District of Columbia
Fee-For-Service Medicaid Coverage of Screening
Covered and Using Updated Guidelines
Highlighted Disparity
Black individuals in the District of Columbia are most likely to be diagnosed with lung cancer.
Lung Cancer Rates
New Cases:
- The rate of new lung cancer cases is 43.2 and significantly lower than the national rate of 54.6.
- The District of Columbia ranks 8th among all states, placing it in the above average tier.
- Over the last five years, the rate of new cases did not change significantly.
5-Year Survival Rate:
- The percent of people still alive five years after being diagnosed with lung cancer (the survival rate) is 26.6% nationally. District of Columbia is one of the 9 states for which survival data is not available as they do not track cases after diagnosis.
Early Diagnosis:
- 26.1% of cases are caught at an early stage, which is not significantly different than the national rate of 26.6%.
- It ranks 30th among the 47 states with data on diagnosis at an early stage, placing it in the average tier.
- Over the last five years, the early diagnosis rate in the District of Columbia did not change significantly.
Lung Cancer Treatment
Surgical Treatment:
- The District of Columbia ranked 24th (out of the 47 states with available data) with 20.1% of cases undergoing surgery as part of the first course of treatment.
- This is not significantly different than the national rate of 20.8% and puts the District of Columbia in the average tier.
- Over the last five years, the percent of cases undergoing surgery in the District of Columbia improved by -39%
Lack of Treatment:
- The District of Columbia ranked 42nd (out of the 47 states with available data) with 24.8% of cases not receiving any treatment.
- This is significantly higher than the national rate of 20.6% and puts the District of Columbia in the below average tier.
- Over the last five years, the percent of cases receiving no treatment in the District of Columbia did not change significantly.
Screening
Screening for High Risk:
- In the District of Columbia, 1.5% of those at high risk were screened, which was significantly lower than the national rate of 4.5%.
- It ranks 46th among all states, placing it in the bottom tier.
- Actual screening rates may be higher in states with large, regional managed care providers that did not share screening data.
Medicaid Coverage:
- The District of Columbia was one of the 49 states whose Medicaid fee-for-service programs covered lung cancer screening as of October 2023.
Prevention
Tobacco Use:
- The smoking rate in the District of Columbia is 9.5% and significantly lower than the national rate of 13.5%.
- It ranks 3rd among all states, placing it in the top tier.
Radon:
- In the District of Columbia, 8.7% of radon tests results were at or above the action level recommended by EPA.
- It ranks 6th among all states, placing it in the top tier.
Racial & Ethnic Disparities
Black individuals:
- The rate of new lung cancer cases is 57.6 per 100,000 population among Black individuals in the District of Columbia, not significantly different than the rate of 56.3 among Black individuals nationally, and significantly higher than the rate of 25.2 among white individuals in the District of Columbia. Survival rates by race and ethnicity are not available for the District of Columbia at this time.
- Nationally, the five-year survival rate among Black individuals is 23.8%, 11% lower than among white Americans.
- 26.0% of lung cancer cases are diagnosed at an early stage among Black individuals in the District of Columbia, not significantly different than the rate of 23.2% among Black individuals nationally, and not significantly different than the rate of 29.0% among white individuals in the District of Columbia.
- 18.3% of Black individuals with lung cancer in the District of Columbia underwent surgery, not significantly different than the rate of 17.0% among Black individuals nationally, and significantly lower than the rate of 28.0% among white individuals in the District of Columbia.
- 26.2% of Black individuals with lung cancer in the District of Columbia did not receive any treatment, significantly higher than the rate of 22.4% among Black individuals nationally, and not significantly different than the rate of 21.2% among white individuals in the District of Columbia.
Latino individuals:
- The rate of new lung cancer cases is 15.1 per 100,000 population among Latino individuals in the District of Columbia, significantly lower than the rate of 28.2 among Latino individuals nationally, and significantly lower than the rate of 25.2 among white individuals in the District of Columbia.
- State-level survival rates are not available for Latino individuals at this time. Nationally, the five-year survival rate among Latino individuals is 22.7%, not significantly different than the rate of 25.0% among white individuals.
- Other lung cancer rates are not available for Latino individuals in the District of Columbia due to too few cases over the time period to allow for accurate analysis.
Asian Americans or Pacific Islanders:
- The rate of new lung cancer cases is 36.2 per 100,000 population among Asian or Pacific Islanders individuals in the District of Columbia, not significantly different than the rate of 32.9 among Asian or Pacific Islanders individuals nationally, and not significantly different than the rate of 25.2 among white individuals in the District of Columbia.
- State-level survival rates are not available for Asian or Pacific Islander individuals at this time. Nationally, the five-year survival rate among Asian or Pacific Islander individuals is 28.6% and significantly higher than the rate of 25.0% among white individuals.
- Other lung cancer rates are not available for Asian or Pacific Islander individuals in the District of Columbia due to too few cases over the time period to allow for accurate analysis.
Indigenous Peoples:
- Lung cancer rates are not available for Indigenous Peoples (American Indians/Alaska Natives) in the District of Columbia due to too few cases over the time period to allow for accurate analysis.
Summary
Despite the early diagnosis rate in the District of Columbia falling into the average tier, the state still has a lot of work to do to make sure that more of those at high risk for lung cancer are screened.
The District of Columbia has improved access to expanded screening by covering it through its fee-for-service Medicaid program. The Lung Association encourages all states and the District of Columbia to cover lung cancer screening based on the latest guidelines across all fee-for-service and managed care plans without any financial or administrative barriers in their Medicaid programs.
It is alarming that the District of Columbia falls into the below average tier for percent of patients receiving no treatment. Some patients do refuse treatment, but issues such as fatalism and stigma can prevent eligible patients from accessing treatment that may save or extend their lives. All patients should work with their doctors to establish a treatment plan and goals.