Missouri
Fee-For-Service Medicaid Coverage of Screening
Covered and Using Updated Guidelines
Highlighted Disparity
Black individuals in Missouri are least likely to receive surgical treatment.
Lung Cancer Rates
New Cases:
- The rate of new lung cancer cases is 68.4 and significantly higher than the national rate of 54.6.
- Missouri ranks 43rd among all states, placing it in the below average tier.
- Over the last five years, the rate of new cases improved by 9%.
5-Year Survival Rate:
- The percent of people alive five years after being diagnosed with lung cancer (the survival rate) in Missouri is 24.7%, which is significantly lower than the national rate of 26.6%.
- It ranks 27th among the 42 states with survival data, placing it in the below average tier.
- Over the last five years, the survival rate in Missouri improved by 26%.
Early Diagnosis:
- 27.4% of cases are caught at an early stage, which is significantly higher than the national rate of 26.6%.
- It ranks 19th 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 Missouri did not change significantly.
Lung Cancer Treatment
Surgical Treatment:
- Missouri ranked 34th (out of the 47 states with available data) with 17.9% of cases undergoing surgery as part of the first course of treatment.
- This is significantly lower than the national rate of 20.8% and puts Missouri in the below average tier.
- Over the last five years, the percent of cases undergoing surgery in Missouri did not change significantly.
Lack of Treatment:
- Missouri ranked 4th (out of the 47 states with available data) with 15.4% of cases not receiving any treatment.
- This is significantly lower than the national rate of 20.6% and puts Missouri in the top tier.
- Over the last five years, the percent of cases receiving no treatment in Missouri did not change signficantly.
Screening
Screening for High Risk:
- In Missouri, 5.8% of those at high risk were screened, which was significantly higher than the national rate of 4.5%.
- It ranks 20th among all states, placing it in the average tier.
- Actual screening rates may be higher in states with large, regional managed care providers that did not share screening data.
Medicaid Coverage:
- Missouri was one of the 49 states whose Medicaid fee-for-service programs covered lung cancer screening as of October 2023.
- While their program did not require prior authorization or copays, they have not shown that it uses the latest recommended guidelines for determining eligibility.
Prevention
Tobacco Use:
- The smoking rate in Missouri is 17.3% and significantly higher than the national rate of 13.5%.
- It ranks 43rd among all states, placing it in the below average tier.
Radon:
- In Missouri, 31.0% of radon tests results were at or above the action level recommended by EPA.
- It ranks 32nd among all states, placing it in the below average tier.
Racial & Ethnic Disparities
Black individuals:
- The rate of new lung cancer cases is 73.3 per 100,000 population among Black individuals in Missouri, significantly higher than the rate of 56.3 among Black individuals nationally, and significantly higher than the rate of 69.1 among white individuals in Missouri.
- The five-year survival rate is 23.8% among Black individuals in Missouri, not significantly different than the rate of 23.8% among Black individuals nationally, and not significantly different than the rate of 24.8% among white individuals in Missouri.
- 25.7% of lung cancer cases are diagnosed at an early stage among Black individuals in Missouri, significantly higher than the rate of 23.2% among Black individuals nationally, and not significantly different than the rate of 27.7% among white individuals in Missouri.
- 13.9% of Black individuals with lung cancer in Missouri underwent surgery, significantly lower than the rate of 17.0% among Black individuals nationally, and significantly lower than the rate of 18.3% among white individuals in Missouri.
- 17.5% of Black individuals with lung cancer in Missouri did not receive any treatment, significantly lower than the rate of 22.4% among Black individuals nationally, and significantly higher than the rate of 15.3% among white individuals in Missouri.
Latino individuals:
- The rate of new lung cancer cases is 28.4 per 100,000 population among Latino individuals in Missouri, not significantly different than the rate of 28.2 among Latino individuals nationally, and significantly lower than the rate of 69.1 among white individuals in Missouri.
- 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.
- 22.2% of lung cancer cases are diagnosed at an early stage among Latino individuals in Missouri, not significantly different than the rate of 23.1% among Latino individuals nationally, and not significantly different than the rate of 27.7% among white individuals in Missouri.
- 22.2% of Latino individuals with lung cancer in Missouri underwent surgery, not significantly different than the rate of 21.6% among Latino individuals nationally, and significantly higher than the rate of 18.3% among white individuals in Missouri.
- 10.8% of Latino individuals with lung cancer in Missouri did not receive any treatment, significantly lower than the rate of 26.1% among Latino individuals nationally, and not significantly different than the rate of 15.3% among white individuals in Missouri.
Asian Americans or Pacific Islanders:
- The rate of new lung cancer cases is 38.7 per 100,000 population among Asian or Pacific Islanders individuals in Missouri, not significantly different than the rate of 32.9 among Asian or Pacific Islanders individuals nationally, and significantly lower than the rate of 69.1 among white individuals in Missouri.
- 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.
- 21.6% of lung cancer cases are diagnosed at an early stage among Asian or Pacific Islander individuals in Missouri, not significantly different than the rate of 22.8% among Asian or Pacific Islander individuals nationally, and not significantly different than the rate of 27.7% among white individuals in Missouri.
- 22.1% of Asian or Pacific Islander individuals with lung cancer in Missouri underwent surgery, not significantly different than the rate of 24.7% among Asian or Pacific Islander individuals nationally, and not significantly different than the rate of 18.3% among white individuals in Missouri.
- 11.3% of Asian or Pacific Islander individuals with lung cancer in Missouri did not receive any treatment, significantly lower than the rate of 20.2% among Asian or Pacific Islander individuals nationally, and not significantly different than the rate of 15.3% among white individuals in Missouri.
Indigenous Peoples:
- The rate of new lung cancer cases is 30.9 per 100,000 population among Indigenous Peoples (American Indians/Alaska Natives) in Missouri, not significantly different than the rate of 39.4 among Indigenous Peoples nationally, and significantly lower than the rate of 69.1 among white individuals in Missouri.
- State-level survival rates are not available for Indigenous Peoples at this time. Nationally, the five-year survival rate among Indigenous Peoples is 22.3% and not significantly different than the rate of 25.0% among white individuals.
- Other lung cancer rates are not available for Indigenous Peoples (American Indians/Alaska Natives) in Missouri due to too few cases over the time period to allow for accurate analysis.
Summary
Despite the early diagnosis rate in Missouri 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.
Missouri has improved access to expanded screening by covering it through its fee-for-service Medicaid program. The Lung Association encourages all states 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.
Missouri falls into the top 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.