Non–small cell lung cancer (NSCLC) accounts for 80% to 85% of cases of lung cancer; when it is diagnosed early, there is a 5-year survival rate of 50% to 80%. Black patients have a lower overall incidence of NSCLC than White patients but are more likely to be diagnosed at later stages. They also are less likely to receive surgery for early-stage cancer.
A recent study published by Annesi et al in The Annals of Thoracic Surgery highlights the impact that structural racism and residential segregation may have on outcomes in Black patients with NSCLC.
Methodology and Results
The researchers analyzed patient data from the Surveillance, Epidemiology, and End Results Program—a database of Black and White patients diagnosed with NSCLC from 2004 to 2016 in the 100 most populous U.S. counties.
They found that Black patients with lung cancer living in the most segregated U.S. counties were 49% more likely to be diagnosed with advanced-stage disease compared with those living in the least segregated counties. Among those with early-stage lung cancer, Black patients in highly segregated areas were 47% less likely to receive surgery. Segregation was used in this study as a proxy for historic housing discrimination and the enduring structural racism that has resulted from it.
KEY POINTS
- Black patients with lung cancer living in the most segregated U.S. counties were 49% more likely to be diagnosed with advanced-stage disease compared to those living in the least segregated counties.
- Among those with early-stage lung cancer, Black patients in highly segregated areas were 47% less likely to receive surgery.
"Our study suggests that Black patients have a greater likelihood of presenting at advanced stage than their White counterparts—a disparity that disappears at low levels of segregation. Similarly, higher residential segregation is associated with increased risk of advanced-stage [disease] for Black patients, but not White [patients]. This may be due to factors such as lack of access to routine medical care and lack of routine screenings for Black patients in segregated areas," explained corresponding author Kei Suzuki, MD, Assistant Professor of Surgery at Boston University School of Medicine.
According to the researchers, fewer Black patients are considered eligible for lung cancer screening criteria, and Black patients are also less likely to complete screening. For many diseases, including lung cancer, Black patients of lower socioeconomic status tend to present to their physician only when their disease is symptomatic, aligning with a later stage of disease.
"Broadly, urban policy can serve to address the structural factors leading to these outcomes. Most immediately, clinicians and health-care institutions can focus screening efforts on these minoritized communities and realize the racialized socioeconomic implications that may impact access to care, which may delay definitive care," added Dr. Suzuki, who also is a thoracic surgeon at Boston Medical Center.
Disclosure: For full disclosures of the study authors, visit annalsthoracicsurgery.org.
