Racial Disparities in Lung Cancer

Introduction to Racial Disparities in Lung Cancer

A sizable body of research has long shown racial disparities in treatment and survival between Black and White patients with lung cancer. Numerous recent studies confirm those persistent gaps while providing additional insights and potential solutions.

This is part 1 of a 3-part series related to the American Lung Association’s 2020 State of Lung Cancer report.

In a study published in 2019 in the Journal of Thoracic and Cardiovascular Surgery, researchers examined data pertaining to 22,724 patients (93.4% White and 6.6% Black) who were diagnosed with primary stage I non-small cell lung cancer (NSCLC) between 1992 and 2009. Patient data was obtained from the Surveillance, Epidemiology, and End Results (SEER)-Medicare registry.¹

Using multivariate regression analyses and adjusting for demographic and clinical factors, the authors found that Black patients were less likely to receive any type of treatment compared to White patients (adjusted odds ratio [aOR], 0.62; 95% CI, 0.53-0.73; P <.0001).

Black patients who were treated were less likely to receive surgery only (aOR, 0.70; 95% CI, 0.61-0.79; P <.0001) and more likely to receive radiation therapy only (aOR, 1.47; 95% CI, 1.24-1.74; P <.0001) or chemotherapy only (aOR, 2.46; 95% CI, 1.74-3.49; P <.0001).

Black patients were also offered surgery less often than White patients (aOR, 0.75; 95% CI, 0.65-0.86), and those were offered surgery were more likely to refuse it compared to White patients (aOR, 1.98; 95% CI, 1.40-2.81).

In general, lung cancer “diagnosis occurs at later stages in minorities, and treatment differs, with Black [patients] receiving less surgical treatment than White [patients],” according to coauthor Emanuela Taioli MD, PhD, director of the Institute for Translational Epidemiology, director of the Center for the Study of Thoracic Diseases Outcomes, and professor of Population Health Science and Policy as well as Thoracic Surgery at the Icahn School of Medicine at Mount Sinai in New York City.

“Our study adds that surgery for stage I lung cancer is significantly less frequent in Black [patients] than White [patients] despite being the gold standard, and mortality is consequentially higher in Black than White [patients],” Dr Taioli said. “However, when the stage-appropriate treatment — in this case, surgery — is performed, survival is the same between groups.”