The state of Indiana has the sixth highest rate of lung cancer in the nation, according to a new report released by the American Lung Association.

The association’s 2019 “State of Lung Cancer” Report ranked the state 44th in the nation among all states and the District of Columbia for new lung cancer case incidence rates.

Only six states reported rates worse than Indiana’s 73.2 new cases per 100,000 people.

“We rank 44th in the country when it comes to incidence, new cases of lung cancer, and so that puts us almost at the very bottom of the country,” said Nick Torres, advocacy director for the American Lung Association in Indiana. “Indiana is not doing very well when it comes to things like tobacco use, and we’re seeing that play out in our rankings for things like lung cancer as well. It’s important for us to get a sense of what all of the contributing factors are.”

Lung cancer occurs when cells in the lung mutate and grow uncontrollably, causing a tumor. Last year, the disease killed about 154,000 people, or about 25% of all cancer deaths in the U.S.

Lung cancer is the second most common form of cancer in Indiana for men and women, but has proven to be the deadliest. About 3,690 Hoosiers are predicted to die of lung cancer this year.

According to the report, lung cancer rates can be attributed to three main causes: tobacco use, radon exposure and air pollution. Indiana ranked poorly for all three risk factors.

TOBACCO USE AND ENVIRONMENTAL IMPACT

“We know tobacco use is the number one contributor for lung cancer,” Torres said. “I think that’s certainly clear in Indiana. We rank near the bottom in smoking rates. We have the lowest cigarette tax in the region. We saw youth tobacco use really jumping up considerably over the last few years.”

Traditional cigarettes contain about 600 ingredients that release more than 7,000 chemicals when burned. At least 69 of the chemicals are known to cause cancer.

E-cigarette solutions, otherwise known as e-liquids, are often approved for oral consumption but have not been approved for inhalation. That means the Food and Drug Administration deemed the liquid acceptable to drink, but did not check whether it would be toxic if made into a vapor.

The Centers for Disease Control and Prevention found that the introduction of e-cigarettes reversed positive trends in teen tobacco use seen in past years. More than 27% of all high school students admitted to using a tobacco product. E-cigarettes were the most commonly used tobacco product followed by traditional combustible cigarettes.

Besides the potential cancer risk by inhalation and second-hand smoke, tobacco product refuse has also proven to pose a risk to human health and the environment.

Tobacco products make up 38% of all road litter, making it the most littered product in the U.S.

Cigarette butts are made of a plastic called cellulose acetate and take up to 12 years to fully decompose. During that time, they leach nicotine, heavy metals and many other toxic chemicals into the environment.

Cigarettes have also been found to poison marine animals in waterways.

E-cigarettes have raised similar toxicity and pollution issues.

Aerosol vapors from e-liquids have been found to be a major source of air nicotine, volatile organic compounds and particulate matter pollution 10 micrometers and smaller.

E-cigarette devices themselves, including lithium-ion batteries, metal casings, wires, plastics and replaceable nicotine liquid cartridges, can also deposit oxidants, which can lead to chemical and DNA damage to living organisms, and heavy metals.

RADON RISK

The second leading cause of lung cancer in Indiana is exposure to radon, a naturally occurring radioactive gas.

Radon is an extremely toxic, colorless gas that comes from the natural radioactive breakdown or uranium in soil, rock and water. Simply breathing in radon can greatly increase your risk of lung cancer.

An estimated 20,000 deaths nationally are attributed to radon-related lung cancer.

Radon is measured in picocuries per liter of air. The average indoor radon level nationwide is about 1.3 pCi/L. Nearly one out of every three homes in Indiana is estimated to have radon levels greater than 4.0 pCi/L.

The gas can seep into homes through cracks, sumps, joints, basement drains or other tiny openings in foundations.

The entire state has at least a moderate potential for radon in the soil, according to the U.S. Environmental Protection Agency. About 62% of counties in Indiana, 57 in total, have a high potential for radon in the soil.

The Indiana State Department of Health recommends Hoosiers test their homes for radon exposure. If found, levels of the gas can be reduced to normal levels.

AIR POLLUTION AND LUNG CANCER

The American Lung Association lists air pollution, particularly year-round particle pollution, as the third leading cause of lung cancer in Indiana.

Particle pollution is created primarily from industrial processes and fuel combustion.

The Indiana Department of Environmental Management said it operates 19 sites that continuously monitor fine particulate matter with a diameter of 2.5 microns or less.

According to IDEM data, annual average PM2.5 levels across the state were on the decline until about 2017, when levels started ticking upwards. The rise in air pollution is most likely due to a pro-industry EPA agenda that has chipped away at existing emissions regulations, including reducing emissions requirements for major sources of hazardous air pollutants by allowing them to reclassify themselves as “area sources.”

The change could be causing health and environmental problems for Hoosiers like heart attacks, irregular heartbeat, aggravated asthma, breathing problems, and lung cancer.

Particulate matter pollution can also have a devastating effect on the environment. It can make lakes and streams acidic, change the nutrient balance in coastal water, deplete soil nutrients, damage forests and farm crops and affect the diversity of ecosystems.

Particulate matter can also stain and damage stone and other materials, including culturally important statues and monuments.

Despite the lung cancer risks in the state due to policy decisions and natural environment, the American Lung Association said there is hope for Hoosiers.

“Screening is an area where our state is doing a little bit above average,” said Torres. “Increasing the rate of screening is a great way to try to catch the lung cancer early when it’s more treatable. If we catch it early, we know that we can save thousands of lives.”

For more information about lung cancer, cancer screenings or other lung health issues, contact your doctor or the American Lung Association's Lung HelpLine at 1-800-LUNGUSA or at their website.