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More people in Southeast Nebraska die of lung cancer than any other type of cancer, and the reason for its high mortality rate may be simple.

While Nebraska has an average rate of screening for the disease, most cases of lung cancer are caught in later stages, according to Dr. Ryan Martin, a pulmonologist at Bryan Health.

"If people follow the recommendations, they get a colonoscopy beginning at the age 45. They detect huge proportions of colon cancers early and people can get resection before they have metastasized," Martin said. "The problem with lung cancer is most diagnoses occur on stage 3 and 4, which are at that point not resectable, which means incurable, and that's really why the high mortality rate."

This summer, the Journal Star and other Lee Enterprises news outlets sifted through data provided by CDC with the goal of answering the question, "What's killing us?" Or, in some cases, "What's not killing us as much as it used to?"

We examined the leading causes of death in nine Southeast Nebraska counties — Cass, Gage, Jefferson, Johnson, Lancaster, Otoe, Saline, Seward and York — and compared our rates locally to the national average.

The American Cancer Society recommends people between the ages of 50 to 80 who are in "fairly good health" but currently smoke or quit smoking in the past 15 years to be screened for lung cancer.

Screening is also recommended for anyone with a 20 pack-year smoking history — a pack-year is one pack of cigarettes per day, per year. One pack per day for 20 years or two packs per day for 10 years would both be 20 pack-years.

Although lung cancer has the highest mortality rate, it's the third-most-common form of cancer in Nebraska, behind breast cancer and prostate cancer, according to the American Cancer Society.

Both breast cancer and prostate cancer are more commonly screened for, allowing cases to be found in earlier stages and to be treated quickly and efficiently.

The organization estimates that about 1,330 Nebraskans have been diagnosed with lung cancer this year as of early August, and 670 of those people have died.

In comparison, the same data showed 1,680 people have been diagnosed with prostate cancer, while only 170 of those cases have been fatal, and about 1,600 diagnoses for breast cancer have been recorded, with 250 women dying of the disease this year.

Colorectal cancer had the second-highest mortality rate in 2022, with 320 people dying out of 960 diagnoses.

Because many cases of lung cancer are detected later, treatment can be difficult.

"The first option when we're going to talk about treatment of lung cancer is always going to be surgical, and whether or not you can potentially resect it," Martin said. "Then, the stage of the tumor is going to determine what the alternative options are there. It just really depends on what we actually see."

Treatment can be a variation of chemotherapy, immunotherapy, radiation therapy or all of the above.

While the No. 1 cause of lung cancer is smoking, an odorless, colorless gas also causes a significant number of cases.

Radon is a gas that seeps into homes through the ground and is known to cause lung cancer in smokers and non-smokers alike.

Nebraska has extremely high levels of radon compared with the rest of the country — especially in eastern Nebraska — and has the fourth-highest levels behind South Dakota, North Dakota and Iowa.

Every year, cancer and heart disease account for just over half of all deaths in the U.S. That's true in Southeast Nebraska, but rates are lower locally.

The reason for that is a rock layer underground in the Midwest that is closer to the surface than in other areas of the country, according to the Nebraska Department of Health and Human Services.

The dangerous gas can be controlled through testing and mitigation, but fewer people have been testing their homes for radon in recent years, said Travis Weber, owner of Weber Home Inspections in Lincoln. 

"A lot of people still to this day don't even know what radon is," Weber said. "And a lot of people think it's a hoax."

Additionally, he said the housing market has played a role in testing, with many buyers bypassing radon tests to speed up the process and to avoid spending extra money on a mitigation system should their house have a radon problem.

The Environmental Protection Agency recommends homeowners install a mitigation system if their house tests at 4 picocuries per liter or more. The system includes a PVC pipe running from the lowest level of the house up past the roof with a fan filtering the air and radon out.

Weber has inspected multiple homes in Beatrice that tested in the 80s and recently tested a home in central Lincoln that had 22 picocuries per liter of radon. However, there's no rhyme or reason to which homes have high levels and which don't, and the age of the house doesn't play a role, either.

Weber, who has been in the business for seven years, said there are homes in certain neighborhoods in his coverage area that typically pass a radon test, like Fallbrook and Highlands, but there’s still no guarantee.

"You truly never know your radon levels until you get a test," he said. "You can have three houses in a row. The two on the ends could fail and the one in the middle can pass. That's just the way it works sometimes."

However, there's no way to tell exactly how a person developed lung cancer, whether that be from smoking, radon or another cause, according to Dr. Steven Dunder, an oncologist at Cancer Partners of Nebraska.

"There's no way to tell for sure, but it certainly seems anecdotally like we're seeing more and more patients that have never smoked and haven't been around secondhand smoke that are coming down with lung cancer," he said.

While researchers still have a long way to go, Dunder said the future is bright. However, more awareness for lung cancer could potentially lead to higher screening rates, more knowledge on risk factors and less stigma surrounding the disease, he said.

“Breast cancer advocacy groups have done an awesome job with lots of pink ribbons, breast cancer month and have increased women getting mammograms,” he said. “It's time for lung cancer and pancreatic cancer to not be the hidden stepchildren anymore. Nobody should be shunned because they got lung cancer. It's not just a disease of smokers and nobody deserves it.”

Lyle Emery, a physical therapist, attends to Mrs. Morris Nelson of Minden as she receives therapy after recovering after a hip prosthesis in 1955.

These beds and chairs were in a four-person ward at Lincoln General Hospital. 

Bob Brungard, Lincoln General administrator, and Herb Hopkins, chairman of the Hospital Community Development Council, stand at an X-ray examining table in the radiology department.

In June 1967, the food service workers spend their time testing out the new kitchen equipment that will help prepare 1,000 meals a day at Lincoln General Hospital.

Mrs. James Venable and Marcia Barnes look across the street toward the area that is to become the hospital's front entrance in 1962.

In January 1965, ground was broken on a $6 million new Lincoln General Hospital. At the ceremony were Dr. George Cover, Joe W. Seacrest, Dr. Fredrick Teal, Dr. Horace Munger and Robert Brungard.

Dorothea Hyde shows Mrs. Duane Swanson and Mrs. E Stewart Maness some of the hospital's current equipment in 1967.

In 1967, cancer survival and cure rates were beginning to climb because of early detection and therapy with tools such as penetrating radiation treatment.

Mounted in the special care unit nursing station, this monitor records the continuous heart behavior of four patients simultaneously at Lincoln General Hospital in 1967.

The new Lincoln General Hospital is ready for patients as the demolition process of the old General Hospital begins in 1969. 

In early 1969, the old hospital is quiet as patients begin to transition into the new hospital.

This former sunroom is empty and in disrepair in the old general hospital in 1969. 

Physical therapist Don Marx wires technician Judy Rovar with electrodes in 1980. 

Pharmacist Paul McLaughlin prepares intravenous nutrition mixtures for patients who are unable to eat in 1982.

As Lincoln General Hospital put the final touches on its $17.5 million construction project in 1985, Judy Charlson, a radiological technologist, and medical secretary Susan Frenke demonstrate the hospital's linear accelerator.

Dr. Harold Harvey calls up messages on a new physician registry designed by Lincoln General Hospital systems and programming supervisor Ray Bloomquist and his staff in 1985.

Reach the writer at 402-473-2657 or jebbers@journalstar.com

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