Widespread Lung Cancer Disparities Highlighted In American Lung Association Report

Racial and ethnic disparities in lung cancer incidence and mortality across the United States are documented in the newly published "State of Lung Cancer 2020 Report" from the American Lung Association (ALA)

"The most surprising finding was how overwhelmingly common lung cancer disparities are in states across the nation," Dr. Zach Jump, lead author of the report, told Reuters Health by email.

"Early diagnosis is key to increasing survival rates," he said. "However, despite expected variation between states for each metric, no racial or ethnic minority groups - Black Americans, Latinos, Asian Americans and Pacific Islanders, and Indigenous Peoples - were significantly more likely than White Americans to be diagnosed early in any state, but were significantly less likely in 49 instances (42% out of 117 comparisons where racial and ethnic group data for states was available)."

"Black Americans and Indigenous Peoples (American Indians/Alaska Natives) were not significantly more likely to receive surgical treatment in any states but were significantly less likely in 29 instances (55% out of 53 comparisons)," said Dr. Jump. "Black Americans and Indigenous Peoples were significantly more likely to receive treatment in only three instances but significantly less likely in 13 (26% out of 50 comparisons)."

"This report helps us realize the importance of lung cancer screening," he added. "Based on (current U.S.) criteria, it's estimated that if everyone eligible in the U.S. were screened, 48,000 lives would be saved."

The report includes state-specific measures of lung cancer incidence, adult smoking prevalence, radon zones, five-year survival, early diagnosis, surgery as part of the first course of treatment, lack of treatment, and screening among those at high risk.

Lung cancer incidence, staging, surgical treatment, and lack of treatment data are for 2013-2017.

Key findings from the report, published on the ALA's State of Lung Cancer website, include the following:

- Overall, the US national average of people alive five years after a lung cancer diagnosis is 22.6% - a 13% improvement over the last five years. Connecticut ranked best at 27.1%; Alabama ranked worst at 17.1%.

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- Nationally, only 23% of cases are diagnosed at an early stage, when the five-year survival rate is much higher (59%); 47% of cases are not caught until a late stage when the survival rate is only 6%.

- Nationally, only 5.7% of those at high risk were screened. Massachusetts had the highest screening rating at 18.5%, while Nevada had the lowest at 1.0%.

- For those ages 55-80 with a 30 pack-year history who still smoke or have quit within the last 15 years, screening with annual low-dose CT scans can reduce the lung cancer death rate by up to 20%.

- Black Americans with lung cancer were 16% less likely to be diagnosed early, 19% less likely to receive surgical treatment, and 7% more likely to not receive any treatment compared to Whites.

- Latinos with lung cancer were 13% less likely to be diagnosed early, 2% less likely to receive surgical treatment, and 39% more likely to not receive any treatment compared to whites.

- Asian Americans or Pacific Islanders with lung cancer were 15% less likely to be diagnosed early and 10% more likely to not receive any treatment compared to Whites. However, unlike other groups, they were 11% more likely to receive surgical treatment compared to Whites.

- Indigenous Peoples with lung cancer were 14% less likely to be diagnosed early, 19% less likely to receive surgical treatment, and 15% more likely to not receive any treatment compared to Whites.

Dr. Victoria Villaflor, Section Chief, Head and Neck Oncology at City of Hope in Duarte, California, and a specialist in cancers of the aerodigestive system, which includes lung cancer, commented by email. "The addition of racial disparities is a helpful index," she told Reuters Health. "This report highlights that people of color diagnosed with lung cancer face worse outcomes compared to white Americans, are diagnosed later and are less likely to receive treatment including surgery. These findings should be further investigated as they are likely multifactorial."

"I would like to better understand why more clinicians are not screening for lung cancer," she said. "We can improve outcomes in early-stage lung cancer if more institutions implemented lung cancer screenings... There are more screenings for breast, colon and cervical cancer, and more needs to be done for the deadliest malignancy, lung cancer."

—Marilynn Larkin

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