Racial Differences in Lung Cancer

Cancer development, treatment, and outcomes are tricky topics to understand. The underlying reasons why a person gets cancer or how they might respond to treatment are often unknown and depend on a variety of factors. Just as we can study different risk factors and treatments, we can study different characteristics of people with cancer. Learning more about the individuals getting cancer and their overall outcomes can help us develop new treatments and better identify those at risk.

Many different cancer characteristics have been studied in recent years. However, there has been a growing interest in learning more about race and ethnicity in relation to lung cancer. In honor of Minority Cancer Awareness Month, interesting findings from a few studies on the topic are below.

Who is getting lung cancer?

Lung cancer may be caused by a variety of environmental and genetic factors. However, there are some differences among different racial and ethnic groups affected.

• Black people have the highest rates of lung cancer. Asian and Pacific Islanders have the second highest.
• Latino people are less likely to get lung cancer than non-Latino people.
• Across the United States, the highest rates of lung cancer are in the South. The lowest rates of lung cancer are in the West.¹

Although we know smoking can increase a person’s risk of getting lung cancer, smoking alone does not tell the whole story. For example, one study found that Asian and Pacific Islanders and Latino people were the least likely to smoke, yet Asian and Pacific Islanders are the second most likely to get lung cancer.¹ Black and White people may have similar smoking rates as well but Black people are more likely to get lung cancer. This suggests that although smoking can play a role in cancer development, there are other factors at work as well.¹

Differences in diagnosis and outcomes

Several differences in diagnosis and outcomes have been investigated in studies. Some of these findings include:

• Along with having the highest rates of lung cancer, Black people also have the highest mortality rates. This trend remains true when just looking at current smokers as well.
• Black people with early-stage non-small cell lung cancer have a shorter survival compared to White people at a similar stage.
• For all stage I and II lung cancers, Black people have a worse overall survival time after diagnosis than White people.
• Asian and Pacific Islanders and Latino people have better overall survival times for early-stage lung cancers than White people.^1,2

Variation in treatment

One study found that Black people are less likely than White people to receive surgery for their lung cancer. They are also more likely to experience delays in treatment and less likely to receive appropriate treatment. Additionally, Black people are less likely to receive chemotherapy for late-stage (stage IV) cancers than their White counterparts.

Advancements in immunotherapy drugs have also changed the lung cancer treatment landscape. However, many of these are in clinical trials. Clinical trial participants involved in these studies may be over 90 percent White. Without involvement in these trials, minority groups are less likely to receive potentially life-extending treatment options.

Further, a study focused on end of life care also found disparities amongst groups. For example, minority groups tended to have more preventable medical encounters compared to White people. This means, they spent more time in healthcare settings at the end of their life than what was necessary. Black and Latino people were also more likely to have more than 1 emergency room visit and at least 1 ICU stay at the end of their life when compared to their White counterparts. These minority groups were also less likely to be referred to hospice at the end of their life and were more likely to die in a hospital setting.³

What does it all mean?

Overall, these results suggest that there are differences in cancer development, treatment experience, and survival with lung cancer between racial and ethnic groups. The reasons for this are not well understood and may be related to a variety of different factors. Some of these may be related to genetics, environmental or work exposures, social factors, financial issues, lifestyle practices, diet, access to healthcare and helpful resources, and more.

This is such an important topic to talk about, as differences in treatment options, more aggressive cancers, and poor end of life care can take a huge toll on quality of life. However, this information is only from a few studies, and much more research is needed to understand the factors at play. For the time being, studies like these can help call out the differences in general and may help doctors better diagnose and treat people from all backgrounds.

Resources for minority groups with lung cancer

This information may seem overwhelming and confusing, especially for individuals belonging to minority groups that appear to have worse outcomes. It is okay to ask for help and support as you navigate your journey.

While some large organizations have resources designed for everyone living with lung cancer, there are some minority-specific organizations that can help as well. Several resources to consider if you or a loved one with lung cancer belongs to a minority group include the following:

• Black Women’s Health Imperative: Provides health-related support to black women and girls.
• Latinas Contra Cancer: Provides health education and support group services to Spanish-speaking women.
• Malecare: Supports male cancer survivors, including underserved populations, like minority men with cancer.
• National LGBT Cancer Network: Supports LGBT cancer survivors through training, education, and support groups.