A recent literature review shows significant racial disparities, indicating that Black individuals are less likely to be screened despite having a higher lung cancer risk. The study also shows disparities in treatment and palliative care.
Lung cancer is the second most common cancer and the leading cause of cancer deaths in the United States, accounting for 238,000 new cases and nearly 130,000 deaths in 2022. Fortunately, over the last four decades, new lung cancer cases have declined significantly across all ethnic groups. However, profound racial, gender, and socioeconomic disparities continue to affect lung cancer care.
This retrospective chart review study, published in the Journal of the National Medical Association, aims to identify the causes of these disparities.
The Study Identified Multiple Sources of Disparities
When it comes to lung cancer incidence, significant racial disparities exist. Epidemiological data show that Black men are 15% more likely to develop lung cancer than their White counterparts. Additionally, Black men living in the southern states were disproportionately affected. Similarly, the study also identified gender disparities. Women who never smoked were much more likely to develop lung cancer than men who never smoked (17.5% vs. 6.9%, respectively).
Similarly, the study identified disparities in lung cancer screening, with racial/ethnic minorities and women more likely to be diagnosed with late-stage disease. Studies show that Blacks and Hispanics are underrepresented in screening cohorts and less likely to be a part of clinical studies. Though studies show that Black men may develop lung cancer at younger ages and with fewer pack-years of smoking than White men, they are significantly less likely to be screened using USPSTF guidelines (32% vs. 56%, respectively). Black patients also have greater wait times for annual screening after a negative screen at baseline compared to White patients (15.3 months vs. 12.7 months, respectively). Further, Blacks were less likely to return for screening after a Lung-RADS category 4 result (33.3% vs. 66.7%). These differences in screening account for disparities in lung cancer stage at presentation.
Similar disparities were identified in other tests and treatments. Blacks were less likely to be referred for biomarker testing within 60 days of diagnosis compared to Whites (14% vs. 26%, respectively). Further, the minority population is also under-represented in biobanks, which are significant biomedical research sources. This lack of inclusion in biobanks may also result in worse outcomes for ethnic minorities.
The study also identified disparities in treatment, with Black patients less likely to receive gold-standard surgery for early-stage lung cancer and more likely to get external beam radiation therapy (EBRT). The SEER database shows that Blacks were 31% less likely to receive surgical treatment and 21% less likely to receive lymph node resection than Whites. Black individuals were less likely to receive immunotherapy than White individuals (11% vs. 82%, respectively). All this means higher mortality rates for Black people than for Whites (64% vs. 54%, respectively). Finally, there are significant differences in receiving end-of-life care, with Black people at a disadvantage.
The Bottom Line
To reduce the disproportionate burden of cancer in the Black population, it is vital to overcome screening disparities and raise disease awareness among the population. It is also essential to encourage greater participation of the Black population in clinical studies, improve biomarker testing, enhance engagement of biobanks, overcome treatment inequalities, and improve access to palliative care.
Duma, N., Evans, N., & Mitchell, E. (2023). Disparities in lung cancer. Journal of the National Medical Association, 115(2, Supplement), S46–S53. https://doi.org/10.1016/j.jnma.2023.02.004