PORTSMOUTH, Va. (WAVY) — Fifty-seven years after the first warnings were added to cigarette packages, Virginia is making progress in wiping out a disease in which 90% of the cases are caused by smoking.

Aleks Casper, director of advocacy for the American Lung Association, has a simple solution.

“We believe that everybody should be breathing clean fresh air and that should be the only thing we should be inhaling in our lungs,” Casper said.

In a just-released annual report, the American Lung Association ranks Virginia among the top tier for lung cancer treatment with 17% receiving no treatment. Nationwide, 20% of cases are untreated.

But there are race-based disparities. Blacks are 21% less likely than Whites to receive surgery as the first course of treatment. Casper said timing is critical if patients are to survive lung cancer.

“One of the reasons that lung cancer is so deadly is because we don’t find it a lot of times until very late,” Casper said. “If we can get people screened and identify it early and get people connected to treatment, which in many cases involves surgery, the new report shows the survival rate has increased by 22% nationally to 26.6% Additionally, the survival rate has increased at a faster rate among persons of color.

Cigarette marketing programs designed to attract young people, such as the outlawed Joe Camel program, have been replaced by tech-savvy vaping devices that are often used with fruit-flavored tobacco. The ALA is watching disturbing trends that could reverse progress in years to come.

Regina Mobley: What are the trends you are seeing in youth and vaping?

Aleks Casper: What it’s showing is there are fewer high school students that are using e-cigarettes, but we are seeing some data around middle school students showing a significant increase among middle school students.

Need help?

If you need help talking to loved ones about tobacco addiction, or if you need information on lung cancer screening, visit lung.org. The organization also asks that constituents contact their representatives in Congress to ask for co-sponsorship of H.R. 4286, which calls for increased access to lung cancer screening.

During lung cancer and COPD awareness month in November, donations to the ALA will be matched, up to $55,000.