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Midwestern states have a mixed record on fighting lung cancer, according to a new report

A drawing of pink lungs against a white background
Missouri ranks fourth in the nation for lung cancer patients receiving no treatment after diagnosis.

Sara Geiken, 43, remembers the first time she felt the pain of her lung cancer after a workout class in 2019.

“I thought I had pulled a muscle,” she said.

Geiken, who had been involved with the American Lung Association in Iowa for nearly ten years as a volunteer, was at low risk for lung cancer.So, when a doctor diagnosed her with adenocarcinoma, which starts in glands that line the insides of the organs, she was caught off-guard.

“It turned out it was actually already at that point: stage three lung cancer,” she said. “It was a complete surprise.”

Geiken’s cancer has since progressed to stage four and is terminal, but she said advancements in lung cancer treatment have given her the ability to live longer.

A selfie of Sara Geiken walking on a trail.
Iowa resident Sara Geiken, 43, is living with late stage lung cancer.

“I didn’t think I’d see my daughter graduate from high school and now she’s done that,” Geiken said. “Now I even have hope I’ll see her graduate from college.”

The annual American Lung Association (ALA) State of Lung Cancer report, released today, shows the five-year survival rate for people living with lung cancer nationally is improving.

The report shows that the five-year survival rate for people of color nationwide — a metric tracked to help reduce health disparities — improved by 17% since last year.

“That is an extraordinary accomplishment,” said Kristina Hamilton, a regional ALA director. “There is still quite a bit of disparity between communities of color and white individuals in America but we are seeing that disparity shrink.”

However, the same report shows a grimmer overall picture for patients in certain states. Rates of new lung cancer cases in Missouri and Iowa are significantly higher than the national rate. And, the five-year survival rate for cancer patients in both states is much lower.

Hamilton said Missouri, Iowa, Kansas and Nebraska all have room to improve in the areas covered by the report, while each state has made progress in specific categories.

A photo of Kristina Hamilton sitting outside in a park.
American Lung Association regional director Kristina Hamilton says states in the Midwest have work to do when it comes to lung cancer survival rates. However, she says the rate at which patients are surviving five years after their lung cancer diagnosis is improving nationwide.

“There’s consistency there,” Hamilton said. “There’s definitely room for improvement for the states to really expand awareness about lung cancer screening, reduce cost barriers, and ensure both patients and providers know that screening is available.”

According to the report, Missouri ranked sixth worst in the nation for new lung cancer cases, with 68.43 new cases per 100,000 people in 2023. For the same year, Iowa ranked 12th worst, with 61.4 new cases per 100,000 people.

The national average is 54.6 new cases per 100,000.

Both states saw a slight drop from 2022’s rates. Missouri’s rate dropped from 70 per 100,000 people to the current rate of 61.4. Iowa’s rate also dropped slightly from 63 new cases per 100,000 people to 61.4.


Both Kansas and Nebraska saw slight increases in the rate of new cases. Nebraska remains under the national average for new cases, while Kansas roughly meets the national average.

Outside of the rate of new cases, the ALA does not have any other metrics from Kansas.

According to the ALA, common symptoms of lung cancer include but are not limited to:

  • a cough that does not go away or gets worse 
  • coughing up blood
  • chest pains made worse with heavy breathing 
  • a loss of appetite
  • unexplained weight loss,
  • hoarseness 
  • shortness of breath 
  •  feeling tired or weak 

Hamilton said in Iowa, Nebraska and Missouri lung cancer patients' five-year survival rate lies below the national average, with Missouri having the lowest percentage of survival at 24.7%.
Nationally, the report found lung cancer five-year survival rates are improving. According to the data, the five-year survival rate for patients with lung cancer increased from 22% to 26.6% from 2015 to 2019.

Geiken is one such survivor. She said the improving rates at survival give her and others fighting lung cancer hope.

“It’s easy, especially once you get that terminal diagnosis, this is it — I’ve got six months,” Geiken said. “It means life, it means experience — it means a lot of things.”

According to the ALA, lung cancer is the leading cause of cancer death in the U.S., accounting for roughly one in five of all cancer deaths.


According to the ALA report, while Iowa ranks 12th highest in the nation for new cases in the country, the state ranked tenth best for early diagnoses and surpassed the national average for lung cancer screenings.

Hamilton pointed to the high prevalence of radon in Iowa, which is the second leading cause of lung cancer in the U.S. Radon is an odorless, invisible, radioactive gas naturally released from rocks, soil, and water.

The report also ranked Iowa:

  • 26th in the nation for five-year survival rate
  • 36th  in the nation for surgical treatment of lung cancer
  • 15th in the nation for patients receiving no treatment for lung cancer


Aside from Missouri’s high ranking for rates of new lung cancer cases, the ALA also found the state ranked fourth in the nation for lung cancer patients receiving no treatment after diagnosis.

According to the report, roughly 15% of Missourians did not receive treatment after a lung cancer diagnosis. That’s compared to a 20.6% national average.

The report also ranked Missouri:

  • 27th in the nation for five-year survival rate
  • 19th in the nation for early lung cancer diagnosis
  • 20th for lung cancer screenings
  • 34th for lung cancer treated with surgery


The report found Nebraska ranked 33rd in the nation for lung cancer screenings with only 3.7% of Nebraskans who are high risk for lung cancer seeking out screenings. Nationally, 4.5% of high-risk patients seek out screenings.

Additionally, the report found Nebraska ranks:

  • 17th for new lung cancer cases
  • 28th for the five-year survival rate
  • 9th for early lung cancer diagnosis
  • 12th for lung cancer treated with surgery
  • 22nd for lung cancer patients receiving no treatment after diagnosis


Kansas surpassed the national average for lung screenings, ranking 14th in the nation with a 7% rate at which high-risk Kansans receive cancer screenings.

The report also found Kansas ranked 36th and 3rd in the nation for adult smoking rates and for positive radon tests, respectively. Smoking and radon exposure are the two leading causes of lung cancer, according to the ALA


You can find more information and resources at the American Lung Association website, or by calling its helpline: 1-800-586-4872 (1-800-LUNG-USA).

This story comes from the Midwest Newsroom, an investigative and enterprise journalism collaboration including KCUR 89.3, IPR, Nebraska Public Media News, St. Louis Public Radio and NPR.

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