide around the survival rate across the nation, and that’s not the case in Alabama,” said Ashley Lyerly, senior director of advocacy for the American Lung Association.
GET THE MORNING HEADLINES.
The 2024 State of Lung Cancer report shows mixed performance for Alabama on indicators for lung cancer. The state ranked 10th nationally for lung cancer screening, with 19.4% of those at high risk screened, but it fell short in other areas. Only 25.3% of cases in Alabama were diagnosed early, when survival rates are higher. The rate of surgical treatment, often crucial for survival, was among the worst in the country.
Smoking is the leading cause of lung cancer in Alabama, according to the report. The report estimates 15.6% of adults in Alabama are smokers — far above the national average of 11.6%. Radon, the second-leading cause of lung cancer, also poses significant risks.
Lung cancer death rates for men in Alabama were significantly higher than the national average. Men in Alabama had a rate of 57 deaths per 100,000, compared to 40.6 nationwide, ranking 5th highest among states. Women in Alabama had a rate of 31.6 deaths per 100,000, compared to 28.6 nationwide, ranking 17th highest in comparison.
Black Alabamians were less likely to receive surgical treatment, reflecting broader barriers to care. Lyerly noted that stigma, high tobacco use, and healthcare costs disproportionately affect marginalized communities.
“I think there’s hesitancy with the health care system among Black individuals, but (there are) also high rates of tobacco use, and also cost of treatment. If we don’t have health insurance that is affordable, even screening or accessing some sort of type of treatment can be certainly a significant barrier,” Lyerly said.
Medicaid gaps may make the issue worse, according to the report. Alabama is the only state where Medicaid does not cover annual low-dose CT scans for lung cancer screening, a proven method to reduce lung cancer mortality by up to 20%.
There is also no state policy requiring insurance plans to cover biomarker testing, which can shape treatments for specific tumor types. Such testing, while essential, is not currently required to be covered by Alabama insurance plans. Biomarker testing coverage is required in 15 states for all insurance plans.
A separate report from the Lung Cancer Association found that Alabama continues to lag behind the rest of the country in policy efforts to prevent and reduce tobacco use. The organization recommends Alabama strengthen state and local smoke-free air laws as well as instituting a tobacco retail licensing program.
For example, about half of states, including Alabama, do not penalize vendors who sell tobacco to minors. 34 states and DC ban smoking in restaurants, while restaurants in Alabama may choose to have a designated area.
Sen. Vivian Davis Figures, D-Mobile, who spearheaded the Alabama Clean Indoor Air Act, said it was important for her to address the consequences of secondhand smoke. She described her personal struggles and legislative challenges in addressing secondhand smoke in her early days in the statehouse.
“I started wearing surgical masks to go down the hall and then with the can of Lysol spray spraying my way chamber,” Figures said as she recalled how exposure to smoke at the time triggered an asthma attack on the Senate floor.
Despite opposition from the tobacco industry and even some health organizations demanding stricter measures, Figures fought for six years to pass a “watered-down” version of the Clean Indoor Air Act. She said the only thing she wouldn’t compromise on was allowing municipalities to pass stronger policies, to which she credited the progress that’s been made.
“Alabama is a big tobacco state, although we don’t grow tobacco. But the tobacco industry has a big hold on it,” she said.
Jane Adams, government relations director for the American Cancer Society Cancer Action Network (ACS CAN) in Alabama, said that the best way to survive cancer is to have access to screenings and preventive care, and that “it’s time for Alabama to join 40 other states and expand Medicaid.”
“Alabama’s poor cancer outcomes have a clear path for improvement: implement fact-based tobacco control policies, including increasing state funding to $6 million and giving people on Medicaid access to full cessation coverage including group counseling,” Adams said in a statement.
She added individuals in states that have expanded Medicaid have earlier stage diagnoses and better cancer outcomes than individuals in non-expansion states.
“Medicaid plays a critical role in helping cancer patients get the care they need to fight and survive this disease. ACS research shows time and again that access to affordable, comprehensive health care is inextricably linked to better cancer outcomes,” Adams said.
Alabama Department of Public Health (ADPH) in a statement highlighted efforts to promote smoking cessation, provide radon testing and encourage high-risk individuals to pursue early screenings.
“Alabamians smoke more than the US average,” said Nancy Wright, director of ADPH’s cancer prevention and control division. “While the mortality and incidence rates for lung cancer are declining, they are not doing so as quickly as the national average. If you are at high risk, talk to your doctor about lung cancer screening.”
Efforts from ADPH to combat these risks include free radon test kits for Alabama residents and the Alabama Tobacco Quitline, which offers cessation coaching and support. Alabamians are encouraged to call 1-800-QUITNOW for assistance in quitting smoking or 334-290-6248 for radon testing.
YOU MAKE OUR WORK POSSIBLE.