Drilling Down to the Causes of Racial Disparities in Lung Cancer

Abstract

A recent study of early-stage lung cancer patients found that African Americans are statistically significantly less likely than whites to receive definitive — i.e., potentially curative — surgery. That finding, which the Journal of the American Medical Association published in June, appeared soon after an American Lung Association (ALA) report that also underscored the need for systematic change in the approach to lung cancer in African Americans. Together, the two reports confi rm the disparity between blacks and whites in lung cancer rates, treatment, and outcomes while exploring some of the reasons — biological, clinical, and socioeconomic — that may explain these differences. African Americans are more likely to develop lung cancer and less likely to respond to available treatments than whites. Cigarette smoking rates can’t account for the disparity, because although white men smoke 30% – 40% more cigarettes, African American men have a higher incidence of lung cancer (75 per 100,000 vs. 64 per 100,000). According to a meta-analysis published in the September 2008 issue of PLoS Medicine , the disparity exists even among nonsmokers (16 per 100,000 among blacks vs. 12 per 100,000 among whites). This disproportionate burden prompted the April 2010 ALA report, which called for a concerted effort to examine underlying biological differences; to reduce cigarette advertising, particularly for menthol cigarettes, in African American communities ( see sidebar); and to educate physicians on how to overcome communication barriers with African American patients.