District of Columbia
Fee-For-Service Medicaid Coverage of Screening
Yes
Highlighted Disparity
Black Americans 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 45 and significantly lower than the national rate of 58.
- The District of Columbia ranks 7th 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 alive five years after being diagnosed with lung cancer (the survival rate) in the District of Columbia is 24%, which is not significantly different than the national rate of 24%.
- The District of Columbia is one of the 6 states for which survival data is not available as they do not track cases after diagnosis.
Early Diagnosis:
- 23% of cases are caught at an early stage, which is not significantly different than the national rate of 24%.
- It ranks 38th among the 49 states with data on diagnosis at an early stage, placing it in the below average tier.
- Over the last five years, the early diagnosis rate in the District of Columbia improved by 51%.
Lung Cancer Treatment
Surgical Treatment:
- The District of Columbia ranked 11th (out of the 49 states with available data) with 22% of cases undergoing surgery as part of the first course of treatment.
- This is not significantly different than the national rate of 20.7% 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 did not change significantly.
Lack of Treatment:
- The District of Columbia ranked 44th (out of the 49 states with available data) with 25% of cases not receiving any treatment.
- This is significantly higher than the national rate of 21% 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 improved by 31%.
Screening
Screening for High Risk:
- In the District of Columbia, 4% of those at high risk were screened, which was not significantly different than the national rate of 6%.
- It ranks 36th among all states, placing it in the below average tier.
Medicaid Coverage:
- The District of Columbia was one of the 40 states whose Medicaid fee-for-service programs covered lung cancer screening as of September 2021.
- While their program used recommended guidelines for determining eligibility and did not require cost sharing, it did require prior authorization.
Prevention
Tobacco Use:
- The smoking rate in the District of Columbia is 13% and significantly lower than the national rate of 15%.
- It ranks 8th among all states, placing it in the above average tier.
Radon:
- In the District of Columbia, 9% 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 Americans:
- The rate of new lung cancer cases is 59 per 100,000 population among Black Americans in the District of Columbia, not significantly different than the rate of 60 among Black Americans nationally, and significantly higher than the rate of 26 among whites in the District of Columbia.
- Survival rates by race and ethnicity are not available for the District of Columbia at this time.
- 23% of lung cancer cases are diagnosed at an early stage among Black Americans in the District of Columbia, not significantly different than the rate of 21% among Black Americans nationally, and not significantly different than the rate of 24% among whites in the District of Columbia.
- 21% of Black Americans with lung cancer in the District of Columbia underwent surgery, significantly higher than the rate of 17% among Black Americans nationally, and significantly lower than the rate of 30% among whites in the District of Columbia.
- 27% of Black Americans with lung cancer in the District of Columbia did not receive any treatment, significantly higher than the rate of 23% among Black Americans nationally, and significantly higher than the rate of 20% among whites in the District of Columbia.
Latino Americans:
- The rate of new lung cancer cases is 20 per 100,000 population among Latinos in the District of Columbia, significantly lower than the rate of 29 among Latinos nationally, and not significantly different than the rate of 26 among whites in the District of Columbia.
- Survival rates by race and ethnicity are not available for the District of Columbia at this time.
- Other lung cancer rates are not available for Latino Americans 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 37 per 100,000 population among Asian Americans or Pacific Islanders in the District of Columbia, not significantly different than the rate of 34 among Asian Americans or Pacific Islanders nationally, and not significantly different than the rate of 26 among whites in the District of Columbia.
- Survival rates by race and ethnicity are not available for the District of Columbia at this time.
- Other lung cancer rates are not available for Asian Americans or Pacific Islanders 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
The early diagnosis rate in the District of Columbia falls into the below 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 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 recommended 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 not receiving any 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.