Disparities in Lung Cancer Biomarker Testing
Lung cancer treatment has made astounding progress in the past 10 years with advancements in precision medicine which includes biomarker testing, targeted therapies and immunotherapy. Unfortunately, the advancements have not benefited all lung cancer patients equally.
Barriers to care based on race
Historically underrepresented populations, including Black Americans, have worse lung cancer outcomes when compared to white Americans. In many parts of the country, Black populations face barriers to receiving high-quality cancer, including access to precision medicine. A recent study in the Journal of the National Medical Association found that when looking at metastatic non-small cell lung cancer, 26 percent of eligible white patients were receiving biomarker testing compared to 14 percent of eligible Black patients.1
And receiving biomarker testing is just one step in a multi-step process to get a patient on the right treatment for them. This whole process from testing to treatment can sometimes take several weeks or even months. Studies have followed patients over time and found that the more appointments or “events” in the sequence from diagnosis to completing treatment, the less likely it is that Black patients will complete the sequence when compared to white patients. 2
Looking at documented treatment disparities for Black patients with lung cancer and all cancers for that matter, we can fairly and confidently acknowledge that a disparity exists: Eligible Black lung cancer patients are likely not receiving biomarker testing and tailored treatment as often as their white counterparts.
It's time to address these disparities
Because precision medicine takes into account a person’s genes or tumor biology, it is important to also understand if people with different ancestries have differences in their genes, which may impact cancer. Many researchers agree that the disparities we see in lung cancer outcomes may be slightly related to genetic differences, but the bulk of disparities are a result of widespread racism, bias, mistrust, and poor communication.
Reducing or eliminating persistent disparities in lung cancer incidence and survival has been challenging because our current understanding of lung cancer biology is derived primarily from populations of European descent. The trials that identify the set of actionable mutations include few African Americans. In fact, in The Cancer Genome Atlas (TCGA), a landmark cancer genomics effort between the National Cancer Institute and the National Human Genome Research Institute sequenced the genome of close to 1,100 lung cancer patients. Of those patients, only 83 were of African descent.
There are scientists looking at the differences in the tumors between Americans of African descent and Americans of European descent. Researchers studying the tumor biology of African Americans have noted differences in genes and gene pathways that may make African Americans more susceptible to lung cancer, amongst other differences that may impact cancer outcomes.2-5
Many physicians are committed to eliminating health disparities through proven successful tactics which include strong patient navigation, community partnership, and building provider/patient relationships based on trust, transparency, and accountability. Additionally, there needs to be a strong commitment (based on many of the principles above) to recruiting Black Americans to clinical trials. Lastly, companies that have access to large data sets of biomarker testing results should be studying those sets and looking for how race and ethnicity may impact tumor biology.
Addressing health disparities and inequities is multifaceted and takes effort. But the life-changing drugs available for many lung cancer patients are useless just sitting on the shelves. The lung cancer community has made real change raising awareness about the importance of biomarker testing. As a community, we need to keep that drumbeat but also shift attention and resources to increasing access to precision medicine within historically underrepresented communities like Black Americans.
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