Health Care Disparities in Lung Cancer

In the United States, lung cancer is the second most common cancer and the leading cause of cancer mortality. Among those diagnosed, African American and black men have both the highest incidence rate and the highest age-adjusted mortality rate. Additionally, although this population has comparable rates of tobacco use to other demographics, they still have the highest rates of lung cancer mortality. Lung cancer screening encourages CT imaging on patients age 55 years or older with a 30-year pack history. These 2013 USPSTF guidelines missed many high-risk black smokers due to younger age, fewer pack years, and shorter quit times in this population. The recent 2021 update hopes to rectify this disparity by making guidelines more inclusive to ensure that younger patients with lower levels of smoking exposure can be screened. However, there are still other issues with the implementation of lung cancer screening changes, including the inconsistent documentation of patients’ smoking history, the geographic location of screening centers, and the financial burden of screening.

When it comes to lung cancer management, black patients are less likely to be offered and receive surgery, and more likely to receive non-surgical treatment modalities like radiation and chemotherapy. Once black patients do decide to undergo surgery, they are also more likely to have a sublobar resection rather than a lobectomy. These sublobar resections, specifically wedge resections, have been associated with a significantly lower probability of survival. Disparities also exist in patient outcomes, with black lung cancer patients experiencing significantly shorter 2-year and 5-year survival rates. In order to mitigate these disparities, healthcare systems must embrace community-engaged approaches and provider-based interventions. As the existence of disparities in lung cancer continues to increase with time, there is a pertinent need for new investigations that attempt to mitigate these disparities in care at the intersection of race, socioeconomic status, and lung cancer.

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