Hawaii ranks worst in the country when it comes to the early diagnosis of lung cancer, according to a new study released Monday by the American Lung Association. The lack of early screening and diagnosis has troubling implications for sufferers’ long-term prognosis, as catching lung cancer early can significantly increase the chance of survival.
While Hawaii has fared better than most states when it comes to its overall rate of lung cancer, it’s still the most deadly form of cancer in the state, killing on average of more than 500 residents annually.
“It’s great that we have lower incidence rates than other parts of the country, but it’s incredibly troubling that we are dead last in early diagnosis,” said Pedro Haro, executive director of the American Lung Association in Hawaii. “We can do a better job in early screening. That’s where we need to move the needle.”
The U.S. Preventive Services Task Force recommends that smokers and former smokers who are at high risk of developing lung cancer undergo a low-dose CT scan annually, which captures detailed pictures of the lungs.
Those who fall into the high-risk category include adults between the ages of 55 and 80 who smoke a pack a day or more and former heavy smokers who quit in the past 15 years.
The annual screenings are limited to the highest-risk smokers, in part, due to the risk of false positive results, which can cause anxiety and lead to follow-up tests and procedures that aren’t needed and carry their own risk.
The task force found that conducting the annual screenings for high-risk smokers can prevent many lung cancer deaths. But in Hawaii, just 2.8% of high risk smokers were undergoing the annual scans, compared to 5.7% nationally, according to the study.
The state-by state analysis also found that just 19% of lung cancer cases in Hawaii are diagnosed early, compared to 24.5% nationally.
The study also found that only 18.5% of those diagnosed with lung cancer in Hawaii underwent surgery, compared with 20.7% nationally, placing Hawaii 33rd in the nation. Lung cancer can often be treated with surgery if it is diagnosed at an early stage.
Of Hawaii residents diagnosed with lung cancer, 26.5% received no treatment, compared with 21.1% nationally, placing Hawaii 45th in the nation.
Just 20.7% of Hawaii residents were alive five years after a lung cancer diagnosis, compared with a national average of 23.7%, placing Hawaii 38th in the nation for survival.
Catching lung cancer early can dramatically improve the chances of successfully treating it. The five-year survival rate for people diagnosed early is 60%. The survival rate drops to 6% when caught at a late stage.
The study also found that Native Hawaiians are more likely to be diagnosed and die of lung cancer than other ethnic groups.
“So we need to be able to do a better job,” said Haro. “It’s a social justice issue in our state when it comes to Native Hawaiians.”
Haro said that sometimes people who quit smoking don’t consider themselves at high risk of lung cancer and therefore they don’t think to seek out annual screenings.
“So for someone who has quit smoking 10 years ago, smoking is no longer part of their regular lives,” said Haro. “They don’t see themselves as a smoker. They feel better. They breathe better. So they are not thinking about things like lung cancer or emphysema, or anything that could come in the future.”
Dr. Samuel Evans, chief of pulmonology for Hawaii Pacific Health Medical Group, said Hawaii’s low ranking for early diagnosis of lung cancer reflects the state’s shortage of primary care physicians and specialists, particularly on the neighbor islands.
“The problem is access to care,” said Evans. “What the public doesn’t realize is that we are about 1,000-plus doctors down in Hawaii.”
Evans said that the lack of primary care doctors results in delays in patients being referred to specialists.
“The outer-island patients, I see this all the time, they will get sent to me and I will see them within five days of the referral,” said Evans. “But then I’ll look at their imaging and low and behold the mass was there three or four months ago.”
Evans said the doctor shortage has only gotten worse during the COVID-19 pandemic.
Indeed, the Hawai‘i Physician Workforce Assessment Project Report for 2020 found that the state’s physician shortage is expected to increase for several years as older physicians leave their practice at higher rates.
Evans said that patients are their own best advocates. “So those who have a smoking history or meet this criteria, they should advocate for themselves and ask their primary doc if they should be screened for lung cancer,” said Evans. “And the primary care docs need to be more assertive with the lung cancer screening.”
Evans said that Hawaii’s low incidence of lung cancer compared to the national average was reflective of the the state’s lower smoking rates. But he worries that high vaping rates among high schoolers could counter that trend. In addition to getting young people hooked on nicotine, he said that the potential cancer risk for vaping is still not clear.
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Get the facts
Hawaii Pacific Health will be conducting a webinar on lung cancer from 5:30 to 6:30 p.m. Thursday. The session will provide residents with information on health screenings, new research and available treatments. More information can be found at hawaii pacifichealth.org/HealthierWebinar.
State of Lung Cancer 2021 by Honolulu Star-Advertiser
