Disparities in Lung Cancer

By Dipesh Uprety 

At the Summit on Cancer Health Disparities, Dr. Nicholas Giustini from UW medicine presented on Disparities in Lung cancer. He started by explaining the difference between race and ethnicity. “Race” refers to physical differences, while “ethnicity” refers to shared culture, such as language, ancestry, practices, and beliefs. 

Dr. Giustini explained the risk of lung cancer among different races and ethnic groups. Smoking is the leading cause of lung cancer. A study by O Stram and colleagues demonstrated that Native Hawaiians and African Americans had a higher risk of all lung cancer at 10 cigarettes per day and at 35 cigarettes per day, but the racial and ethnic differences were less pronounced at 35 cigarettes per day than at 10 cigarettes per day. Among never smokers, the risk of lung cancer is higher for Asian American, Native Hawaiian, and Pacific Islander (AANHPI) groups [2]. Dr. Giustini further explained additional environmental factors contributing to lung cancer, such as Radon and PM2.5.  

Dr. Giustini provided numerous examples where Blacks are less likely to have receive recommended treatment compared to whites.  They are less likely to undergo surgery, genomic testing to guide systemic therapy, and receive immunotherapy [3-6].  In addition to receiving the standard care, there is racial and ethnic disparity in clinical trial enrollment as well. A study by Duma et al showed that the African Americans, Hispanics and women were less likely to be enrolled in a cancer clinical trial [7].  

References:  

1. Stram DO et al. Racial/Ethnic Differences in Lung Cancer Incidence in the Multiethnic Cohort Study: An Update. J Natl Cancer Inst. 2019 Aug 1;111(8):811-819.   

1. DeRouen MC et al. Incidence of Lung Cancer Among Never-Smoking Asian American, Native Hawaiian, and Pacific Islander Females. J Natl Cancer Inst. 2022 Jan 11;114(1):78-86.   

1. Lathan CS, Neville BA, Earle CC. The effect of race on invasive staging and surgery in non-small-cell lung cancer. J Clin Oncol. 2006 Jan 20;24(3):413-8.   

1. Meernik C et al. Racial and ethnic disparities in genomic testing among lung cancer patients: a systematic review. J Natl Cancer Inst. 2024 Feb 6:djae026.  

1. Verma V et al.  Racial and Insurance-related Disparities in Delivery of Immunotherapy-type Compounds in the United States. J Immunother. 2019 Feb/Mar;42(2):55-64.   

1. Ermer T et al.  Association Between Food and Drug Administration Approval and Disparities in Immunotherapy Use Among Patients With Cancer in the US. JAMA Netw Open. 2022 Jun 1;5(6):e2219535.   

1. Duma N et al. Representation of Minorities and Women in Oncology Clinical Trials: Review of the Past 14 Years. J Oncol Pract. 2018 Jan;14(1):e1-e10.