Lung cancer is the leading cause of cancer death in both men and women in the United States, and accounts for over one-fifth of all cancer deaths. According to the CDC, Missouri had the seventh-highest rate of new lung and bronchus cancer diagnoses among states in 2019, and the ninth-highest rate of deaths from lung and bronchus cancer. Although Missouri’s smoking rate has declined over the past decade, at 18% it remains significantly higher than the national rate of 14%. 

Lung cancer screening in Missouri’s commercially insured population was the focus of a recent Midwest Health Initiative report, Lung Cancer Screening: The Missouri Story. While lung cancer screening rates in Missouri doubled between 2018 and 2021 - they remain low at about 6.6% of eligible adults.

Like other cancers, lung cancer survival is greatly improved when the cancer is detected early, as treatment options are less likely to be curative once the cancer has spread. In an effort to reach a broader and more inclusive population of at-risk patients sooner, the U.S. Preventive Services Task Force (USPSTF) changed lung cancer screening guidelines in 2021: low-dose CT screening is now recommended annually for current smokers, or those that quit within the past 15 years, aged 50 to 80, with a history of 20 or more pack-years.

Although early detection of lung cancer is critical, the decision to partake in screening is more complex than it may initially seem. There are potential risks, such as false test results, low doses of radiation exposure, and overdiagnosis. Patients should be counseled on these prior to being screened. Additionally, lung cancer screening is not appropriate for patients who are unwilling or unable, due to other health conditions, to undergo treatment if lung cancer is found. Early detection won’t change the outcome for patients who will not be treated, but screening and diagnosis may cause emotional or physical harm. 

Missouri and other states’ lung cancer statistics can be compared on this American Lung Association interactive website. 

• Overall, patients in Missouri are diagnosed early at a similar rate to patients nationally, except for Latino Americans, who were least likely to be diagnosed early in Missouri.
  
  
• People diagnosed with lung cancer in Missouri are less likely to undergo surgery or other treatment.  
  
  
• Missouri’s five-year survival rate for lung cancer is meaningfully below the national average.

While surgery remains the ideal first-line treatment for patients with early-stage lung cancer, patients who are not healthy enough to undergo the procedure or whose cancer has spread may not be candidates. Other treatments may be recommended, such as chemotherapy, radiation, targeted therapy, or immunotherapy. Recent improvements in survivability are likely due in part to advancements in immunotherapy and targeted treatments informed by biomarker testing.

A new and rapidly evolving field, biomarker testing, enables medical professionals to study tumor cells and characterize their genetic mutations, protein expression, and tissue environment in order to identify treatments that can target the specific molecular pathways of cancer cells. Clinical stage, biomarkers, tumor histology, and several other factors all contribute to the treatment decision. In lung cancer, testing is primarily utilized for late-stage non-small cell lung cancer.

An MHI report coming soon will provide additional insights into targeted therapy and coverage for lung cancer biomarker testing. MHI analysts reviewed clinical guidelines across Missouri’s major health plans and summary plan documents (SPDs) from a handful of self-insured employers and found no barriers to these evolving and game-changing biomarker tests. All Missouri major health plans’ biomarker policies were consistent with national standards. While employer SPDs were generally silent on “biomarker” testing, they explicitly covered medically necessary diagnostic services and genetic testing. Employers may benefit by referencing the National Comprehensive Cancer Network® (NCCN®) in their plan documents. This collaboration of 33 leading cancer treatment centers across the U.S., including Siteman Cancer Center in St. Louis, has established “a comprehensive set of guidelines detailing the sequential management decisions and interventions that currently apply to 97 percent of cancers affecting patients in the United States.” Employers could simply state that their plan provides coverage for biomarker testing consistent with NCCN guidelines, much like the way they state their plan covers preventative screenings recommended by the USPSTF, and rest assured that their coverage will remain consistent with best practices and evolving science overtime.

What else can employers do?  

1. Connect employees with Missouri Department of Health and Senior Services’ free Missouri Tobacco Quit Services. This confidential service is an effective way to help Missourians quit all forms of tobacco, including e-cigarettes and smokeless tobacco. Prevention is always the best policy.
   
   
2. Educate eligible tobacco users and their family members on the importance of annual screenings and early detection, noting the importance among Latino populations and emphasizing the fact that lung cancer screenings have first dollar coverage. 
   
   
3. Educate employees on available support programs, such as those offered through your EAP, which can help with issues like depression and anxiety, coping with emotions, and even managing money issues.
   
   
4. Support employees and their dependents in achieving their best health, and encourage protective factors to boost resilience, such as a nutrient-dense diet, improved physical activity, and healthy sleep habits.
   
   
5. Join BHC members for the April 12th community forum, “Building Immunity: The Science of Healthy Living” for an update on this science. Register here.

Warm regards,

Louist Y. Probst

BHC Executive Director